Case of a Painful Plantar Lesion in a Pregnant Patient

Case at a Glance

A 32-year-old pregnant woman presented with a new, painful lesion on her heel, raising clinical suspicion for a verruca plantaris (plantar wart) and prompting a discussion on safe diagnostic and treatment approaches during pregnancy.

Patient's Story

The patient is a 32-year-old female in her pregnancy, with no significant prior medical history. She presented with concerns about a lesion on the plantar aspect of her heel that had appeared several weeks prior. The primary symptom was localized, pressure-related pain, which was most pronounced during ambulation.

Initial Assessment

Physical examination of the foot revealed a well-demarcated, hyperkeratotic papule on the plantar surface of the heel. The lesion was tender upon direct palpation. The classic pinpoint black dots (thrombosed capillaries) often associated with plantar warts were not clearly visible through the thickened overlying skin. The patient's main concern was to confirm the diagnosis and understand the appropriate treatment pathway, specifically comparing over-the-counter (OTC) remedies with a formal podiatry consultation, given her pregnancy.

The Diagnostic Journey

The primary differential diagnoses included verruca plantaris, clavus (corn), or a localized callus. The patient's reported symptoms could be consistent with any of these conditions. A consulting specialist noted that a definitive diagnosis often requires paring down the hyperkeratotic tissue with a sterile blade. This procedure helps to visualize the underlying structures: the presence of pinpoint petechial bleeding upon debridement is pathognomonic for a wart, whereas a corn would reveal a hard, translucent central core.

Final Diagnosis

Based on the clinical history and appearance, the working diagnosis was Verruca Plantaris (Plantar Wart), pending confirmation by a podiatrist.

Treatment Plan

Given the patient's pregnancy, treatment considerations must prioritize maternal and fetal safety. The patient inquired about using OTC salicylic acid. While topical salicylic acid has low systemic absorption, its use during pregnancy is often approached with caution. A formal consultation with a podiatrist was strongly recommended to confirm the diagnosis and discuss the safest management options. Pregnancy-safe treatments may include cryotherapy, simple debridement for symptomatic relief, or observation, with more aggressive therapies deferred until post-partum.

Outcome and Follow-up

The patient was advised to seek an in-person evaluation with a podiatrist. A definitive diagnosis via clinical examination and potential debridement would allow for the development of a safe and effective treatment plan aimed at alleviating her pain and resolving the lesion without posing any risk to her pregnancy.