Verruca Treatments
Your local experts here to help defeat stubborn verrucae
There are various treatments used for the treatment of plantar warts, (verrucae) at Care For Feet.
This article will provide a summary of some of the evidence behind the treatment methods.
What is the most effective treatment for persistent Verrucae?
There is no definitive answer, although there are a number of ways that the HPV evades our immune system. Its best defence appears to be how it stops inflammation which prevents our cells from ‘dealing with the virus’.
For an immune response to occur, virally infected tissue must be taken up by skin cells to the lymph nodes then recirculated to the skin where they recognise and kill the HPV infected skin cells.
Once our cells find the virus they mount an inflammatory global attack and destroy all lesions. Therefore, the aim of any treatment is to initiate this inflammatory response.
However, treatments can fail due to the messengers being ambushed, hence why no single treatment is effective all of the time.
What treatments are offered in clinic?
We only offer the best evidence based treatments in our podiatry clinic.
We may suggest caustics, occlusive therapy, debridement, Falknor’s method, Swift Therapy or no treatment, dependent on the individual.
Our team are highly experienced and can provide you with further information if you are uncertain.
For example, Falknor’s verruca treatment is one of the treatments we can offer and is designed to make the immune system aware of the presence of the verruca through stimulation, conducted under local anaesthesia. When the lesion is completely numb, the infected tissue can be broken down with a small needle.
Below are the before and after photos of a recalcitrant/long standing painful verruca that was successfully treated with one session of Falknor’s Verruca Treatment.
Swift Microwave Technology
Swift has been developed in the UK and licenced for the general treatment of skin lesions in podiatry and dermatology.
A study lead by Ivan Bristow found that 75.9% of recalcitrant plantar warts with an average lesion duration of over five years cleared1Bristow I, R, Webb C, Ardern-Jones M, R: The Successful Use of a Novel Microwave Device in the Treatment of a Plantar Wart. Case Rep Dermatol 2017;9:102-107. doi: 10.1159/000477377. (Review the study here.)
This compares well to previous studies using cryotherapy or salicylic acid of just 23-33% resolution.
Microwaves are situated between radio waves and infra-red waves and cannot cause any damage to living DNA. When they enter the body from the applicator, they agitate water molecules and cause some friction. They do not break the surface of the skin.
Swift heats the warty tissue to 41-44 C in a highly controllable, uniform manner.
The treatment microwaves penetrate to a depth of over 3.5 mm travelling in a straight line with energy deposited in alignment.
The ‘beam’ emitted from the device has little lateral spread and minimal damage to surrounding tissue.
The wart is sensitive to heat, and this results in tissue damage or death to the cell membranes and cell structure, this in turn can activates your body’s immune response.
Falknor’s Verruca Treatment
The podiatrist will conduct the procedure in the Clinic for your comfort and convenience.
Falknor’s method is a highly effective treatment for eradicating benign types of Human Papillomavirus (HPV).
By puncturing through the skin cells of the verrucae this method seeks to cause an inflammatory response that stimulates the body’s immune system helping it to recognise and destroy the virus.
A study by Ivan Bristow in 2013 found that 69% of cases demonstrated complete resolution of verrucae after the procedure. Compared to cryotherapy and acid treatments the high rate of complete resolution makes this option very favourable.2Longhurst B, Bristow I. The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases. J Clin Med. 2013 Apr 2;2(2):13-21. doi: 10.3390/jcm2020013. PMID: 26236985; PMCID: PMC4470114.
(Read more about the Study here).
What does the Falknor’s Method involve?
- Local anaesthetic will be administered to numb the area being treated and surrounding area. In some cases, this may be around the ankle to numb the sole of the foot, or the toes.
- The podiatrist will then remove any overlying hard skin or callus with a scalpel blade and cleanse with iodine
- They will then begin to carefully needle the verrucae repeatedly using a sterile needle ensuring the entire lesion is perforated and bleeds
- Finally, a dressing will be applied, and the podiatrist will provide you with aftercare advice
- After the treatment is completed, the patient is advised not to drive and to rest for 1-2 hours after the procedure. Walking on the foot can cause increased bleeding, so resting and elevation allow a scab to form
Risks & Complications
Although rare, the following risks remain:
- Infection
- Recurrence
- Delayed healing
- Adverse reaction to local anaesthesia
- Scar tissue
Tape Occlusion Therapy
A 2002 study found that Tape Occlusion Therapy was more effective than Cryotherapy for the treatment of common warts 84.6% vs 60.0%, respectively.
At each appointment, the verruca is examined, photographed and measurements noted in your file. As a non-evasive home treatment, many patients find this method suitable initially.
During your appointment in clinic, the Podiatrist will debride overlying callus from the verruca with a sterile scalpel blade.
Afterwards, they apply a sticky zinc oxide tape. Approximately, 2mm larger than the lesion then keep it covered.
At home we recommend to remove the tape daily, wipe surgical spirits over wart when necessary, reapply with the tape just removing long enough to put a fresh piece on.
Do not leave the tape off for longer than 2 minutes.
The tape will trap TEWLS (Trans Epidermal Water Loss) and engorge the hardened/painful corneocytes so that they soften and become painless whilst waiting for the adaptive immune response to kick in and enable future immunity against that strain of HPV. It can take up to 24 months to do so, so be patient.
If the lesion is painful or spreading please contact your local HCPC podiatrist for further advice and treatment.
Swift to fight Verrucae
Swift delivers a precise, highly controlled energy dose. As microwaves travel into the
tissue, water molecules begin colliding and creating localised heat energy – quickly destroying all infected tissue within a predetermined depth.
Tape Occlusion Therapy
At each appointment, the verruca is examined, photographed and measurements noted in your file.
As a non-evasive home treatment, many patients find this method suitable initially.
Falknor’s Treatment for Verrucae
By puncturing through the skin cells of the verrucae this method seeks to cause an inflammatory response that stimulates the body’s immune system helping it to recognise and destroy the virus.
MEDICAL DISCLAIMER
Medical Disclaimer. Always consult your Podiatrist before beginning any treatment program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional.
