Verrucae
Verrucae can be one of the most frustrating of conditions with many patients attended the Centre having had all manner of treatments at other locations. The Centre offers a range of treatments for the management of these virally induced skin lesions. Often, cryosurgery is undertaken and patients routinely receive a nerve block so that the procedure can be undertaken in a painless manner.
If effective cryotherapy (some practitioners are too conservative with this treatment) has proven unsuccessful then more invasive treatments can be performed. This includes dry needling and surgical interventions, either in the form a procedure known as controlled depth excision, or full thickness excision where the wound is sutured closed. Various plastic surgery techniques are utilised to minimise the risk of painful scar formation. The exact type of the surgery depends on the nature, size and location of the verrucae. Patients can send pictures of their foot to the Centre for a preliminary opinion.
Please see below the rationale behind our verrucae treatment options:
CRYOTHERAPY
How does Cryotherapy work?
Cryotherapy involves the application of liquid nitrogen to the verrucae site. The treatment is believed to work by destroying a small area of skin which contains the verrucae. The duration and type of freeze depends on the size, location and your skin type.
What does Cryotherapy involve?
- Depending on the severity of the verrucae, a local anaesthetic injection may be administered to your ankle or in your foot to numb the skin and deeper tissues around the verrucae site.
- Once your foot is numb, a cryotherapy canister is used to spray the verrucae site with liquid nitrogen.
- A sterile dressing is then applied.
- Continued cryotherapy follow-up appointments may be necessary at later dates to ensure the verrucae is successfully removed.
What are the benefits of Cryotherapy?
- Crotherapy is a low-risk and effective treatment.
- The procedure can be carried out in the clinic, not requiring hospital admission.
What are the risks and possible complications? Risks and complications of this procedure are uncommon but can include:
- Blistering
- Pain or discomfort during and for several days following the procedure
- Infection
- Painful scar tissue formation
- Adverse reaction to local anaesthesia (if performed)
- Recurrence or regression of the verrucae virus
- Chronic Regional Pain Syndrome (CRPS)
VERRUCAE DRY NEEDLING
How does dry needling work?
Dry needling pushes the virus to the outer layer of skin (epidermis) into the deeper dermis layer of skin, aiming to induce a cell-mediate immune response that targets the verrucae virus directly.
What does verrucae needling involve?
- A local anaesthetic injection is administered to your ankle or in your foot to numb the skin and deeper tissues around the verrucae site.
- Once your foot is numb, a sterile needle is inserted into the verrucae several times until all of the surfaces of the verrucae has been punctured.
- A sterile dressing is then applied.
- Several follow-up appointments will be performed at later dates to ensure appropriate healing.
What are the benefits of verrucae needling?
- Dry needling is a low-risk and effective treatment. Studies show that it works in 67-69% of cases (B. Longhurst, I. Bristow, 2013) which is higher than any other non-surgical verrucae treatment.
- It is different to other less invasive verrucae treatments, as it often only requires one or two treatments.
- The procedure can be carried out in the clinic, not requiring hospital admission.
What are the risks and possible complications? Risks and complications of this procedure are uncommon but can include:
- Infection
- Painful scar tissue formation
- Adverse reaction to local anaesthesia
- Recurrence or regression of the verrucae virus
- Chronic Regional Pain Syndrome (CRPS)
VERRUCAE CONTROLLED DEPTH EXCISION SURGERY
For those patients who have become resistant to both over-the-counter ointments and cryotherapy treatments, surgical options such as a controlled depth excision can be considered.
How do verrucae-controlled depth excision surgeries work?
Controlled depth excision is a minor surgical procedure used to completely remove the verrucae from the surrounding healthy skin. As well as excising the verrucae lesion, the procedure attempts to induce a cell-mediated immune response is induced, to fight off the verrucae virus.
What does Controlled Depth Excision involve?
- A local anaesthetic injection is given around the ankle or in the foot to numb skin and deeper tissues around the verrucae site.
- Once your foot is numb, the verrucae is carefully excised between the dead and live layers of the skin, at what is known as the dermo-epidermal junction.
- The underlying skin is then cauterized using an electric needle, destroying any remaining viral tissue.
