Plantar Warts: Symptoms, Causes, Treatments, and Natural Approaches

Plantar warts are painful foot lesions caused by a common virus.

Plantar warts appear as thickened skin with tiny black dots and may be painful, especially when walking. The Epoch Times/Shutterstock

Plantar warts, also known as plantar verrucae and foot warts, are common skin growths caused by the human papillomavirus (HPV). They develop when the virus infects the skin, typically appearing on the bottom—the plantar side—of the foot.

The virus is species-specific to humans, making people the primary reservoir for HPV. It is estimated that 40 percent of people are infected with HPV, and warts develop in 7 percent to 12 percent of those infected.

Human papillomavirus (HPV) targets the skin’s epidermis and often spreads in moist environments like locker rooms and showers. The Epoch Times/Shutterstock

What Causes Plantar Warts?

Warts are caused by an infection in the outer layer of the skin, called the epidermis.

The virus typically enters through small cuts or breaks on the sole of the foot.

Plantar warts often spread through direct contact with infected skin or contaminated surfaces in public places such as changing rooms, shower stalls, and around swimming pools. Plantar warts can also be transmitted through autoinoculation or self-spread by scratching or rubbing. HPV does not spread through body fluids, except from the wart itself.

Once HPV comes into contact with a host, it enters the skin through breaks, cuts, or other weak areas on the bottom of the foot. After penetrating the surface, the virus infects the skin’s basal layer, where stem cells actively divide. The virus enters the infected cell and, after an incubation period of one month to 20 months, establishes viral DNA within the host cell. After infection, three outcomes are possible: the infection can clear if the person is immune to that specific HPV type, remain latent, or develop into a visible plantar wart.

In addition to exposure to HPV, other risk factors for plantar warts include:

• Having a history of plantar warts: People who have had plantar warts before are more likely to experience recurrence.
• Age: Warts are most common in children and adolescents, with peak incidence between ages 12 and 16
• Poor hygiene practices: Inadequate foot hygiene or sharing personal items may increase the risk of infection.
• Broken skin: Plantar warts are more likely to develop on wet, damaged, or broken skin.
• Certain occupations: Jobs or activities that involve barefoot movement on shared surfaces—such as in sports or dance—can increase vulnerability to HPV. For example, gymnasts and dancers often practice barefoot on communal floors.

What Are the Symptoms and Signs of Plantar Warts?

Warts are noncancerous localized thickenings of the skin, and plantar warts are those that develop on the soles of the feet. Plantar warts can appear anywhere on the sole or toes, often forming on pressure points such as the heels and balls of the feet. The warts can range in size from a few millimeters to over 1 centimeter.

In many cases, plantar warts do not cause symptoms. Some signs may include:

• Thickened skin: A plantar wart often resembles a callus because of its tough, thick tissue. Myrmecial warts usually protrude from the surface of the skin and grow deeper into the skin. This growth typically occurs slowly, starting small and enlarging over time.
• Pain: Because the soles are weight-bearing and rub against footwear, plantar warts can cause discomfort. Walking, standing, or squeezing the sides of the wart may be painful. Myrmecial warts tend to be deep and tender, while mosaic plantar warts are typically painless.
• Tiny black dots: These dots, which often appear on the surface of the wart, are actually dried blood trapped in capillaries—tiny blood vessels.
• Loss of skin lines: Unlike calluses, which retain natural skin pattern, plantar warts disrupt or erase these lines.

What Are the Types of Plantar Warts?

There are two types of plantar warts:

1. Solitary Warts (Myrmecial Plantar Warts)

Solitary warts are individual, tender warts that grow inward and may develop additional “satellite” warts nearby. They can range in color from flesh-toned to yellow or grayish-brown.

2. Mosaic Warts

Mosaic warts consist of a group of small warts growing close together in one area. Mosaic warts are generally more challenging to treat than solitary warts.

How Are Plantar Warts Diagnosed?

