A variant of a widespread sexually transmitted infection could be present in the feet of countless Americans without their awareness, yet failing to address it may result in discomfort and serious health issues.
Over 200 variants of human papillomaviruses (HPV) exist, ranging from high-risk sexually transmitted types that may trigger cancer to lower-risk varieties acquired from contaminated surfaces that produce stubborn warts.
When HPV affects the genital region, the sexually transmitted infection frequently presents no visible signs but may lead to cancer in subsequent years. Vaccination can significantly reduce this risk.
Though HPV is primarily recognized as a sexually transmitted disease, its appearance on the feet is termed a verruca, or plantar wart.
This particular variant is less severe but can remain asymptomatic – and similar to the STD form, without treatment, verrucae can cause significant problems.
These warts can penetrate deeply into tissue, resulting in pain, walking difficulties, rapid transmission to other body areas, and secondary bacterial infections.
Each week, I treat numerous patients experiencing the troublesome consequences of warts, including one individual so concerned about viral transmission across his foot that he maintained an aggressive treatment protocol for thirty days.
Additionally, a dedicated cyclist who consulted me was so troubled by the discomfort and dimensions of the verruca on his heel that he immediately chose microwave therapy in an attempt to eliminate the virus.
While HPV is most known as an STD, when it shows up on your feet, it is called a verruca, or plantar wart (stock image)
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What is a verruca?
Despite being benign, HPV verruca is extremely contagious and depends on moisture for survival.
The soles of our feet provide an ideal location for this inconspicuous virus to infiltrate minor cuts, fissures, or moist compromised skin.
After the virus penetrates and infects the uppermost skin layer, it generates a response that stimulates excessive hard skin production.
Walking pressure on this skin region forces the lesion to burrow deeper into tissue, producing its characteristic ‘cauliflower’ texture.
The HPV-induced infection in foot skin causes tiny blood vessels known as capillaries to form clots, generating the distinctive black specks seen in warts.
The virus exploits this environment to persist and contaminate additional body regions through a mechanism called autoinoculation – the transmission of infection from one body area to another.
Recent research indicates that approximately ten percent of Americans develop foot warts, with 20 percent of these cases occurring in school-age children.
Current studies indicate that foot HPV infection occurs more frequently in women compared to men, with immunocompromised individuals facing elevated risk.
How does HPV infect the foot?
Around ten percent of the US population develops warts on their feet (stock image)
Shared facilities including locker rooms, swimming pools, and fitness centers rank among the locations most commonly linked with HPV presence.
Minor cuts and skin fissures serve as optimal entry points for undetected viral penetration.
Scratching represents a behavior that both creates infection targets and facilitates viral transmission to additional body regions. As skin cells shed, the virus disperses, spreading effortlessly across surfaces.
Our feet contain roughly 250,000 sweat glands, creating a dark, warm, humid environment that enables HPV to persist outside skin and re-enter when tissue becomes softened and more vulnerable to infection.
Physical pressure can heighten verrucae susceptibility, as barefoot walking exposes foot soles to damp surfaces favorable to HPV and may cause existing verrucae to develop inward, potentially generating increased pain for affected individuals.
Contaminated items including shoes, socks, and towels present elevated infection risk.
The essential strategy involves avoiding use of clothing or towels belonging to others. Utilizing personal shoes, socks, and towels is vital for minimizing foot HPV infection risk.
How would a verruca affect me?
Zinc oxide tape is a common treatment that covers the lesion to prevent its spread (stock image)
Numerous infected individuals remain unaware of their condition until the lesion emerges. Months may elapse before the verruca becomes visible, and following its appearance, months or occasionally years may pass before it ultimately resolves.
Affected individuals may experience pain and swelling when standing or walking.
Jonathan Brocklehurst (pictured) is a podiatrist based in the UK
HPV viral infection impacts not only standing and walking capabilities but can negatively affect mental wellbeing, particularly regarding aesthetic self-consciousness in social settings.
Significant complications from verrucae include rapid wart proliferation to other body parts and secondary bacterial infections resulting from picking or scratching the wart.
Worst-case scenarios frequently involve intense pain, misdiagnosis as squamous cell carcinoma (cancer), or ulceration in diabetic individuals with neuropathy.
Without treatment, warts may proliferate, enlarge, and become intensely painful, interfering with daily activities such as walking.
How is HPV of the foot treated?
Minimally invasive treatments such as cryotherapy and microwave ablation have shown high rates of success of eliminating plantar warts (stock image)
Because of its autoimmune characteristics, the HPV virus becomes inactive only when the immune system identifies it and responds by attacking infected cells.
Dermoscopy serves as a crucial assessment method that assists podiatrists in confirming whether the lesion represents a verruca.
Avoiding self-diagnosis and self-treatment until a podiatrist evaluates the suspected verruca is essential.
Following diagnosis, numerous treatment approaches exist for managing foot HPV infection.
Zinc oxide tape represents a hypoallergenic conservative approach that covers the lesion to inhibit the autoinoculation mechanism.
Topical solutions containing salicylic and lactic acid may be considered as alternatives, though current evidence indicates a success rate of merely 30 percent.
More powerful minimally invasive interventions including cryotherapy and microwave ablation have demonstrated superior success rates, especially in pediatric and adolescent populations.
Jonathan Brocklehurst, MSc, MIRL, MRCPod, is a podiatrist based in the UK.
