Everything you need to know about warts and surgical removal

What causes a wart?

Warts on the feet are common; they are caused by a viral infection involving the human papillomavirus (HPV). Warts on the feet are also known as verrucae or verrucae pedis.

They are very common, can be spread by direct contact from person to person, or as commonly occurs, a small piece of wart tissue with the virus attached is shed in an area where bare feet are exposed.

This maybe in a swimming pool, a shower recess, a changing room, a hotel bathroom and anywhere really where bare feet are exposed.

Wet environments can make it easier for the virus to survive and be transferred, hence the reason why swimming pools or damp shower recesses are a perfect place for warts to be contracted.

What do warts look like?

Warts on the feet can look slightly different to warts in other areas that are not weight-bearing. Warts on the hands or genitals can sit proud of the skin and seem to grow above the level of the surrounding skin.

Warts on the feet are often flat or sit slightly raised above the surrounding skin with a gradual rise. They may have a callus or hard skin over them that can make them look thicker than they are.

This difference occurs as warts on the feet are compressed as they bare weight.

There is often a border to the wart, and if you look close you can notice the ridges of the skin; like fingerprints are pushed aside, and the wart pushes the ridges apart. A corn or callus, for example, can still contain the ridges of the skin and may not have a specific border.

If you look at the wart closely inside the border can have the appearance of a tiny cauliflower.

What if they are discoloured or a colour change occurs?

Warts are typically skin coloured; however, sometimes small dots of blood can be squashed into them form the underlying capillaries. If your lesion is dark coloured, blueish or a colour change occurs it is imperative you contact your podiatric surgeon or GP as soon as possible to ensure it is nothing more sinister.

How do kids get warts?

As mentioned above, warts are spread by contact or from walking on surfaces with bare feet after someone else with a wart has walked. When children start to attend school, they will be exposed to the wart virus when shoes and socks are taken off and perhaps when they commence swimming lessons or swimming in a friend’s pool.

The child may not have been exposed to that strain of the virus and have no immunity to it, and hence it can infect that child’s foot.

Are warts contagious?

Yes, they are a viral infection and hence if exposed you can contract the wart virus. You may start with one wart and then as the virus spreads to the surrounding cells, the wart will often grow larger and can even spread to other parts of the foot and the other foot.

It is common for a person to start with one small wart and end up with multiple warts all over both feet.

Are warts dangerous?

Warts on the feet are not dangerous. If small, they may not even be painful.

Warts are an infection of the skin and do not penetrate the deeper structures.

Do remember that if the colour changes or they rapidly grow to have them assessed in case something more sinister is occurring.

Do warts have roots?

No, they do not. The old belief was that warts have roots and that all these roots need to be removed. This was one of the reasons that some warts were cut and stitched. We now know that this is not the case, and no excision or suturing is required.

The wart can spread outwards and become more extensive and infect a larger area.

What happens if you leave a wart?

There is evidence to show the body can attack the infection and remove the wart. The wart is a viral infection, and it may take the body a long time; however, the body can finally identify the virus and attack it and eradicate the wart.

During a consultation, a patient will be informed this is one of the options. If the wart is not painful, then “wait and see” is an option. Be aware however they may spread in that time.

However, many warts will not go on their own, and it must be borne in mind they can grow and spread in this time.

Foot Wart Removal

How to remove warts

How can I remove warts?

There are various options to treat warts.

• Over-the-counter creams. These can typically be purchased at the chemist and contain a weak acid. This can take a long time and is only effective on small warts.
• “Acids”, sometimes known as caustics, are usually applied by a podiatrist every week. Then the burnt wart is trimmed until it is all removed. This is the most common treatment.
• “Freezing”, sometimes known as cryotherapy. A podiatrist, GP or dermatologist do this and involves spraying liquid nitrogen onto the wart. This should gradually kill the wart over a few applications. Also commonly done.
• Swift is a new technique that is showing some promising results.
• Falkner’s needling is an effective way of encouraging the body’s immune system to attack the wart. This is minimally invasive and involves puncturing the wart multiple times under local anaesthetic. Some podiatric interventionists perform this.
• Curettage is a method of “scooping” the wart out in one go. Podiatric surgeons and some dermatologists perform it.

