Introduction
Patients will often see us because they notice a painful “lump” of skin on their feet. What this skin lesion is might not be so obvious. However, the two most common skin lesions we see are corns and plantar warts. In this article, we will go through the key differences of corns and warts and how we best treat them.
Corns vs. Plantar Warts: Understanding the Differences
Corn is a thick, hardened layer of skin that forms when the skin tries to protect itself against repetitive pressure or friction. They often form on feet and toes but also can develop on hands.
Plantar warts are rough, hard growths that are caused by the Human Papillomavirus (HPV) and are contagious. They also often form on the feet and toes but also can develop on the hands.
Given the similarities how can we tell the difference? Thankfully, we can often clinically diagnose the skin lesion without using a magnifying glass, skin scraping, or referring to a dermatologist. The table below provides some key differences between Corns and Plantar Warts.
| Factor | Corns | Plantar Warts |
| Appearance | Translucent skin with “white” core | Tiny black spots |
| Skin integrity | Smooth | Rough (cauliflower like) |
| Skin lines | Pass through normally | Go around the wart |
| Location | Boney prominences that press against shoes or often in contact with ground | Soles of feet (not necessarily over boney prominences) |
| Other causative factors | Tight shoes, lack of padding under balls of feet/heel. Claw toes, hammertoes | Young children swimming. Use of shared showering facilities |
| Pain elicited | Direct pressure over the corn site | Squeezing skin lesion |
The Appearance of Corns Vs Plantar Warts
The images below also show subtle differences mentioned in the table above.
Once we have identified the type of skin lesion we can then recommend appropriate treatment.
Treatment for Corns
For Corns, we ideally like to remove the causative factor. So if there is a shoe that is too tight we either stretch out the shoe, avoid wearing the shoes, or avoid thick shoes. If there is insufficient padding we recommend insoles or shoes that provide additional cushioning. Sometimes we recommend wide shoes with soft stretch upper for those with claw toes, and hammertoes.
As podiatrist we can cut out the corn with a scalpel and because it is dead skin this should not be painful. This will provide instant relief and stop the corn from becoming deeper and more painful over time. We can also make recommendation to prevent the causative factors.
Treatment for Plantar Warts
For Plantar Warts, there are few more options for treatment and these are summarised in the table below.
| Treatment | Evidence | Comment |
| Salicyclic acid | Good scientific evidence for common plantar warts 29% cure rate over placebo | Usually effective for common plantar warts. However, strength can vary from 20-80%. May be used in conjunction with another agent. |
| Liquid nitrogen – cryotherapy | Fair/inconclusive scientific evidence for common plantar warts | May require aggressive application and can be quite painful |
| Silver nitrate | Good scientific evidence for common plantar warts 30% higher than placebo | Can stain. Ideally use distilled water. |
| SWIFT | Good scientific evidence. Claim of 83% success | Treatment involving burning the skin and can be very painful so not possible on young children. |
| Duct tape | Inconclusive scientific evidence for common plantar warts | Controversial technique. Modest improvement in some studies and other consider placebo. |
| Surgery | No strong scientific studies as placebo no possible. | Often only considered after other conservative treatment has failed. Risk of scarring over site is 30% |
References for Evidence: Plantar warts: a persistently perplexing problem – BPJ65 December 2014 (bpac.org.nz) & RACGP – Treating common warts – options and evidence
So you might wonder what is the best treatment option for plantar warts? Well it really depends on several factors, such as the size, location, number, and type of warts, the patient’s age, health, preferences, and tolerance for pain, and the availability and cost of the treatments. There is no one-size-fits-all solution for plantar warts, and different treatments may work better for different people. Therefore, it is important to consult with a podiatrist or doctor before starting any treatment for plantar warts.
We hoped this article helps you determine what skin lesion you may have.
If you would like to have us provide a clinical assessment and treatment you can see us at Leading Edge Podiatry (Formerly Complete Podiatry Blackwood). Feel free to book online or call us at 7120 6063! We look forward to helping your feet be pain-free.