Plantar Warts (HPV) - Prevention and Treatment (Grapplers)

Grapplers:

I am writing this long damn post as a public service announcement for the grappling world. I see post after post on these chains referring to ringworm and staph. Obviously the latter is very serious, but HPV is something that falls between the two in terms of seriousness and inconvenience.

I got HPV (plantar warts) on my feet when I was in Abu Dhabi for the World Pro in 2011. At the hotel, they emptied a billiards room and brought in mats so that people could practice there. I also competed, but am virtually positive that I contracted them on the nastier practice mats, which I never saw cleaned. The only reason I am dealing with it is because of the failure of others to observe proper hygiene. This virus has caused me serious pain and discomfort and has greatly limited my ability to train over the past year. I am still dealing with the painful treatments after about 18 months of constant treatment (using various methods).

This post discusses
(1) General information on plantar warts (HPV)
(2) How it’s transmitted
(3) How to avoid contracting it or passing it along to others
(4) Impact on training and life
(5) Treatment methods and advice for anybody unlucky enough to contract them

(1) What are plantar warts?

Plantar warts are warts (also called “verruca&#8221 on the bottom of the feet, which can become very painful. They settle deep under the skin, can grow to be very large, and are contagious. These are caused by the human papilloma virus (HPV). There are various strains of the virus, and so it’s very difficult – if not impossible – to generate a vaccine. Different strains have different “homes.” For example, genital warts are a different strain of HPV, but they are localized. Similarly, warts on the hands and feet (plantars) are transferrable to the palms and feet. These are the most likely concerns for grapplers.

While they can become ridiculously large (feel free to google images), they can be very small and difficult to identify at the outset. They can be mistaken for callouses, and typically look like the following

http://boneyzinspiredperceptions.files.wordpress.com/2008/09/plantar-wart-1.jpg





(2) How do you get them? Why is this relevant to BJJ or grappling?

HPV which thrives on warm, moist surfaces (swimming pools, gym floors or mats, bathrooms). It is a highly contagious pathogen and can survive for months without a human host. When in contact with infected skin or surfaces, the virus can enter through cuts, abrasions, and other skin breaks on your feet (basically miniature cracks in dry skin). If an infected person walks barefoot on a florr or mat, virus particles may be released which you can catch by walking across the same surface. It’s also possible to become infected from fabrics (towels, socks, shoes, etc.) used by someone with plantar warts.

That means that I can not only give them to people at my gym - or wear wrestling shoes the rest of my life while training - but also to your daughter due to our using the same shower, walking on the same floors (Shanghai is very humid and the floors are damp during much of the Summer). You can transfer it from towels, and fabrics, meaning that I'd have to walk around for the rest of my life with socks on indoors (and sleep in them) even in the hot summer. I would never be able to walk around barefoot at a pool again for fear of infecting someone else. I would prefer not to give your daughter or anyone else I know a skin disease that they might never be able to get rid of. That is the reason I'm being so adamant about treating them immediately and effectively, regardless of discomfort.

Over time, people develop immunity to most types of HPV that cause common warts (hence warts are widespread in children and young adults because their bodies haven't yet had enough time to become immune to this common virus. However, this may take several years
(http://www.mayoclinic.org/medical-edge-newspaper-2011/may-20b.html)

 

(3) How do you avoid getting them or passing them on to others?

Individuals: Long story short, be hygienic. I don

 

(4) Impact on training and life

As mentioned below, most of the treatments are painful. Some are incredibly painful, and make it hard to even walk. While not life-threatening, this is a serious struggle to deal with. For this reason, it’s difficult to train while dealing with them. I have missed months of training where I could hardly participate and was discouraged. Must also admit to hating training in wrestling shoes, which were indispensible once I got infected. However, I wouldn't go do yoga in a public place wearing wrestling shoes, so I have stopped doing that. Obviously don't go to public pools right now either.

That aside… I absolutely LOVE walking around barefoot and can’t. As mentioned above, HPV can be transferred via fabrics and surfaces. I live with my fiance right now, and this ultimately means that I am never barefoot around the house. Even when it’s 95 degrees and humid, I’m wearing socks around the house. I have not slept in my bed barefoot in 17 months. Very annoying. Every time I use the shower, I have to spray it with detol afterwards to kill anything I may have tracked in there. Every time.

The treatments (and dealing with the general abuse and ulcerations they cause on your feet) are incredibly time consuming. There is no quick fix and it may be years before the infection is resolved. I shudder to think how much time I’ve spent researching this, going to doctors, taping up my feet, treating them with ointments, disinfecting my shower, washing and rewashing clothes, and other things that may have contacted my damn feet. It’s a horrible, horrible annoyance, and you should make sure you never have to deal with it, but less give it to someone else.

