I don’t like causing pain. Maybe it’s a psychological thing…..but, regardless, I dislike hurting people. And yet, as a physician, there are some situations where it is unavoidable. (I’m hoping this sentiment is true for most healthcare providers but I’ve read no survey on the topic.) Because of this aversion, I’ve sought out ways to minimize the discomfort associated with many invasive procedures.

Early on, I had the opportunity to use a device which employed air pressure to insert a tiny amount of local anesthetic. Prior to performing an injection, the device allowed me to numb a tiny area, but big enough that insertion of the needle caused no pain. It became obvious though, with use, that the air-driven anesthetic injection was as painful as the needle. Now a spray numbs the skin momentarily, long enough for painless administration of the needle. My favorite question after an injection is “when am I going to give them the shot?”

A very common pain-inducing scenario is in the treatment of the dreaded plantar wart. Plantar warts are those found on the bottom of the foot (the definition of plantar) so all of your body weight is pressing down on these callused lesions. Warts are due to an infection of skin cells by a virus. But because viruses take over the machinery of our cells but don’t change the surface, our immune system does not recognize the infected cells as being “not you.”

Our treatments for these common contagions have historically been rather brutal, entailing the intentional injuring of skin in the area of the lesion, hardly a precise procedure. We are attempting to kill the infected skin, employing either an acid or a blistering agent. All of these methods require traumatizing some skin……which you’re walking on. The procedure, as you might imagine, is not a particularly comfortable one, with many describing it as significantly painfulHealthcare providers know this approach is destructive. It should be no surprise it’s not popular with patients or with providers. After all, physicians take an oath not to cause harm. And yet, with these treatments, we are intentionally causing pain. The fact the entire body is resting on that callused lesion is important to take into consideration.

Unfortunately, after multiple treatments, a few cells with the virus often remain viable (i.e. still living), going on to reproduce and eventually leading to recurrence of the wart. This is a disheartening occurrence, but common with the destructive methods since we are unable to specifically identify the cells with the virus versus those simply “in the area.” Depending on the study quoted, return of the wart is seen up to a third of the time (hardly the makings of an effective and desirable treatment).

Surgical removal is an option and can be successful in the appropriate situation. But if the wart is in a part of the foot that is weight bearing (meaning not in the arch area), an incision will be prone to scar tissue formation, which you’ll be walking on the rest of your life. Various skin flaps and grafts are possible to remove the painful scar but these are involved procedures. And all for a simple wart.

To the treating physician, there is nothing more frustrating than wart recurrence. Traditional wart treatment is not a simple process, with the multiple applications required, the pain experienced from walking on the skin we’ve injured. In the normal course of treatment, the patient returns for evaluation and there will be no signs of the infection. Only to have the patient return several months later, complaining of recurrence of the lesion.

There is finally another option for the care of warts on the bottom of the foot. Modern technology has come to the rescue. A completely different approach became available nearly two decades ago with the Swift device. The therapy is based on the concept that we can educate the immune system. It can be taught that the skin cells infected with the virus are not “self” but are, in essence, foreign tissue. Once recognized, these cells are identified, attacked, and sloughed like a scab, painlessly.

The issue of regrowth after our treatment highlights the beauty of this new device: the recurrence rate is less than 1%. In the world of dermatologic medicine, this is staggering, a real game-changer. If disregarding the issue of the pain associated with traditional techniques, return of the wart is the most challenging issue when it comes to care of these common but problematic skin lesions.

Sometimes technology can provide effective, beneficial options for some treatment or diagnosis, but often the claims are simply hype. Studies performed or funded by a manufacturer must always be viewed with skepticism. Well recognized in medicine is the fact that numbers can lie and statistics can be manipulated. When some new method is put into practice and used on a day-to-day basis, a more accurate evaluation of the device becomes possible. I am happy to report that the treatment of warts will never be the same.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.