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Massage therapy schools, certification programs and continuing education courses all place a great deal of emphasis on teaching bodywork contraindications. In keeping with the motive to do no harm, massage therapists are well versed in the conditions they must avoid. However, sometimes the conditions that are supposed to raise cautionary flags for massage therapy have not yet been identified by the client. Plantar warts present an example of this dilemma, because clients are not always aware that their feet harbor this skin condition that locally prohibits massage. In order to avoid spreading this potentially contagious infection, massage therapists must become an expert in detecting plantar warts even before their clients can.
About Plantar Warts
Known as a plantar wart, Verrucae Plantaris is a common viral infection of the skin. Infecting the skin by direct contact, the Human Papilloma Virus (HPV) causes plantar warts. While antibodies can destroy HPV, some people are more susceptible to this virus than others. The virus more easily enters the body through an area of skin that is moist, peeling or cracked.
Growing on the bottom surface of the foot, plantar warts tend to be found in areas that endure pressure, such as the heel and ball of the foot. Plantar warts typically grow into the deeper layers of skin because of the forces they are under. Because of their weight bearing location, plantar warts often cause pain and may make walking difficult.
Plantar warts can be difficult to identify because their location typically involves internal growth, rather than externally protruding from the skin. Hence, they are often mistaken for corns or calluses. Five factors to help distinguish a plantar wart from a more innocuous skin anomaly include:
- Small, fleshy, grainy bumps on the soles of your feet
- Hard, flat growths with a rough surface and well-defined boundaries
- Gray or brown lumps with one or more black pinpoints, which are actually small, clotted blood vessels
- Bumps that interrupt the normal lines and ridges in the skin of the foot
- Plantar warts grow anywhere on the bottom of the foot; corns and calluses grow in areas that receive the most wear-and-tear
How Prevalent are Plantar Warts?
In the U.S. it is estimated that less than 1% of the population have plantar warts. These numbers differ based on age, sex, race and health status. Plantar warts most frequently occur in children starting usually around 5 years old and peaking between 12 – 16 years old. While the rate of plantar warts decreases in adulthood, the warts tend to last longer and are more resistant to standard treatments.
Plantar Wart Infectivity
Although most experts insist that plantar warts are not highly contagious, they are caused by an infectious virus. Any skin that flakes off around a wart, or any blood that seeps from around an irritated wart, may carry HPV. By simply touching a plantar wart, it can proliferate on the same host or to another:
- The virus may spread to additional spots on the same foot
- Viral particles could slough off and land in a location where someone else could pick them up
To reduce the risk of plantar warts, experts advise the following:
- Avoid direct contact with warts, including your own warts
- Keep your feet clean and dry; change your shoes and socks daily
- Don’t go barefoot in public areas; wear shoes or sandals in public pools and locker rooms
- Don’t pick at warts as picking may spread the virus
If you do see what you believe to be a plantar wart, it is important to avoid any direct contact with it, including skipping local massage. However, it is inappropriate for bodyworkers to make a diagnosis. Instead, Ruth Werner, LMP, NCTMB, suggests advising your client to have the area checked by a dermatologist or podiatrist before trying to remove the rough spot with clippers or a pumice stone. Werner proposes that massage therapists take this opportunity to educate their clients about the potential for transforming a mildly annoying plantar wart into several large, painful and even crippling growths on the feet.
Since many massage therapists routinely touch people’s feet with their bare hands, their assumption that a bump or rough spot is a simple foot callous could cause harm. For this reason, massage therapists should know how to identify and visually examine their client’s feet for plantar warts.
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