Again, at some point your body may develop an immunity to the virus and kill them naturally. However, this can take several years. For certain people, it may take up to 5 years.

 

(5) Treatments

Treatments available are varied. A comprehensive summary is provided in this article
An Armamentarium of Wart Treatments http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764803/.

The following are the ones most commonly used, and these can be used in combination.

• Salicylic acid - Daily application of acid to the wart twice a day. Use a nail file or pumice stone to remove the dead skin from the wart each day.
  
• Prescription anti-wart medication
  
• Cryotherapy (freezing) - Apply liquid nitrogen to the plantar wart using a spray-tip or cotton-tip applicator. Does not guarantee more/less success than duct tape or acid treatments.
  
• Duct tape - Apply the tape to your wart and leave it there for a week. Then wash the affected area, dry, scrape away dead skin with either a nail file or pumice stone, clean, then reapply tape. This method generally takes weeks/months.
  
• Apple cider vinegar – home remedy which some have found effective
  
• Laser removal - CO2 laser surgical removal, though expensive and painful.
  
• Electrodessication - Effective but leaves a noticeable scar on your foot.
  
• Cantharidin - a poison secreted by the blister beetle. It causes a blister where the wart is, and essentially erupts under your skin, forcing the infected tissue out. This can be very painful in the days/weeks afterward as your foot heals.
  
• Immunotherapy creams/injections - doctors inject antigens (e.g., Candida) or creams (e.g., Fluorouracil, Aldara) directly into the wart in an attempt to trigger your immune system to attack the wart. These are often used as cancer treatments, so doctors are hesitant to prescribe them.
  
• Bleomycin injections - injection of a saline solution of bleomycin into the wart every 3-4 weeks until the wart is gone. In most cases only one injection is necessary, but it can be painful during and after the injection. Very painful. This is also a cancer treatment.
  
• Pulse dye laser – this is a treatment used for varicose veins, because it reduces the size of the blood vessels. Tissue with the plantar warts have a higher concentration of blood vessels, such that limiting them will starve the wart. It has been shown effective in treating plantars.
  http://www.realself.com/question/huge-bigger-fifty-cent-piece-plantar-wart-foot-pulse-dye-lase

In addition, the main thing you need is for your body to fight the virus, meaning you need to boost your immune system. I work in a job that leads to both high stress and limited sleep, both of which deplete your immune system. I also drink a good bit on weekends, which also isn’t great for your immune system. Here are some other general tips
http://www.health.harvard.edu/flu-resource-center/how-to-boost-your-immune-system.htm

My treatment history is as follows:

Beginning in June 2011, I began treating them with Apple cider vinegar (which my girlfriend hated because it smelled after I soaked my feet) and Salicylic acid. After several weeks of treatment with the salicilic acid, they peeled (this is good because it removes infected tissue) the day prior to my scheduled appointment with a dermatologist. The dermatologist told me that "they look like they are pretty much taken care of" and that nothing further was needed. Being somewhat skeptical, had the holes in my feet where the warts were Frozen with liquid nitrogen anyway. He did, and it was very painful. I also asked him to provide me with something more "heavy duty" to apply to them if they were to reappear. He wrote the prescription for a Prescription topical treatment (higher concentration salicilic acid and other substances). I received it a couple weeks later - as my feet had become to heal – and applied them every night until it was gone. At that point, my feet were very chewed up, but I had completed the treatment. I let them heal. The skin grew back, and I could walk around without pain, but a few weeks later a similar bump arose where one of my three warts had been.

The next time I saw the dermatologist, I asked for Cantharidin as well as the Aldara cream. The cantharidin treatment was incredibly painful, and it was hard to walk for 2-3 weeks. After they finally shed the damaged flesh, I applied the Aldara until all tubes were empty. The warts did not appear to be fully healed, and so at my next consultation, my dermatologist suggested the joint use of Fluorouracil and Duct tape. In other words, I applied the Fluorouracil to my warts, then covered them with duct tape, and kept that on all day and night. In the morning, I would get up, shower and clean the area. Then I’d apply more Fluorouracil and a new strip of duct tape. This eventually ate down into my foot like the other treatments. I did this for 2-3 months. This is frustrating, because if you exercise and your feet sweat, the duct tape will come off. That defeats the purpose. Also, you have the tape on every day.

At this point I started trying random stuff. I would soak my feet in bleach for 20-30 minutes every night. It was helpful, but is harsh on your skin. Also, there is no scientific data to show it works for warts. It’s simply that nothing lives in bleach, so soaking the skin in bleach seemed (in my own mind) worth considering. It obviously did not succeed.

