Does implantation of verruca plantaris into the abductor hallucis muscle belly in conjunction with CO2 laser ablation prevent recurrence?

• Published in: Foot (Edinburgh, Scotland) Vol. 39; pp. 45 - 49
• Main Authors: Zulauf, Emily E., Sahli, Hannah, Alexander, Kevin, DeMore, Matthew, Ehredt, Duane J., Kawalec, Jill
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.06.2019
• Subjects: Inoculation; Keywords: Immunization; Plantar; Recalcitrant; Wart; Keywords: Immunization; Inoculation; Recalcitrant; Plantar; Wart
• ISSN: 0958-2592; 1532-2963
• DOI: 10.1016/j.foot.2019.02.009

•Plantar warts are caused by the human papilloma virus.•There is a lack of evidence-based guidelines for the treatment of plantar warts.•Current treatment therapies available have disappointing efficacy rates, but salicylic acid has been demonstrated to be the most effective at 81% success rate.•A technique for treatment of recalcitrant plantar warts involving implantation of viral tissue into the contralateral lower extremity to evoke an immune response.•Further research is needed to study the body’s response to implantation of viral tissue. Often times, conservative treatment is unsuccessful in long-term resolution of recalcitrant verrucae plantaris lesions. In addition to being aesthetically displeasing, severe cases that are left untreated can be debilitating, often leading to chronic pain, gait abnormalities, and further cutaneous spread. Inoculation through implantation of verrucae plantaris into a muscle was previously postulated to provoke an immune response against the human papilloma virus, resulting in auto-immunization. The purpose of this study was to determine the rate of recurrence following two methods of treatment: A) Surgical removal and subsequent implantation of verruca plantaris into the contralateral abductor hallucis muscle belly and B) Surgical excision of verrucae plantaris. A retrospective chart review of 43 consecutive patients was performed. Group A was comprised of 25 patients who underwent surgical removal of verrucae plantaris followed by implantation of a biopsied specimen into the contralateral abductor hallucis muscle belly. Group B was comprised of 18 patients who underwent only surgical removal of the verrucae. The presence or absence of verrucous lesions was recorded at a post-operative follow-up at an average of 27.5 months. Correlations between recurrence of disease and age, sex, and medical comorbidities were evaluated. Our results suggest that implantation of verruca plantaris into the abductor hallucis muscle belly yields no significant difference in clinical recurrence rates when compared to surgical removal.