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The Problem With Verrucas

Warts on the feet called verrucas have long been seen a nuisance. And much has been done in the past to try and rid pools of these ‘plantar warts’ - so-called because they grow on the plantar or bottom of the foot - all to no avail. But should we worry about them? Read on.

Few coaches, teachers or pool managers would argue they are anything other than a nuisance. However, experience has led us to the opinion nowadays that to place resources into eradicating verrucas is a waste of time.

Verrucas, like most warts, are due to a viral infection of the growing layers of the skin. Injury of the skin is a prerequisite for the contraction of warts, and there is a predilection for the hands, knees and feet to be more prone to minor injury during childhood activities.

This is especially the case for barefoot activities surrounding swimming pools. With the plantar skin being slightly soggy, together with possibly damp duckboards or foot mats and the skin of the feet being more easily damaged by slight irregularities of the floor, it is easy for the virus to be implanted.

So, how do we get rid of verrucas?

As with most infection, particularly viral, immunity to the causative (virus) occurs in time. This is possibly why such warts occur less often in adolescents and adults. By the time that adolescence is reached, most individuals have reached an adequate immunity.

Such an immunity may well be under hormonal control, and while it is probably not as strong or as long lasting as that found in infections such as measles and rubella (German measles), an effective immunity usually exists for a decade or two.  This is sufficient to cover the period during which contraction of warts is likely to occur.

The majority of dermatologists, skin specialists, are not in favour of treating plantar warts. Many feel that because the virus is so widespread, it could be beneficial to spread it as much as possible and as early as possible in the lives of children.

The use of devices, such as plastic socks, to protect the feet should be discouraged. As with elasticated knee bandages, the socks have limited value other than of attracting attention. The use of a waterproof plaster is sufficient.

Most enlightened associations and professional bodies believe the exclusion of children with plantar warts from barefoot activities - such as swimming, physical education, dancing or communal showering - is no longer justified.

However, not advocating virtual quarantine for such infections may be slow in acquiring support from non-medical opinion. So we must re-emphasis that as far as plantar warts are concerned, many children develop immunity to the virus without having knowingly developed a plantar wart.

This is well recognised in other viral infections, such as true glandular fever, or in what is now loosely called ‘swimmers virus’ in the swimming world, a glandular fever-like illness.

It is possible that people are infectious during part of the long incubation period. But in the case of plantar warts, the most scrupulous foot inspection would fail to reveal any problem.

Is there a situation when plantar warts should be treated?

The main indication for treating plantar warts is intolerable pain or tenderness on walking. This is usually because of the hard skin that accumulates around the wart. Keeping this under control poses problems if a pumice stone, for example, is used when the hard skin is moist after a bath or after wearing a piece of bare ‘sleek’ on the lesion for a few days.

Chemists’ shelves are full of expensive wart remedies, principally because none of them work

satisfactorily. Most of them work from time to time for the simple reason that all warts will eventually disappear in time. Even hypnotherapy has been known to ‘cure’ such warts.

Occasionally, symptoms may make treatment inevitable and while cryotherapy with liquid nitrogen is best avoided on the foot, curettage (scraping out) under local anaesthesia is valuable in skilled hands.

Soaking multiple lesions in 4.5% formaldehyde solution for 10minutes is also valuable and painless. It must be emphasised, however, that a medically qualified person should carry out all such treatments. Most wart treatment (especially plantar warts) can be time consuming and painful and the response to treatment is unpredictable.

Where there is no firmly laid down policy with regard to verrucas (plantar warts) it is suggested that a practice of ‘masterly inactivity’ be adopted, unless painful. Treatment then, if indicated should be under strict medical advice.

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