Following this, I was incredibly disheartened. I looked online for other treatments, and located the Armamentarium of Wart Treatments article. The author works for Dermatology Associates of Wisconsin, and their website seemed to suggest the most aggressive (and effective) treatment for warts was the bleomycin injections (http://dermwisconsin.com/warts.php). I began monthly injections back in September 2012 with a different doctor. These injections are VERY painful at the time of injection, but do not have any pronounced pain afterward. This meant that I could walk around and exercise without significant difficulty.

At the time of the first few treatments, my warts had begun to spread. Rather than having 3 warts (2 on my left foot and one on my right heel), I had 4 on my left. Not only that, but they were migrating towards my toes (a very problematic area to treat). Considering the spreading of the warts, my doctor suggested that we try simultaneous use of bleomycin injections and freezing. This resulted in some not only very painful injections, but also continued discomfort for weeks afterward as my feet healed from the freezing. I am still undergoing this treatment and my dermatologist recently began to supplement these two with Pulsed Dye Laser treatments to attack the blood vessels in the wart.

Long story short, plantar warts are incredibly stubborn and resistant bastards. The best approach is to treat them AGGRESSIVELY at the outset to ensure that they’re killed before they become deeply entrenched or battle-hardened. I feel that my initial doctor failed miserably by trying half-measures rather than blowing them out of the water. Had he done so, perhaps this would have been behind me a year ago.

Consider yourselves warned.

 

Wow.

 

Exactly. I had absolutely no idea what I was in for when I saw those tiny little spots on the bottom of my feet. I would've killed for an informative resource like this at that time and would've beaten my dermatologist mercilessly until he gave me the more serious treatments. It has been miserable, and taking them lightly at the outset is NOT what you want to do.

 

Awesome post though. Watching people walk from the bathroom to the mats at tournaments is absolutely putrid and I see it at EVERY tournament.

If you are one of the unhygienic animals doing that you need to stop that shit immediately. You are going to give us all foot AIDS!

Seriously, this should be common sense but unfortunately it's not.

Thanks for the FYI TS.

 

I have had a wart (very big and noticeable) on my hand for the past 6 years.

I have tried a lot of treatments and nothing worked. My doctor eventually did surgery to remove it. It was gone for a few months, then returned in the exact same spot. I only have one and have just learned to live with it.

No one I train with or any of my friends have ever gotten a wart after contact with me. Everyone has just become accustomed to it, even as far as people nicknaming it.

I am not even sure if it will ever disappear. My friends mother told me to put hydrochloric acid on it everyday, admittedly she was a hippie.

 

I had a bad case of warts in my feet couple years ago (before I started grappling). I'm pretty sure I got them from the locker room of the place where I trained.

 

I had them twice growing up. Pretty sure from the swimming change rooms(I know not grappling related). Ended up getting them cut out under local anasthesia(sp), which was the norm at the time.

 

i got a plantar wart on the bottom of my foot while in college. Might have been from the gym showers, or possibly a friends gf using our bathroom who had a wart like that before. Shit was annoying as hell and painful, but not very life changing for me as I wasn't grappling at the time. I think i got it frozen twice before that fucker came off.

 

whats the difference with Molluscum contagiosum?

 

Duct tape works better than anything else, but it takes a week or 2 of constantly covering them with duct tape. No one really knows why it works but it does

 

There needs to be a 'mat marshall' at gyms and competitions.

 

Kids get these all the time because they're in changing rooms and swimming pools a lot. To be honest, in my experience they're not all that hard to manage and get rid of.

One reason they can be harder to treat than a normal wart like on your hand is because they get pushed into the foot by your weight. So if you get a corn plaster ring on it for a while it will start growing out like a normal wart and is much easier to attack with the usual wart treatments.

If you're having problems with them check out the relatively new drug: Veregen

 

I had them when I was in high school. It took almost a years worth of freezing treatments at the doctors office to get rid of them.

 

I got bad plantars warts a couple years ago. I had to have 3 injections of bleomycin to get rid of them. I almost kicked the hot little PA in the face as she was injecting me.

 

Thanks for the awesome and informative post; I've had to deal with plantar warts back in my competitive swimming days, but luckily have been able to avoid them since.

 

This stuff is ridiculously common in the general population. Something like 97% of people have some form of HPV.

I'd assume that for grapplers, it's probably 99%+. There's really no way to not be exposed to this. Most people just become immune and don't get the warts.

The warts are a pain in the ass to take care of, but they almost always go away on their own eventually once the body builds up immunity. It can take a while (i.e. years) to build that immunity.

 

is there anything duct tape can't fix?