What is a verruca?
- brandonpodiatry
- Mar 11, 2025
- 4 min read
Updated: Jul 30
A verruca is a wart that develops on the sole of the foot. It is caused by infection with certain strains of the Human Papillomavirus (HPV), which infects the outer layer of the skin. Verrucae are usually harmless and many disappear naturally, but some become painful, particularly when they develop on weight-bearing areas of the foot. (Kwok et al., 2012; Sterling et al., 2014)
What Is a Verruca?
A verruca (plural: verrucae) is a common viral skin infection affecting the feet.
It develops when the Human Papillomavirus (HPV)—most commonly HPV types 1, 2, 4, 27 and 57—enters the skin through tiny cuts or abrasions. Once inside, the virus infects the outer layer of the skin (the epidermis), causing skin cells to multiply more rapidly than normal. This produces the rough, thickened lesion recognised as a verruca. (Kwok et al., 2012; García-Oreja et al., 2021)
Although anyone can develop a verruca, they are particularly common in children, teenagers and young adults. Adults can also develop verrucae, particularly if they frequently use communal changing rooms, swimming pools or showers.
What Does a Verruca Look Like?
Verrucae can vary in appearance, but they commonly have the following features:
A rough or grainy surface
Small black dots (tiny blood vessels)
Thickened hard skin (callus)
Pain when standing or walking
A single lesion or a cluster known as a mosaic verruca
Unlike warts on the hands, plantar verrucae are often pushed inwards because of the pressure created when standing and walking. This inward growth can make them particularly uncomfortable. (Sterling et al., 2014)
How Do You Catch a Verruca?
HPV spreads through direct skin contact or by coming into contact with contaminated surfaces.
Warm, damp environments such as:
Swimming pools
Changing rooms
Communal showers
Gym floors
can increase the opportunity for transmission, particularly if the skin has small cuts or abrasions. (Lipke, 2006)
However, being exposed to HPV does not necessarily mean you will develop a verruca. Your immune system plays an important role in determining whether the virus establishes an infection. (Sterling et al., 2014)
Why Can Verrucae Be Difficult to Treat?
One of the reasons verrucae can persist is that HPV infects only the outer layers of the skin and has developed ways of avoiding detection by the immune system.
As a result, some verrucae disappear within months, while others remain for several years despite treatment.
Research shows there is no single treatment that works for every patient. Success depends on several factors, including:
Your immune response
The age of the verruca
Its size and location
Previous treatments
General health
(García-Oreja et al., 2021; Kwok et al., 2012)
Do Verrucae Need Treating?
Not always.
Many verrucae resolve naturally without treatment as the immune system eventually clears the virus.
Studies suggest that around half of verrucae in children disappear within one year, with many resolving within two years. In adults, clearance often takes longer. (Sterling et al., 2014)
Treatment may be recommended if your verruca is:
Painful
Increasing in size
Spreading
Affecting work or sport
Causing difficulty walking
Before starting any treatment, it is important to confirm that the lesion is actually a verruca, as several other skin conditions can look very similar.
What Treatments Are Available?
There is no single "best" treatment for every verruca.
Current evidence suggests treatment should be tailored to the individual after discussing the benefits and limitations of each option with your podiatrist.
Treatment options may include:
Observation
Many verrucae resolve naturally without treatment.
Debridement
Carefully reducing the overlying hard skin can reduce discomfort and improve walking. Although this does not remove the virus itself, it often improves symptoms while your immune system responds. (Vlahovic and Khan, 2016)
Topical Treatments
Certain chemical treatments may be recommended depending on your age, medical history and the appearance of the verruca.
Other Treatments
In some cases, your podiatrist may discuss additional treatment options if they are clinically appropriate.
The most appropriate treatment depends on:
Your age
Medical history
Pain levels
Previous treatments
How long the verruca has been present
Your personal preferences
(García-Oreja et al., 2021)
When Should You See a Podiatrist?
Arrange an assessment if:
Your verruca is painful.
It continues to spread.
Home treatment has not helped.
You're unsure whether the lesion is actually a verruca.
You have diabetes, poor circulation or reduced sensation.
The lesion changes rapidly in colour, shape or appearance.
An accurate diagnosis is important because not every lesion on the foot is a verruca.
💡 Brandon Podiatry Tip
Many people try to cut verrucae out themselves or repeatedly apply over-the-counter treatments without knowing whether the lesion is actually a verruca. Having the lesion professionally assessed first helps ensure the correct diagnosis and prevents unnecessary treatment.
What Does the Evidence Say?
High-quality evidence shows that many verrucae resolve naturally without treatment and that no single treatment is universally effective. Current best practice recommends tailoring management to the individual based on symptoms, patient preference and clinical assessment rather than adopting a one-size-fits-all approach. (Kwok et al., 2012; García-Oreja et al., 2021; Sterling et al., 2014)
Frequently Asked Questions
Are verrucae contagious?
Yes. HPV can spread through direct skin contact and contaminated surfaces, although not everyone exposed to the virus develops a verruca.
Can a verruca disappear on its own?
Yes. Many verrucae resolve naturally as your immune system clears the virus, although this may take months or even years.
Can I swim if I have a verruca?
Yes. Current guidance does not recommend excluding people with verrucae from swimming pools. Wearing pool footwear can help reduce the chance of transmission.
Should I use over-the-counter treatments?
Some over-the-counter treatments may be appropriate, but they are not suitable for everyone and should not be used unless you are confident the lesion is a verruca. If you have diabetes, poor circulation or reduced sensation, seek professional advice before using these products.
References (Harvard)
García-Oreja, S., Álvaro-Afonso, F.J., García-Álvarez, Y. et al. (2021) 'Topical treatment for plantar warts: A systematic review', Dermatologic Therapy, 34, e14621.
Kwok, C.S., Gibbs, S., Bennett, C., Holland, R. and Abbott, R. (2012) 'Topical treatments for cutaneous warts', Cochrane Database of Systematic Reviews, Issue 9, CD001781.
Lipke, M.M. (2006) 'An armamentarium of wart treatments', Clinical Medicine & Research, 4(4), pp. 273–293.
Sterling, J.C., Gibbs, S., Haque Hussain, S.S., Mohd Mustapa, M.F. and Handfield-Jones, S.E. (2014) 'British Association of Dermatologists' guidelines for the management of cutaneous warts 2014', British Journal of Dermatology, 171(4), pp. 696–712.
Vlahovic, T.C. and Khan, M.T. (2016) 'The human papillomavirus and its role in plantar warts: A comprehensive review of diagnosis and management', Clinics in Podiatric Medicine and Surgery, 33, pp. 337–353.
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