At a Glance

Plantar warts vs corns

Plantar warts

Clinical features

  • Extremely common, especially in children, teenagers and the immunocompromised.
  • Caused by infection of epidermis by HPV, usually types 1, 2 or 4.
  • Occur most commonly in pressure areas such as ball of foot and heel.
  • Usually resolve spontaneously - given time.
  • Tendency to recur.
  • Almost no malignant potential. Rarely change to squamous cell carcinoma (SCC).
  • Grey/yellow hyperkeratotic lesions that start as 'sago grain-like' papules.
  • Central pin-point petechiae.
  • Groups of warts may fuse together to form mosaic warts.
  • Tender, may be painful on walking.

Management

  • Verruca socks, sandals in swimming pools and washroom areas, may reduce risk of transmission.
  • Symptomless warts may not require treatment.
  • Success rate of treatments averages only 60-70 per cent.
  • Clearance very difficult in the immunocompromised.
  • Topical salicylic acid is probably the most effective approach.
  • Cryotherapy; formaldehyde or glutaraldehyde daily application of gel or solution

Corns

Clinical features

  • Hyperkeratotic lesions caused by excess pressure over bony prominences on feet.
  • More common in the elderly.
  • Hard corns are commonest over interphalangeal joints.
  • Soft corns - in moist area eg, often between the toes.
  • Related to ill-fitting shoes or foot deformities, and peripheral neuropathy.
  • Hyperkeratotic lesions with shiny surface on the foot.
  • Commonly under prominent metatarsals or over distal interphalangeal joints.
  • Tender and may cause problems with mobility.
  • Central core of keratin (unlike plantar warts).
  • No pinpoint petechiae on paring.
  • Soft corns - white and macerated.

Management

  • Soak to soften and pare with pumice stone or emery paper.
  • Topical moisturiser cream to soften.
  • Footwear advice.
  • Avoid chemical applications (sometimes in corn plasters) unless advised by podiatrist.
  • Chiropodist may pare and trim corns.
  • Podiatrist supervision for patient with diabetes, peripheral neuropathy - this may reduce problems of ulceration.
  • Foot pads and protection.
  • Surgery may help in some cases of foot deformity.

Contributed by Dr Jean Watkins, a sessional GP in Hampshire.

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