#703 Plantar wart treatment options in runners - DOC

#703 Plantar wart treatment options in runners

Today on the Doc On The Run Podcast, we’re talking about plantar wart treatment options in runners.



You may not want to listen to this topic while you’re eating dinner, but I’m going to go ahead and tell you a story because I have one that actually goes along with dinner. Believe it or not. One time we went out with a bunch of friends, we were going to a restaurant, we were at dinner.

In medical school, Dr. Sheer, one of my professors warned me that someday you’re going to be at a dinner party, a cocktail party, something, and you’re going to tell somebody you’re podiatrist and they’re going to take off your shoes. And that’s exactly what happened. This guy took off his shoes and he said, “Hey, what do you think of this?” He literally had plantar warts, a special kind of plantar. Oh, plantar, by the way, just means bottom of the foot. And a wart, well, you know what a wart is.

But plantar warts are on the bottom of the foot. They’re difficult to treat because they’re in thick skin and he had a thing called mosaic warts. It’s where you start getting them all over. In fact, the entire bottoms of both of his feet, the entire surfaces were completely, completely covered with mosaic warts. And yes, even though I’m not going to show you a picture, it was disgusting. It was even doubly disgusting because we were at dinner at a restaurant with a bunch of people.

He said, “What do you think?” And I said, “I think that’s the nastiest appetizer I’ve ever seen, but I think it’s a problem.” And he told me that he had actually seen a podiatrist who said, “We’re not going to be able to treat these with the usual things. We can’t do blistering agents. We can’t do all this other stuff. You tried topical stuff forever, it’s not going to work. We just need to take the skin off your feet. And then take skin grafts and put them on there and try to grow new skin.”

That’s a terrible idea because the skin on the bottom of the foot is different. And if you take skin from your thighs and you put it on the bottom of your feet, it will not work. It will wear the skin right off and then you’re in big trouble. I said, “I wouldn’t try that routine, but you got to treat it somehow.”

The first treatment that most people try is a topical thing, meaning you put it on the top of the skin, called salicylic acid. This is what’s in the little discs that you can buy that have wart remover pads, little things like some topical liquids that you put on the wart yourself that you can buy over the counter at the drugstore.

There are different percentages of this stuff called salicylic acid. It basically eats away at the wart. Now, if you’re a runner, you can try that, but in my experience, what happens is the salicylic acid works a rim of healthy tissue. It eats away at it faster than the thick callous stuff where you have the wart. And so, it creates this little moat around the wart. And it has to eat itself all the way down to where the wart comes out. That can take a long, long time.

I’ve seen patients that have had those salicylic acid treatments for months and months and months with zero success, except that it hurts a lot. Feels a little bit like a blister all the time when it gets almost to where it works, but they give up before it actually gets there. Usually it doesn’t work so great for runners because you’re smearing it around when you run and it takes a long time.

Second thing is duct tape, believe it or not. Yes, I actually grew up in Tennessee, so we use duct tape for everything. We believe it has some medicinal value, maybe some religious benefits too. But duct tape is a really common thing in the south. And duct tape works for a couple of different ways theoretically.

One of them is that we think that when you put duct tape on it, since it’s waterproof, it’s occlusive and it basically macerates the tissue. Makes the tissue so moist that it kind of eats away at that bad, thick skin, a similar way that salicylic acid does. There are also a lot of people are allergic to the adhesives in duct tape. And we think that there may be some kind of thing that happens in terms of your immune system attacking the wart particles in a similar way to some of the other treatments we’re going to talk about.

You might have an allergic reaction that works to your benefit and helps to get rid of the viral particles and destroy the wart and get rid of it. But it can work. You have to use it for a long time. But that doesn’t really hurt so much, but it can be tedious because you have to use it for a long time.

Another thing you can do is there’s a candida antigen, which is a thing, like a yeast that people are allergic to. Sometimes we take that and inject it into the wart. And your body then reacts to the antigens that we inject. Now it hurts because we poke it with a needle. But sometimes that will actually work really effectively where your body’s natural immune system attacks the wart at the same time that it’s attacking these antigens that we injected in there and the wart goes away. If it does, that’s great. Usually that’s not a whole bunch of treatments, but that can be effective. It’s kind of painful at the outset.