Foot Wart Removal.

Falkner’s needling procedure and recovery.

How is Falkner’s needling done?

This involves puncturing the wart multiple times, once it has been numbed with a local anaesthetic.

• You will lie down on the examination chair or bed in the consultation room.
• Nitrous oxide/laughing gas is also available if you are concerned about he injection.
• In most cases, it is done under local anaesthesia; however. An injection is administered under the wart to numb the surrounding area.
• The foot is scrubbed with an antiseptic wash.
• Once numb, the wart is punctured multiple times with the same needle that was used to numb the region.
• The area is again cleaned with more antiseptic.
• Dressed with a large antiseptic dressing.
• The actual procedure takes approximately 15 minutes, and you will be in the room for a total of about 45 minutes.
• You will need to wear sandals or thongs.

What is involved in the recovery process after wart removal with needling?

A large dressing is applied after the surgery as they tend to bleed after the procedure. You must go home immediately, rest, and elevate your foot both during the day and at night.

The large dressing is left in place and kept clean and dry for approximately five days; however, it can remain in place for up to a week if necessary. While the large dressing is on, you must take it easy; however, you can get around.

Once the large dressing is removed, a daily salt soak is advised, and the wound is dressed with a simple dressing that is supplied. A scab usually occurs approximately five days later. You will then return to your activities, but refrain from participating in sports until your review appointment.

You will then be reviewed two weeks after the needling, to ensure a scab has formed and all is well.

This procedure works by stimulating the body’s immune system to attack the wart, and in most cases, the dead wart comes away with the scab.

Curettage surgery and recovery

How is wart curettage done?

The curettage procedure involves removing the wart by “scooping” it out.

The wart infects only the skin, and therefore, there is no need to cut and remove the infected skin. The white fibrous layer, which demarcates where the wart ends and the healthy tissue begins, is identified, and the wart is removed.

Procedure:

• You will lie down on the examination chair or bed in the consultation room.
• In most cases, it is done under local anaesthesia. An injection is administered under the wart to numb the surrounding area.
• The foot is scrubbed with an antiseptic wash.
• Once numb, the tip of a scalpel is used to mark the area where the wart is located. Typically, the region approximately 2 mm wider will be curetted to ensure all of the wart is removed.
• Once all the wart is removed, the base is wiped with a chemical called phenol to ensure that all the wart is killed and cauterised.
• The area is again cleaned with more antiseptic.
• Dressed with a large antiseptic dressing.
• The actual procedure takes approximately 15 minutes, and all up you will be in the room for about 45 minutes.
• You will need to wear sandals or thongs.

Can it be done under general anaesthetic or sedation?

Yes, it can. The injection under the wart is very quick; however, it can be painful. There is the option of having a colleague of Dr Lafferty provide laughing gas in the rooms. If you do not want to be awake at all during the procedure, it can be carried out in the day theatre, on one of Dr Lafferty’s surgery lists in the day hospital. It will not require an overnight stay.

Is wart curettage painful?

In most cases, no, the quick final application of the phenol has a very handy side effect. It cauterises the nerve endings in the base of the wart, and in most cases, this results in NO pain after the procedure. Very occasionally, pain may be experienced; however, if this is the case, it can easily be managed with simple analgesics.

What is involved in the recovery after wart curettage?

A large dressing is applied after the surgery as they tend to bleed after the procedure. You must go home immediately, rest, and elevate your foot both day and night.

The large dressing is left in place and kept clean and dry for 3-4 days; however, it can remain in place for up to a week if necessary. While the large dressing is on, you must take it easy; however, you can get around.

You can see the referring podiatrist or GP for dressing changes, or you can see Dr Lafferty.

