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Tuesday, November 2, 2010

Plantar's Wart: Email Advice in a Chronic Condition

Sent 11/1/10
The Day the San Francisco Giants Won the World Series!!!

Dear Dr. Blake,



I have been fighting a Plantar's wart since 1998. I have had it frozen, cut out, I've tried duct tape, home remedies and the likes, but it keeps reoccurring. I have to cut it down weekly to make it bearable to walk. I have read that it eventually goes away, but 12 years later it is still here, and I've given myself a bunion from walking on it, or I should say trying not to walk on it. Do you have any advice that can help me? What makes life difficult is that I am on my feet for 10 hours a day do to my profession, it appeared shortly after I broke my ankle back in 1997. I would appreciate anything. Thank you.

Sincerely,

Brett
 
Dear Brett,
 
     Thank you so very much for emailing me. I have a few patients with plantar's warts that have lasted this long, but yours is unusual due to the pain. Normally, patients can co-exist with their warts with occasionally care and perhaps some shoe inserts. Of course, this is the less than 1% that do not respond to treatment during a 1 year period, which you have passed.
 
     First of all, do you have a wart or another type of skin lesion? This would be important to know and perhaps you had it removed at some point. Did the lab actually say it was a wart, also called verruca plantaris? With laser treatments, cryo (cold) therapy, bleomycin injections, cantharone or phenol acid treatments, there is a myriad of treatments available out there to attack the virus (and destroy). Please confirm that you actually have a virus.
 
     Second of all, in removing warts, some doctors go too deep, breaking through the dermal layer and leave you with a painful scar. Perhaps this is more what is hurting you. A painful scar is a totally different animal to treat than a wart. In Philadelphia, near you I believe is the Pennsylvania College of Podiatric Medicine at 8th and Race Street. One of my dear friends, a Dr Howard Palamarchuk could consult with you and even let me know what he thinks, or at least get you to the right person.
 
     Many times the wart is under a bony prominence that has become more prominent over time. A special xray called a Plantar Axial for the bottom of the foot may reveal even a bone spur or bad position of the bones.
 
     So, I would see or at least talk to Dr Palamarchuk and see if he can confirm you have a wart, see if your treatment left you with scar tissue, entrapped nerve, or bone spurs have developed. He can then let you know if you are a candidate for one of the big guns in wart treatment like bleomycin, laser, cold therapies, etc. And he could make sure the shoe inserts you have adequately take pressure off the sore area (sounds like you need something better than what is in your shoes).
 
    Please let me know if this info was helpful. Rich Blake

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.