Plantar Warts in Children and Teenagers: Understanding Treatment Options

Plantar warts, also known as a verruca, are a common skin condition that can impact people of all ages although they are particularly common in children. As podiatrists, we are often the first point of contact for patients seeking treatment for their plantar warts.

What causes warts?
Plantar warts are caused by the human papillomavirus (HPV), which can enter the skin through tiny cuts or abrasions on the soles of the feet. The virus thrives in warm, moist environments such as swimming pools and communal showers, which are often frequented by children. Unfortunately, another example of a warm, moist environment is a sweaty foot in a shoe! Once the virus has entered the skin, it causes a rapid growth of cells on the outer layer of the skin, leading to the formation of a wart.1

How can warts be treated?

Podiatrists offer a range of treatment options for plantar warts, tailored to the child’s age, overall health, and the severity of the warts. Some of the treatments podiatrists offer are listed below.  

Silver nitrate
Silver nitrate therapy is a good initial treatment option for plantar warts in children due to the fact that it is less painful than other alternatives. The treatment involves the application of a silver nitrate stick (that looks like a long matchstick) to the wart. When dipped in sterile salty water and applied, it stains and crusts up the wart. Silver nitrate treatment can be done in the podiatrist’s office and usually requires multiple applications over several weeks. It’s important to note that while silver nitrate therapy can be effective, it will cause a black stain on the skin for a few weeks.

Salicylic acid
Other topical treatments involve the application of solutions or creams directly onto the wart. These treatments typically contain salicylic acid and are known as a keratolytic therapy because the treatment results in a gradual peeling of the wart layer by layer.2 You can buy off the shelf preparations from a pharmacy but, because of their training, podiatrists can use preparations with higher concentrations of salicylic acid to optimise effectiveness and safety.

 
Cryotherapy
Cryotherapy, or freezing, is another common treatment for plantar warts. This procedure involves applying liquid nitrogen to the wart, causing the wart tissue to freeze and eventually fall off.3 This treatment is often used for warts that are resistant to topical treatments.

Education
Podiatrists also play a crucial role in educating parents and children about plantar warts. This includes explaining how the virus is contracted, the importance of wearing footwear in communal areas, and how to check for signs of warts. By providing parents and children with this knowledge, we can help prevent the spread of the virus and the development of new warts.

Summary 

Plantar warts in children, while common, can cause discomfort and distress. Podiatrists play a vital role in treating these conditions and educating families about prevention strategies. Through a combination of salicylic acid, cryotherapy, and silver nitrate treatments, podiatrists can help children return to their everyday activities free from the discomfort of plantar warts.

1Sterling, J. C., Handfield-Jones, S., & Hudson, P. M. (2001). Guidelines for the management of cutaneous warts. British Journal of Dermatology, 144(1), 4-11.

2Lipke, M. M. (2006). An armamentarium of wart treatments. Clinical Medicine & Research, 4(4), 273-293.

3Bunney, M. H., Nolan, M. W., & Williams, D. A. (1992). An assessment of methods of treating viral warts by comparative treatment trials based on a standard design. British Journal of Dermatology, 126(2), 163-170.