Warm Texas weather means more pool days and barefoot activities. This leads to an increased risk for our children to acquire painful and unsightly warts. These stubborn lesions often require specialized care by a podiatrist due to their persistent nature.

Plantar warts begin after a minor trauma to the foot that allows the HPV into the skin. Typically, surfaces that cause infection are those that are frequently trafficked barefoot by others who are already infected, like the pool or locker room. The number one risk factor of acquiring warts is having someone else in the same household who is infected. 

Once the virus enters the skin, usually through a traumatized part of the skin, it begins to create some very typical changes to skin that aid in diagnosis. Before a diagnosis can be made, usually trimming of skin with is scalpel is required.

Diagnostic Characteristics

  1. Pinpoint petechiae – these thrombosed capillaries look like black pepper spots
  2. Interruption of skin lines – normal skin lines typically go around, not through the lesion
  3. Painful with side-to-side pressure – pinching creates more pain than direct pressure

Podiatrists have many options for in-office treatment. Depending on size and treatment choice, care may require numerous treatments. 


  1. Freezing – has limited use on the bottom of the foot due to the thick plantar skin that protects lesion, and if used normally requires numerous treatments
  2. Salicylic acid – application to wart helps exfoliate epidermal layers of skin, requires frequent treatment and removal of skin with pumice stone.
  3. Cantharadin – Thank God for the blister beetle! Cantharadin is a beetle’s venom and causes the wart to blister which is then trimmed away at return appointment. Kids love to hear about this one, but the days following treatment can be very tender.  
  4. Bleomycin – “Bleo” is one of the big guns - literally! This chemotherapeutic agent is injected into the lesion with an air gun and causes wart to blacken and fall off.
  5. Surgical removal – most warts can be removed by trimming the lesion away from the underlying skin layer. Of course this requires an anesthetic injection, and is usually used for warts that do not respond to other treatments.


This is probably the only time you will hear a podiatrist say this, “Wear flips flops.”  These shoes are designed for pool decks and locker rooms so kids should use them when in these situations. Appropriate, breathable socks and shoes also reduce risk for those children with sweaty feet.

At Foot and Ankle Associates of North Texas we try to select the most appropriate therapy, taking into account the patient age, comfort level, and previous therapies. Let us help you help your patients shed that pesky HPV. 

Interesting Wart Facts:

  • Home remedies, over-the-counter (OTC) and prescription foot drying agents can reduce sweating and wart recurrence.
  • It is rumored that a wrestling coach who was trying to prevent spread of warts between athletes discovered that duct tape can cure some warts, unfortunately it takes a very long time and daily applications, with no guarantee of resolution. 
  • Left untreated, warts can spread rapidly and can require surgical excision in an operating room.
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