CLINICAL CASE · FOOT HEALTH
After months of aggressive first-line treatment with no resolution, one patient finally found relief through a procedure most people have never heard of.
Plantar warts are stubborn and often painful growths that appear on the soles of the feet and are caused by the human papillomavirus (HPV). They’re more common than most people realise, and while many resolve on their own, others dig in and refuse to budge no matter what you throw at them.
This is the story of one such patient. Over the course of treatment, they tried four different evidence-based interventions before we finally arrived at the solution that worked: needling — a minor surgical procedure that, in the right hands, can produce remarkable results where all else has failed.
A long road of treatment attempts
| TREATMENT | OUTCOME | NOTES |
|---|---|---|
| Canthacur | No resolution | Blistering agent applied in-office causing localised tissue destruction. Multiple applications with partial response only. |
| SWIFT microwave therapy | No resolution | Microwave energy delivered to wart tissue to stimulate an immune response. Well-tolerated but ultimately ineffective for this patient. |
| Imiquimod 5% cream | No resolution | Topical immune response modifier applied at home over several weeks. Intended to prompt the body to recognise and fight the virus. |
| Silver nitrate | No resolution | Caustic chemical agent used to destroy wart tissue. Applied on multiple occasions with temporary reduction but no lasting clearance. |
| Needling | Resolved | Minor surgical procedure under local anaesthesia. Significant and sustained improvement following a single session. |
So what exactly is needling?
Needling; also known as Falknor’s technique in the podiatric literature — is a procedure that works on a clever principle: controlled disruption. Rather than trying to destroy the wart tissue from the outside, needling deliberately punctures the wart and the tissue beneath it, driving infected cells into the fat layer of the foot where they come into contact with the body’s immune surveillance system.
The theory is that the HPV virus responsible for plantar warts can “hide” from the immune system within the thick skin of the sole. By mechanically disrupting the wart and introducing viral particles to a more immunologically active tissue layer, needling essentially forces the immune system to mount a response, often leading to clearance not only of the treated wart, but also of any satellite lesions elsewhere on the foot.
The procedure, step by step
- Local anaesthesia — The area is numbed with a local anaesthetic injection, ensuring the patient remains fully comfortable throughout the procedure.
- Betadine prep — The foot is cleaned and sterilised with povidone-iodine (betadine) to establish an aseptic field and minimise infection risk.
- Needling — A fine needle is used to repeatedly puncture the wart and the subcutaneous tissue beneath it, introducing viral antigen to the deeper immune-active tissue layer.
“After everything we’d tried, it was genuinely satisfying to see the wart finally respond. Needling isn’t always the first choice — but for resistant cases, it can be the one that changes everything.”
The outcome
Following the needling procedure, the patient experienced a gradual but significant improvement. The wart, which had persisted through four prior treatment modalities, began to resolve, a result that speaks to both the effectiveness of the technique and the importance of not giving up when first-line options fall short.
What this means for patients
If you’ve been struggling with a plantar wart that hasn’t responded to over-the-counter treatments, cryotherapy, or other in-office procedures, know that there are still options. Needling is a safe, well-tolerated procedure with a growing body of evidence behind it, and it’s an important tool in the management of treatment-resistant verrucae.
Every patient is different, and treatment success depends on a range of factors including the duration of the lesion, immune status, and how deeply the virus has established itself. Working with a podiatrist or chiropodist who is familiar with the full range of available plantar wart treatments in Toronto gives you the best chance of finding what works for you.
Don’t settle for persistent pain underfoot. There may be more options than you think.
