NEW RESEARCH FINDS VIRAL CAUSE FOR COMMON FOOT CALLUS

The following is a scenario often repeated in every podiatrist’s office, all across the nation. An individual calls the office complaining of a painful wart on the bottom of their foot. The staff duly records the individual’s complaint. The doctor notes the individual’s chief concern when our patient presents to the office. Considering the frequency with warts occur on the bottom of the feet, this diagnosis is at the very least “a good guess.”

Warts are a very common condition and can certainly be painful depending on their location. A wart is a viral infection of the skin and, like many contagions, can be spread to others. Treating plantar warts (plantar means ‘on the bottom’) is extremely difficult, at least to do it well. The number of therapies listed is prodigious, indicating there is no best method. As most sufferers will confirm, it is challenging, at least in part because they are pushed into the foot rather than growing out and away. It’s just another example of the far-reaching consequences of our bipedal weight-bearing status.

Our proposed patient will typically describe the gradual development of a small, callused spot, commonly developing on an area doing more of the weight-bearing….but not always.  Many people live their lives with these small, rounded calluses: they can be tremendously enduring. The afflicted experiences recurrent pain from their feet, although not of the crippling variety.

It is possible to live with these, termed a porokeratosis, but there actually are complications. These don’t lead to ulcers of the foot like some calluses can. But living with foot pain leads to many falls, especially in seniors. Another potential consequence is impaired cardiovascular health: people walk less when they will reliably have pain.

Our prototypical patient will be examined by his physician who will find a pinpoint, circular, callused lesion. For decades, these have been explained as the result of a plugged oil or sweat gland (and we all start out with thousands on the bottom of our feet). It was believed that when one of these glands becomes dysfunctional, it leads to pressure to the skin overlying it. This pinpoint area of pressure produces eventually a small knot of callus tissue. Over time, the callus tissue becomes thick enough to stimulate the pain receptors.

Although the treatment of a plantar wart and a porokeratosis tend to be similar, it is likely only because the technique for both is one of, quite simply, destruction. This is achieved either through the application of a powerful acid or intense, burning cold, sometimes the application of a medicine leading to a deep blistering. causing the word lesion to be separated from deeper tissues.

The simplest treatment for a porokeratosis is the precise removal of the callous. This indeed will reduce the symptoms, simply by reducing the amount of material pressing into the foot. Unfortunately, because these are so small and defined, it is extremely difficult for the average individual to adequately remove just the callus tissue and not some skin as well. The proper technique requires the use of a scalpel, a procedure best performed by a licensed physician. But this alone is an inadequate treatment since recurrence of the lesion is guaranteed.

Similarly, surgical methods, although significantly less time consuming are not so dissimilar in that the ‘poro’ is being destroyed…..simply by removing it. Unfortunately, this approach carries with it some notable potential complications, especially one resulting in a painful scar. The scarred skin is thicker, resulting in callus and an even worse problem.

Some recent studies have revealed some startling new information in the study of this common skin condition. By performing biopsies of these lesions and then a genetic analysis (aka phenotyping), it has been discovered that many of these lesions have, at their root, the same type of viral organism causing your everyday plantar wart.

Research into the treatment of warts led to the development of a new technology which treats the lesion with tiny bursts of energy. This functions to release viral proteins from the wart-infected cells, used by the body’s immune system to program Its defense against the infected cells. Perhaps the most significant benefit is the absence of any wounding of the skin. Another positive of note is a tremendous reduction in recurrence.

The device was used extremely successfully on the calluses in question, the common porokeratosis. This may explain why this new “energy” technology is so effective against the so-called plugged sweat gland callous condition. Various explanations had been proposed, but these new findings may explain it best of all.

The condition technically termed a porokeratosis may remain something of a question mark. Is it a simple skin response to chronic pressure, because of a failed sweat gland? In contrast, could it be a type of wart, a “simple” viral infection of the skin? Or, more likely, some combination! Another medical mystery many Americans want solved!