By: Michael Zapf, D.P.M., M.P.H., F.A.C.F.O.

Breeann and Jessica are sisters in name only. Jessica is older and is very athletic. She is one of those teenagers who is always on the soccer or softball fields. As an athlete she is used to a little pain now and then. When she has an injury or a problem she wants it taken as soon as her busy schedule would allow. Breeann is her younger sister and definitely not into sports. Breeann is also not into pain. She will do almost anything, as a matter of fact, to avoid anything painful, including athletics. With two sisters so different it is no wonder that when they recently developed plantar warts they developed two distinctly different types.

Viruses cause warts. There are more than 50 different types of wart viruses. Usually a patient gets infected with a single type. Some wart viruses like the hands, some the skin of the face, some the genital area and four or five types love the bottom of the feet.

The wart virus enters the skin through a small, imperceptible crack in the skin. The virus works its way down to the living layer of skin cells and attaches to one of the cells. Then a mysterious thing happens. The wart virus, like all viruses, injects its DNA or RNA into a living cell. The invading DNA or RNA takes over the reproductive machinery of the cell. The cell, in this case a skin cell, tries to reproduce itself. Instead of dividing into two new cells, it can only make new viruses. When the cell is chock full of new viruses it ruptures, freeing the newly minted virus particles that go on to invade neighboring cells. The cycle continues until there are millions of skin cells with wart virus. At this point the lump of cells is visible to the eye as a wart. The whole process is akin to a microscopic science fiction movie.

Back to our sisters. Jessica had one very large wart lesion under her heel. It is about a third of an inch in diameter and nearly as deep. It hurt when she walked, let alone played goalie. Her pediatrician tried a couple of times to freeze it with liquid nitrogen. Liquid nitrogen treatments are painful and with thick warts fail more often than they succeed. Because of this wart’s thickness, topical acids are also bound to fail. The quickest and surest way to get rid of such a lesion is to gently remove it. The wart is simply scooped out after first preparing the area with local anesthesia. The local anesthesia hurts for a few seconds and then there is no more pain. What is left is a void that will fill in with regular skin in a week or two. Done properly the wart comes out as a single, firm mass and the deep layer of the skin is left completely intact. Only if the deep layer is accidentally penetrated during removal can there be a painful scar. Make sure your doctor has plenty of experience in removing plantar warts before he or she attempts this. Jessica’s wart was removed in this very manner and it went well. She gritted her teeth and uttered nary a word. I expect her to be back on the soccer field in a little over a week.