Do plantar warts always need treatment?
Short answer: No. Observation is reasonable for a correctly diagnosed, painless wart when the patient accepts that resolution may take months or years and spread can occur.
Treatment is more reasonable when a wart is painful, bleeding, enlarging, spreading, affecting sport or work, causing distress, or persisting despite time. Immunosuppression, neuropathy, poor circulation and diagnostic uncertainty change the risk calculation and require clinician oversight.
Spontaneous clearance complicates every wart study: improvement after treatment does not prove the treatment caused it. Trials with placebo groups have reported substantial natural clearance, although rates vary widely by age, duration and follow-up.
The least invasive suitable option is usually considered first. A long list of failed treatments, however, should prompt strategy review rather than automatically repeating the same therapy indefinitely.
When should I seek an assessment?
Consider assessment when the diagnosis is uncertain, the lesion is painful or changing, warts are spreading, self-care is unsafe, or reasonable treatment has failed. Chronic lesions should be re-examined before another destructive course is started.