The following methods are used to diagnose plantar warts:

1. Observation: Doctors usually diagnose plantar warts based on their appearance. Skin lines do not continue across the wart, and tiny black dots may be visible. Warts may also bleed when shaved.
2. Dermatoscopy: Dermatoscopy uses a dermatoscope—similar to a magnifying glass—to enlarge skin details up to 10 times. Under dermatoscopy, warts show red or purple dots (blood vessels) surrounded by white rings (thickened skin).
3. Paring: Paring involves carefully shaving or scraping away the thickened outer layer of the wart to reveal diagnostic features, such as tiny black dots.
4. Biopsy: Biopsy may be performed when the diagnosis is uncertain or if the lesion appears darker than the surrounding skin, has an irregular shape, bleeds, or grows rapidly. Biopsy is rarely needed, as plantar warts are usually benign.
5. Swab method: The swab method uses tissue samples collected via swab for histopathological study or polymerase chain reaction testing for HPV DNA. The swab method is as effective as a biopsy but is noninvasive, quicker, and more comfortable for patients.

What Are the Possible Complications of Plantar Warts?

While usually benign, plantar warts can occasionally lead to:

• Cancer: In rare cases—especially in people who are immunocompromised—long-standing warts may undergo malignant transformation into squamous cell carcinoma or plantar verrucous carcinoma.
• Knee or hip pain: Pain from myrmecial plantar warts can interfere with walking and sports activities, which may lead to joint pain.
• Secondary infections: Injured or scraped plantar warts can become infected with bacteria.

What Are the Treatments for Plantar Warts?

Plantar warts can be difficult to treat and frequently recur, but they often disappear on their own, particularly in children under age 12. However, this process may take months or even years, as HPV can survive on surfaces for extended periods.

Most plantar warts can be treated with pharmacist advice and over-the-counter treatments.

See a doctor if the wart is painful, bleeding, changing, interfering with daily life, spreading despite treatment, or if you have diabetes, reduced foot sensation, or a weakened immune system.

First-Line Treatments

First-line treatments are typically the most accessible and least invasive options for managing plantar warts. These methods are often effective, especially in early or mild cases.

• Wait and see: Allowing warts to resolve naturally works in about 58 percent of cases involving solitary warts. However, the approach is less effective for mosaic warts and is not recommended for people with weakened immunity.
• Topical creams and ointments: Applying salicylic acid or silver nitrate daily until the wart disappears is a common treatment method. Salicylic acid removes dead skin and boosts immune response, requiring use over several months. Silver nitrate is applied directly to destroy wart tissue over a shorter course. Proper application and precautions are essential to avoid skin damage and potential toxicity.
• Duct tape: Covering the wart with duct tape for six days, then soaking, filing, and leaving it uncovered overnight may help. The process can be repeated for up to two months. Although evidence is mixed, some people report success with this approach.
• Over-the-counter pain relievers: Taking medications such as acetaminophen or ibuprofen may help relieve discomfort associated with plantar warts.

Second-Line Treatments

Second-line treatments are typically considered when first-line methods fail or when warts are persistent, widespread, or particularly painful. These options may involve more intensive procedures or specialized therapies.

Cryotherapy: Cryotherapy involves freezing warts with liquid nitrogen, and is typically repeated every two to three weeks for up to three months. Using salicylic acid between sessions may enhance results. Cryotherapy often causes pain, blisters, and burns, and may reduce mobility for several weeks. It is generally not recommended for children due to side effects. Clinical trials report low cure rates ranging from 6 percent to 65 percent for plantar warts, as the thick epidermis on the soles can limit effectiveness. Cryotherapy may be more effective on warts in other areas of the body.

Hyperthermia: Hyperthermia raises skin temperature to promote viral cell death (apoptosis) and stimulate an immune response. Hypothermia requires specialized equipment—such as exothermic skin patches, radiofrequency devices, or infrared lasers—and carries a risk of burns, which limits its use in general practice.

Laser treatment: Laser treatment uses focused light to heat and destroy tissue and the blood vessels that feed it, effectively cutting off the wart’s blood supply.

