- 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.
- 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
- 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.
- 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.