However, they can impair exercise performance if their location results in sufficient pressure to cause pain. Plantar warts appear as sharply defined lesions that have a rough, hyperkeratotic surface surrounded by a smooth collar of thickened keratin. A wart can be distinguished from normal skin by its soft keratinous mass and hypertrophied papillae with punctate black dots representing thrombosed capillaries. Further paring causes pinpoint bleeding from these capillaries. Such findings easily differentiate warts from plantar keratoses and corns.
Warts can be asymptomatic but can also cause disabling pain.
The larger the wart and the closer it is to a pressure point like a metatarsal head, the greater the likelihood of pain or discomfort. In choosing a treatment, physicians and patients should weigh the degree of the patient's disability and discomfort with the possible side effects of treatment and the possibility that the warts will spontaneously resolve. The persistent irritation from these agents may stimulate the patient's immune system to increase activity in the area of the warts, and they also soften the lesion. With recalcitrant warts, surgery with simple curettage to the base of the lesion is possible. However, surgery can cause scarring, and recurrence at the surgery site is not uncommon.