Once the large dressing is removed, a daily salt soak is recommended, and the wound is dressed with a special dressing provided.

The podiatrist, Dr Lafferty, must add a deflective pad to an insole, allowing you to walk with very little pain and enabling the wound to heal well.

Once you reach the saltwater soak stage, you can live a reasonably normal life, avoiding long walks and strenuous sports activities.

Typically, it takes approximately two weeks to heal; however, larger warts may take longer.

Will warts come back after curettage surgery?

Rarely, however, some warts will persist and recur.

What complications can occur?

Wart needling and curettage surgery are generally safe, and complications are now rare; however, certain risks must be made aware of, regardless of their rarity.

The risks of foot surgery are similar to those associated with other surgeries, including infection and unexpected pain. Infections are rare

The warts may return.

A painful scar may develop; however, as the deep layers of the foot are not breached, this should not occur and is exceptionally rare.

Bleeding, as mentioned before, is a common occurrence with warts, which can bleed following needling and curettage. Therefore, elevation must be strictly adhered to.

More significant warts may take several weeks to heal fully.

Risks associated with surgery are explained to the patient during their pre-operative consultation. You will have every opportunity to ask as many questions as you like during the consultation.

Useful resources:

The Australasian College of Podiatric Surgeons

https://www.acps.edu.au/

The American College of Foot and Ankle Surgeons

https://www.acfas.org/

The Academy of Minimally Invasive Foot and Ankle Surgery

https://www.aafas.org

FAQS

What is a foot wart?
A foot wart (plantar wart) is a viral skin growth caused by the human papillomavirus (HPV), typically on the sole.

1. How do I know if I have a plantar wart?
   Look for small, rough, callus-like growths on the sole, sometimes with black dots (clotted capillaries) and pain when walking.

2. How do people get foot warts?
   HPV enters through small skin breaks, often from public showers, pools, or direct skin contact.

3. Are foot warts contagious?
   Yes, they can spread to others or other areas on your own feet through direct or indirect contact.

4. When should I see a podiatrist for a foot wart?
   If it’s painful, growing, multiplying, or not responding to over-the-counter treatments.

5. How are plantar warts treated by a podiatrist?
   Options include needling, cryotherapy, topical acids, or surgical removal, depending on the case.

6. What is wart needling treatment?
   A procedure where the wart is punctured multiple times under local anaesthetic to stimulate an immune response.

7. Does foot wart treatment hurt?
   Some treatments may cause mild discomfort; a local anaesthetic is used for procedures like needling.

8. How many treatments will I need?
   Some cases are clear with one treatment; others may need multiple sessions, depending on size, number, and immune response.

9. What is the success rate of wart needling?
   Studies report ~65–70% clearance after one session, sometimes requiring a second.

10. Can warts come back after treatment?
    Yes, but once cleared, they often don’t return to the same site; new infections can occur if exposed again.

11. Is cryotherapy effective for foot warts?
    It can be, but deeper warts often need additional treatments like needling or surgical removal.

12. Can I walk after wart treatment?
    Yes, though you may have mild tenderness for a few days, especially after needling.

13. How can I prevent foot warts?
    Keep feet dry, wear sandals in public showers, avoid picking at warts, and don’t share towels or shoes.

14. Are over-the-counter wart treatments effective?
    Mild cases may respond, but stubborn or deep warts often need podiatric treatment.

15. Can children have foot wart treatment?
    Yes, treatments are adapted for age and tolerance, often using less painful methods first.

16. How long does wart treatment take?
    Procedures like needling take ~30 minutes; resolution can take weeks as the immune system responds.

17. What shoes should I wear after wart treatment?
    Comfortable shoes that reduce pressure; avoid tight footwear immediately after treatment.

18. Is foot wart treatment covered by Medicare or insurance?
    Check with your clinic; some treatments may have rebates or private health cover.

19. Why choose a podiatric surgeon for wart removal?
    They offer specialised, evidence-based treatments with higher success rates and lower recurrence.