How did I get this wart?

Summer time is slowly coming to an end, a time of year that many kids spend endless hours at the pool.  It is normal to get a few bumps and scratches along the way, especially on the toes and feet.  Breaks in the skin allow potential viruses to get into the skin and grow.  One of the most common viruses found in this environment is the virus that causes plantar warts.

Verrucae, commonly known as warts, are the result of an infection of a virus, which is part of a family of viruses called the human papilloma virus or HPV.   If that sounds familiar to you, it is because this family of viruses is responsible for cervical cancer and gential warts.  Thankfully, when concerning the manifestation of warts on the feet, they are benign and will disappear on their own without any treatment in a couple of years.

The virus is confined to the thick skin on the soles of the feet, which while it keeps the virus from spreading, it allows the virus to hide from the immune system.  This allows the virus to grow and seed on the plantar skin.

How can we tell a wart from a simple callus or IPK?  When shaved with a small blade, a wart will have small distinct pores that will bleed, a phenomenon termed “pin point bleeding.”  In addition, the skin lines on the soles of the feet will be interrupted by the growth of the wart.  Another way to correctly diagnose a wart will be to squeeze the wart between your fingers.  This will induce exquisite pain, more so than if direct pressure is applied to the surface of the wart.

As you probably know, this is a very common problem among children and young adults.  As such, there is no end to the many treatments that have been attempted, some more successful than others.  We’ll discuss the possible treatments in the upcoming posts.

PTTD Surgical Treatments

Once conservative treatments have failed in treating posterior tibial tendon dysfunction, surgery can be looked at as a potential way to reduce pain and correct the collapsed arch.  There are a wide variety of procedures that have been used.  Some involve repairing tendons or other soft tissues.  Others involve making cuts in bone to shift their position to reestablish their correct position.  If there is cartilage damage or arthritis in the joint, fusing the joints may be beneficial.  We’ll discuss each category of procedures.

Before any surgical decisions are made, an MRI should be ordered and reviewed with your doctor.  With the help of an MRI, the entire length of the posterior tibial tendon can be analyzed and the extent of damage can be determined.  If cartilage damage is present, this will be obvious on the MRI images.  MRI is an important tool that is essential for determination of the best procedure.

If the condition is not too far advanced, a soft tissue procedure can be done to help stop progression of the problem.  This may involve repairing the damaged tendon, or transferring a healthy tendon to take its place.  In some cases, using a tendon graft can help strengthen the tendon.  The nice thing about these procedures is that once the incision is healed (about 2 weeks), you can walk on the foot which was operated on.

If the condition is too far advanced, a soft tissue procedure will not be powerful enough to correct the problem.  In such cases, bone must be cut in order to re-align the foot under the body.  These procedures provide more correction than the soft tissue procedures.  In situations where cartilage damage is present, the surgeon may choose to fuse the damaged joint.  Although these procedures are more definitive and have more potential benefit, the recovery time is much longer.  When bone is cut, the patient should be non-weight bearing for up to 6 weeks to allow the bone to heal in proper position.  Additional non-weight bearing time may be necessary depending on how fast each particular patient heals.  The doctor will want to see you every 2-3 weeks to take xrays to insure proper healing.

PTTD is a difficult condition to treat.  Discuss with your podiatrist which procedure option best suits your situation.  Most patients see dramatic reduction in pain and a foot that allows for normal ambulation.