Second one is blistering agents. Now this is actually my favorite. It’s not necessarily best for runners. It’s my favorite because it’s pretty effective. I have really high success rates with this. There are two kinds. One of them is Canthacur. And what we do is we take a scalpel and we scrape off the thick stuff on the top of it, put a little drop on there, cover it with a piece of tape. And it causes a reaction, an actual blister. And this is stuff that’s actually in the blistering beetle, is what’s in the active ingredient of Canthacur.

The good thing about it is you can control it. If you have pain and you take the tape off and wash it with soap and water, it’s probably enough to cause a blister that it’s going to do what it’s supposed to do. And when the blister forms, it actually lifts the wart off with it. And then when the healthy skin grows in underneath, the warts gone.

If you leave it on and it’s killing you and you can’t even sleep, then you may get a huge blister. And I’ve had a couple of people, both of them men, both of them fair skinned, who were really tough and left it on way too long, got a huge blister. Now it did work, but they had gigantic blisters. That’s bad. But they made a mistake. They left it on way too long. And I told them so.

There’s another blistering agent called bleomycin, which you can inject into the wart. And bleomycin is very, very painful when you inject it. I know a lot of doctors that swear by this. But truthfully, I just don’t use it because number one, you can’t control it. You inject it, that’s how much is going in. Whereas if you do Canthacur, when you put it on, it’s diffusing in.

If it feels like you’ve already got enough reaction, you can stop the procedure right then by removing the tape and washing it with soap and water. But those are blistering agents. Can be effective, but they cause a blister. A blister’s going to hurt when you run, at least for some period of time. Just depends on how much the warts been bothering you. Maybe it’s worth it, maybe it’s not.

The last one I’m going to talk about is Tagamet. Now, Tagamet is a medication that you take for gastroesophageal reflux or stomach acid problems. And there were some interesting studies in kids where they noticed that when kids took high doses of Tagamet, that it actually caused their warts to go away. Has a very high success rate in kids and a pretty good success rate in adults.

The guy I was telling you about at the dinner thing, that’s what I did with him. I said, “Look, man, this is the best option for you because these things are covering the entire bottom of your feet. I don’t know if it’ll work because this is really horrible and you’ve already wrecked my dinner. But that’s what I would try.” And so, he did Tagamet. I didn’t hear from him for a couple of months.

When I called him one day, I said, “Hey, whatever happened.” I said, “I never heard from you after we had dinner that night. And did you do the Tagamet? What happened?” He said, “Yeah, I did it.” He said, “I’m a believer, it’s gone.” Completely cured him. He said, “It took a while, but they just started to fade away. And gradually, they just went away and now they’re all gone. And I’m cured and I really appreciate the help.”

That might be an option. You could talk to your doctor about it, but you don’t want to take it if you have certain conditions. Don’t just start taking Tagamet and think that I gave you advice to do that because I’m not telling you to do that. And I’m not telling you what the dosage is you should take either. But it is something you can talk to your doctor about.

But that one actually, if it’s not messing up your stomach or anything and you don’t have a problem with Tagamet, then it may be the one that actually causes the least amount of disruption of your actual running because it’s not causing any irritation of the warts on the bottom of your foot during the process of removal.

One quick note about Tagamet that you have to understand is that for this treatment, this is what we call an off-label use. And what does that mean? Well, all of the drugs that were approved by the FDA are tested specifically for certain conditions. And they get FDA approval for use for that particular condition.

Although there are some studies where some pediatricians did some published reports about the use of Tagamet in kids and in adults as well, which you can look up, your doctor might not even be aware of them. It just depends on whether or not your doctor has used this approach or not.

You have to understand that that’s not FDA approved. It doesn’t mean that your doctor cannot do it. Your doctor can prescribe things that are off-label use, but it’s not really something that’s been studied quite as closely as if you were taking Tagamet for one of these other conditions for which it was originally intended. With that disclaimer, you can discuss it with your doctor.

Those are some of the options to consider for runners. I don’t do surgical excision of warts almost never anymore, for lots of reasons I won’t talk about that here. But I think that those are options that you might want to think about if you’re a runner and you have plantar warts.

If you like this episode, please like it, please subscribe and I’ll see you in the next training.


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