Immunotherapy: Immunotherapy stimulates the immune system to fight HPV-induced plantar warts. Treatment often involves applying a topical chemical, such as diphencyprone, to trigger a mild allergic reaction and boost the immune response. Immunotherapy is generally used for people with multiple or treatment-resistant warts.

Microwave therapy: Microwave therapy delivers energy in the 8 gigahertz range through a handheld device applied directly to the infected tissue. The energy is administered using a single-use applicator tip to reduce the risk of cross-infection. Successful treatment may require two to three sessions.

Surgery: Surgery is considered a last resort option for plantar warts that do not respond to other treatments. Risks include pain, infection, scarring, and recurrence within the scar. Surgical methods include burning off the wart (electrocautery), scraping it off (curettage), or completely removing it (full-thickness excision).

Self-care: Self-care can prevent the spread or worsening of plantar warts. Key steps include avoiding self-treatment, wearing comfortable shoes, maintaining foot hygiene, and protecting feet in public areas. People should also avoid sharing footwear, picking at warts, or ignoring persistent growths that do not respond to treatment, as further evaluation may be needed to rule out other conditions.

How Does Mindset Affect Plantar Warts?

Mindset can influence the development and treatment of plantar warts in several ways:

• Stress and immune function: Chronic stress can weaken the immune system, making it harder for the body to fight off the HPV virus. A positive mindset may help reduce stress, support immune function, and potentially lower the risk of wart development or recurrence.
• Psychological impact on healing: A person’s attitude toward treatment can influence how well they adhere to the plan. An optimistic and committed mindset increases the likelihood of consistently following through with potentially painful treatments, while a negative mindset or lack of motivation may lead to inconsistent care and slower recovery.
• Perception of pain: Psychological factors such as anxiety or fear can amplify pain perception. A more resilient mindset may help people better tolerate discomfort during treatment, leading to faster healing and reduced pain.

What Are the Natural Approaches to Plantar Warts?

It’s worth noting that many natural medicines don’t have randomized controlled trials due to limited pharmaceutical or government funding.

The following natural remedies require further research, so it’s recommended to consult your health care provider before trying them.

Topical Zijinding paste: A 2019 study found that topical Zijinding paste led to complete healing in three patients with refractory plantar warts within one to five months of treatment, with no relapses for at least 10 months. Its antiviral and immune-boosting properties may explain its effectiveness.

Medicinal foot soaking therapy: A 2024 study suggested that combining cryotherapy with herbal foot soaks containing astragalus, purple gromwell (Lithospermum erythrorhizon), and other herbs was more effective than cryotherapy alone. The combination inhibited wart proliferation and helped thin the lesions.

Moxibustion: In a 2016 study, heat therapy using Chinese mugwort (Artemisia argyi) eliminated chronic plantar warts in three patients after five to 19 sessions, possibly by triggering localized wound-healing responses.

Smoke from Populus euphratica tree leaves: A 2008 study showed a 100 percent cure rate when treating plantar warts with smoke from burned tree leaves for 10 minutes over multiple sessions. This approach outperformed cryotherapy, which had an 83 percent cure rate, though the sample size was small.

Bee propolis: Propolis is a resin-like substance produced and used by bees to build their hives. It is believed to have antibacterial, antiviral, antifungal, and anti-inflammatory properties, and may support skin healing. A 2009 study found propolis effective as an alternative remedy for treating plantar warts.

How Can I Prevent Plantar Warts?

Take these steps to prevent plantar warts and aid recovery:

• Avoid sharing towels, shoes, socks, equipment, or other personal items.
• Wear footwear in communal showers and locker rooms to avoid contact with infected surfaces.
• Sanitize shared sports equipment with isopropyl alcohol, ethyl alcohol, or diluted bleach to kill potential viruses.
• Choose well-ventilated footwear and athletic clothing to reduce moisture and prevent infections.
• Practice good personal hygiene.
• Change socks daily.
• Allow shoes to dry completely between uses.
• Focus prevention efforts at home and school, where children often acquire warts.
• Clean the bottoms of showers and bathtubs thoroughly.
• Avoid direct contact with other people’s warts, and wash hands thoroughly after any contact.