They present with a complaint of pain in the toe, sometimes localised to the nail fold. Sometimes the swelling itself may cause pressure on the shoe. Some have a history of trauma or previous nailbed surgery (which may have been for an “ingrowing toenail’ that was, in fact, the exostosis).

Examination shows a firm swelling under the nail, usually in the medial nail fold. It is usually covered with epidermis, but may be raw or granulating.

The main differential diagnosis is ingrowing toenail, with a nailbed tumour such as melanoma, squamous carcinoma or glomus tumour as a much rarer possibility.

The lesion normally continues to grow so is best removed when diagnosed. This can be done under digital block anaesthesia as a day case. Sometimes the nail fold can be elevated and preserved, but usually it cannot be separated from the lesion and must be sacrificed. Even with careful excision of the whole lesion, the recurrence rate averages about 10%. A few patients require removal of so much nail bed that there is significant post-operative nail deformity, so that plastic nail bed reconstruction may be consdered (Suga 2005).

If you feel you may have a painful subungual exostosis, please see Dr. Kory Williams or Dr. Silvers at Advanced Foot and Ankle Center for treatment.

References

• De Berker DA, Langtry J. (1999). Treatment of subungual exostoses by elective day case surgery. Br J Dermatol 140(5): 915-8
• Dalle S e al. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156(5):871-4
• Gray RJ et al. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705
• Lee SK et al. Two distinctive subungual pathologies. Subungual exostosis and subungual osteochondroma. Foot Ankle Int 2007; 28:595-601
• Suga H et al. Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail. Ann Plast Surg. 2005;55(3):272-5

Enjoy! Have a great day!

P.S. – These are not recommended to wear.

~Dr. Williams

Plantar’s Warts

A plantar wart (verruca plantaris) is a wart caused by the human papilloma virus (HPV). It is a small lesion that appears on the sole of the foot and typically resembles a cauliflower.

A plantar wart may have small black specks within it that bleed when the surface is cut or shaved; these are abnormal capillaries or blood vessels feeding the wart.

Though the name plantar wart describes specifically HPV infection on the sole of the foot, infection by the virus is possible anywhere on the body and common especially on the palm of the hand, where the appearance of the wart is often exactly as described above for plantar warts. Because of pressure on the sole of the foot, a layer of hard skin forms over the wart.

A plantar wart may or may not be painful. It can be spread in showers, around swimming pools, by sharing shoes, etc. Plantar warts, can often be differentiated from corns by close observation of the skin lines. Feet, like hands, are covered in skin lines or “fingerprints”. With plantar warts, the skin “fingerprints” go around the lesion. If the lesion is not a plantar wart, the fingerprints continue across the top layer of the skin.

Plantar warts tend to be painful on with pressure from either side of the lesion rather than direct pressure. Corns tend to be painful on direct pressure rather than pressure from either side.
 The difference between plantar warts and warts on other parts of the body is that warts are generally outgrowth lesions, but on the bottom of the foot, they are pushed inward by the pressure of walking.

Since the skin on the bottom of the foot tends to be thicker, the treatment of plantar warts is more difficult.When discussing treatments, no treatment in common use is 100% effective.

Podiatrists are considered specialists in the treatment of plantar warts. Although immunization is available for the HPV and strains causing cervical cancer, there is currently no vaccination treatment for plantar warts.

The treatment of warts by keratolysis involves the peeling away of dead surface skin cells with chemicals like Canthacure (canthiridin, derived from a blistering beetle) or trichloroacetic acid or salicylic acid. Cryosurgery with liquid nitrogen is a common treatment that works by producing a blister under the wart. It is painful but usually nonscarring. Lasers utilized in the operating room are also a great option.

Surgical excision of the wart is a last resort option but appears to be the most definitive for recalcitrant lesions.

Dr. Williams and Dr. Silvers have extensive training in using these products as well as surgical options concerning warts. Patiently waiting may be appropriate since many warts will eventually resolve due to the patient’s own immune system.

In many cases, the body will become naturally immune to the wart and the verrucæ will fall off, although it can be months to years before this takes place.Warts may spread, develop into clusters or fuse to become a mosaic wart. Plantar warts can be painful making it difficult to walk and run. Overaggressive treatment may lead to scarring. Others may get infected. If a wart is being treated professionally and does not seem to improve in a reasonable period of time, the growth should be excised and biopsied.

Avoid walking barefoot in public areas such as showers and public changing rooms. Change shoes and socks daily.

Avoid sharing shoes and socks. Avoid direct contact with warts on other parts of body.

Avoid direct contact with warts on other persons.

If you have a painful plantar’s wart and are seeking treatment, please come visit Advanced Foot and Ankle.