Reason for attending the office: This patient attended complaining plantar wart that had been on the bottom of the right foot with a secondary cluster under the ball of the foot for some time. It measured the size of a quarter and the patient said it had been present for ‘many, many years!’ The patient had been having a series of treatments every 2-weeks over several months prior to attending and wanted to consider more radical treatment.

Agreed treatment: After discussing options including surgical and non-surgical interventions it was mutually agreed that ‘needling’ would the best initial treatment option. A needling procedure is carried out under sterile surgical conditions painlessly whilst numb under local anaesthetic. The aim of this treatment is to trigger the bodies own immune response – boosting the patients own body to fight off the infecting wart virus infection. This procedure suited the patient as there are generally rapid recovery times, minimal discomfort and prior treatment had failed to impact the condition.

Alternative Treatment Discussed: It was discussed that further treatment may be needed which could include the use of other surgical modalities such as laser surgery and the use of acids or caustics amongst others.

Outcome: Following needling other treatment modalities were then utilised to achieve a complete resolution for this patient including the use of special chemical compounds applied directly to the wart, Laser Surgery and a prescription of a topical cream to boost the immune response.

Timeframe: 18 months to resolution

Conclusion: This is a good example of an ‘intractable’ plantar wart infection which unlike typical plantar wart infections, does not respond quickly to typical treatments. An 18-month timeframe was not unrealistic in the management of this case.

Please note that in most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the hierarchy, with single case studies, expert opinion and anecdotal experience at the bottom.

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