- Such procedures tend to bleed readily, therefore a large sterile dressing is then applied once the procedure is complete.
- Several follow up appointments will then be provided in the following weeks to ensure successful healing.
What are the benefits?
- Controlled depth excision is a low-risk and effective verrucae treatment.
- While more invasive than most other verrucae treatments, it can still be performed in our specialist day surgery facility, thus not requiring hospital admission.
What are the risks and possible complications?
Risks and complications with controlled depth excision are uncommon, but they can include:
- Adverse reaction to the local anaesthetic
- Infection
- Painful scar formation
- Recurrence or regression of the verrucae
- Thrombosis
- Chronic Regional Pain Syndrome (CRPS)
Please contact the centre for more information.
Verrucae FAQ
What is verruca caused by?
Verruca is a virus. There are many types of human papilloma virus (HPV) that can cause verrucas. They can present in different ways. Some verrucas can be spread out and superficial while others seem more like corns, being deep and painful. Corns and verrucas can look very similar. There are a number of ways in which the difference between a corn and verrucae can be determined. This includes the use of diagnostic ultrasound (used at our Centre)
How can you tell the difference between a corn and a verruca.?
There er many ways in which this can be determined, Some types of verrucae look nothing like corns and are much more spread out. However certain types of verrucae can look very similar to corns. The practitioners know the difference using a combination of the history and presentation. For example, we can use a specialised ultrasound scan to assess the lesion as most verrucae have a different type of presentation on a scan. Also corns generally do not occur in the very young, are generally (but not always) more painful and usually present on specific weightbearing areas.
How do you get rid of a verruca fast?
At the London Podiatry Centre, we have found that cryotherapy is one of the most effective ways of treating verruca. Some practitioners use the treatment for too short a period. It must be used for long enough to break down the verruca and effectively kill the tissues with the verruca in it. Other treatments used at The London Podiatry Centre include laser and surgery to excise. However, cryotherapy is one of the safest treatments because of the reduced risk of scarring.
What happens if a verruca is left untreated?
Sometimes one verruca will stay exactly the same for many years and not alter its appearance. Other times if left untreated, it may spread and cause greater problems. Verrucae in children are more likely to go at some point without treatment than in adults.
How to get rid of a verruca?
At the London Podiatry Centre, we tend to use cryotherapy. However, surgical excision and laser is also used when appropriate.
What causes verruca on feet?
A verruca is a virus. It can be contagious. It is transmitted through close skin contact and most commonly picked up in communal changing rooms. The virus begins to multiply in the tissues of the foot so causing the distinctive appearance.
What is the most effective verruca treatment?
The London Podiatry Centre will use various types of treatment depending on the presentation. We find cryotherapy effective although in some cases, other treatments are more appropriate. This might include dry needling and various kinds of chemicals.
Does cryotherapy work for verrucas?
Yes, The London Podiatry Centre finds cryotherapy is often effective. However, verrucas can be challenging, and in some cases, multiple treatments are needed, whilst other times only one treatment is required.
Is a verruca contagious after freezing?
If the freezing has been entirely successful in killing all the verruca tissue, then there is less likely to be transmission. If there are still some remaining verrucoid tissue, then transmission is more likely.
Can I get my verruca frozen off
Yes, this is a treatment offered at The London Podiatry Centre.
Does freezing of a verruca hurt?
It can be quite painful, although we find that most patients can tolerate the treatment. If it proves too painful, then a local anaesthetic can be administered.
How painful is cryotherapy?
This depends on your pain threshold. When it is applied, we give the patient the option of continuing or not. If it is too uncomfortable, then we can administer a local anaesthetic.
What happens to a verruca after cryotherapy?
The tissue effectively dies with the verruca inside it.
What are the side effects of cryotherapy?
Side effects include blistering, which can sometimes be quite severe. When the tissue is broken down, there is some risk of infection. We have not really seen any examples of scarring from cryotherapy but there is a small risk. Recurrence and regression are other risks.
Do verrucas fall off after freezing?
No, the tissue simply dies and is reabsorbed by the body.
What is a verruca?
A verruca is a type of wart that affects the bottom of the feet. A verruca can be painful when walking, as it can press on the nerves in the foot.
