Warts are caused by the HPV or human papillomavirus


Podiatrists have a high degree of knowledge with respect to skin related problems of the feet and lower legs.  One of the most common problems (and likely the most frustrating) is warts.  Warts are caused by the HPV or human papillomavirus and are caused by direct transmission through the skin in most cases.  The lifespan of the virus can be as long as two to three years.  However, warts tend to spread.  This is because the virus can live on the inside of our shoes and our foot movement in our shoes can spread the virus.  Thus, what usually starts as one lesion frequently will grow into several satellite lesions or clusters.


Most patients try self treatments


Most patients try self treatments such as OTC topical acids or freezing methods.  Some even have multiple treatments performed by Dermatologists, Pediatricians, or PCPs with liquid nitrogen which is very painful.  These methods usually fail because the treatment is designed to destroy tissue with the hope that the virus is destroyed too.  Acids rarely work and many common freezing methods simply are not cold enough or done properly to effectively destroy the virus.


Autoimmunization options


An option I've used successfully for over 20 years is the use of lasers with an autoimmunization.  The laser will destroy the tissue down to what is know as the basement membrane (this is the junction between the outer skin, the epidermis, and the next layer, the dermis).  Contrary to popular belief, warts do not have roots.  They only extend to the bottom of the epidermis.  CO2 lasers can effectively and precisely destroy only this "warty tissue" and do not cause surgical scars.  


The second part of my treatment is an autoimmunization.  Prior to using the laser, I first excise one single wart and set it aside.  I will remove some of the epidermal tissue from the specimen and will then make a small incision over the inner part of the arch of the foot and imbed the wart into a small muscle belly in the foot.  This produces what is known as cell mediated immunity.  It takes several months for this to "kick in" but provides the patient an added benefit in getting rid of recalcitrant warts and immunity to the virus.  


The procedure is usually done with some light sedation.  The patient walks immediately in a surgical shoe and the single suture is removed in roughly one week.  Pain is minimal and complications are extremely rare.  If you or a family member has been suffering from painful or unsightly warts, come in for a consultation.




Image above shows completion of the laser removal of the wart and autoimmunization.  Note the small incision and suture to the arch.