Verruca Needling
(Falknor's Needling)

What is verruca needling?

Verruca needling is a minor procedure performed under local anaesthetic.

Verrucae are caused by the human papillomavirus (HPV). They can sometimes persist because the virus is located within the outer layers of the skin and can avoid an effective immune response.

During the procedure, the verruca is repeatedly punctured through its depth using a sterile needle. This disrupts the affected tissue and is intended to expose viral material to deeper layers of the skin, creating a local inflammatory and immune response.

The aim is to encourage your own immune system to recognise and respond to the HPV-infected tissue.

Why has needling been recommended?

Needling may be recommended when a verruca is:

• persistent or longstanding
• painful or affecting walking or activity
• resistant to previous treatments
• large or troublesome
• recurrent; or
• part of an area containing multiple verrucae.

One of the potential advantages of needling is that it is normally performed as one main treatment procedure, rather than requiring repeated applications every few weeks.

Your podiatrist will have considered your verruca, previous treatments, medical history and individual circumstances before recommending the procedure.

How successful is verruca needling?

Published clinical studies have reported encouraging results.

Several studies of Falknor's needling have reported complete resolution in approximately 65–71% of patients, including patients with persistent verrucae.

Interestingly, some studies have also reported improvement or clearance of verrucae that were not directly needled, which supports the proposed role of the body's immune response following treatment.

Results do vary between studies and between individuals, and no verruca treatment can guarantee complete clearance.

Needling should therefore be considered a treatment with encouraging published outcomes rather than a guaranteed cure.

What happens during the procedure?

Your podiatrist will first examine the area and confirm that needling remains appropriate.

Local anaesthetic

Local anaesthetic is injected around the treatment area to make the procedure comfortable.

The anaesthetic injection can briefly sting or feel uncomfortable. Once the area is numb, you should not normally experience sharp pain during the procedure.

Preparing the verruca

Any overlying hard skin is carefully reduced where appropriate to expose the verruca.

Needling

A sterile needle is then used to repeatedly puncture the verruca through its depth.

This creates controlled disruption of the verruca tissue and is intended to stimulate the local inflammatory and immune response associated with the needling technique.

Class IV laser

Following needling, your podiatrist may use our Class IV laser with a fine fibre over the treated tissue.

The laser is used to help control minor bleeding and provide a controlled thermal/coagulative effect to the treated area.

You should not normally feel this part of the procedure because the area remains numb from the local anaesthetic.

Dressing

Once treatment is complete, the area is cleaned and an appropriate dressing is applied.

Your appointment normally lasts approximately 60 minutes, allowing sufficient time for assessment, local anaesthetic, the procedure and dressing.

What if I have several verrucae?

It is not always necessary to needle every individual verruca.

Because one of the aims of needling is to stimulate an immune response to HPV, treatment of selected verrucae may potentially result in improvement of other verrucae elsewhere.

This effect has been reported in clinical studies, although it cannot be guaranteed.

Your podiatrist will decide which verruca or verrucae are most appropriate to treat.

What happens afterwards?

The local anaesthetic normally keeps the area numb for a period following the procedure.

Once this wears off, the treated area may feel tender, bruised or sore, particularly if the verruca is located on a weight-bearing part of the foot.

You can normally walk after the procedure, although some temporary discomfort is expected.

A dressing will be applied before you leave the clinic.

Looking after your foot

Keep the initial dressing clean and dry for approximately 24–48 hours, unless your podiatrist advises otherwise.

If the dressing becomes wet, dirty or loose, replace it with a clean dressing.

Do not pick, cut or attempt to remove the treated tissue yourself.

Your treatment package includes 2–3 follow-up/redressing appointments, allowing us to check healing and monitor the response of the verruca.

Activity after needling

We recommend keeping activity relatively light during the first 24–48 hours following the procedure.

Normal essential walking is usually possible, but prolonged walking, running, gym activity, sport and other high-impact activities should initially be reduced.

During the first week, you can generally gradually return to normal activity according to comfort.

The amount of discomfort varies depending on the location and extent of treatment, so your podiatrist may provide more specific advice.

When will I know whether it has worked?

Needling does not normally make the verruca disappear immediately.

The treatment is intended to stimulate a biological and immune response, so changes generally occur gradually over the following weeks.

Published studies reporting successful treatment have observed clearance developing over approximately 8 weeks to several months.

Your podiatrist will monitor the area during your follow-up appointments.

What are the potential benefits?

Potential benefits of verruca needling include:

• published studies reporting complete resolution in approximately 65–71% of patients
• usually requiring one main treatment procedure
• treatment performed under local anaesthetic
• an approach intended to stimulate your body's immune response to HPV
• the possibility that other verrucae may also respond
• an option for persistent or treatment-resistant verrucae; and
• structured follow-up while the area heals and responds.

What are the possible side effects and risks?

Most patients experience some temporary tenderness, bruising or soreness following treatment.

Potential side effects and risks include:

• discomfort from the local anaesthetic injection
• tenderness, bruising or soreness after treatment
• minor bleeding
• temporary discomfort when walking
• swelling
• blistering or local tissue reaction
• delayed healing
• infection
• temporary or persistent changes in skin colour
• altered sensation or nerve irritation
• scarring; and
• an allergic or adverse reaction to local anaesthetic, antiseptic or dressing materials.

Because a Class IV laser may be used as part of the procedure, there is also a small risk of thermal injury, blistering or additional tissue damage. The laser is applied in a controlled manner by the clinician to minimise this risk.

There is also a possibility that the verruca may not completely resolve, may recur, or may require further or alternative treatment.

Is needling suitable for everyone?

Needling is not appropriate for every patient.

Because the procedure involves local anaesthetic, controlled tissue injury and subsequent healing, your podiatrist will consider factors including:

• circulation to your feet
• sensation
• diabetes
• wound-healing problems
• immune system conditions or immunosuppressive medication
• anticoagulant or antiplatelet medication
• allergies or previous reactions to local anaesthetic
• current infection
• pregnancy where relevant; and
• other significant medical conditions or medications.

Treatment in children and young people is considered individually according to their medical history, the verruca and their ability to comfortably tolerate a minor procedure under local anaesthetic.

If your health, medication or allergies change before your procedure, please tell us.

What are the alternatives?

There are several ways of managing verrucae and no single treatment is appropriate for everyone.

Depending on your individual circumstances, alternatives may include:

• monitoring the verruca without active treatment
• appropriate home or topical treatments
• Verrutop
• CryoPen cryotherapy
• Swift microwave therapy; or
• Class IV laser therapy.

Your podiatrist can discuss these alternatives with you if you are uncertain about proceeding.

How much does verruca needling cost?

Verruca Needling (Falknor's Needling): £425

Your treatment package includes:

• clinical review and confirmation of suitability
• local anaesthetic
• Falknor-style verruca needling
• Class IV laser/fibre treatment where clinically appropriate
• initial dressing; and
• 2–3 follow-up/redressing appointments.

When should I contact the clinic?

Some tenderness, bruising and discomfort following the procedure are expected.

Please contact us if you experience:

• severe or increasing pain
• increasing redness, heat or swelling
• discharge, pus or an unpleasant smell
• persistent or excessive bleeding
• fever or feeling significantly unwell
• unexpected numbness or altered sensation
• difficulty with healing; or
• anything else that concerns you.

If you are unsure whether something is part of normal healing, please contact the clinic for advice.

Your next step

If you have already booked your procedure

Please read this information carefully and complete the pre-procedure questionnaire sent to you.

Please let us know before your appointment if there has been a significant change in your health, medication or allergies.

Your podiatrist will confirm that treatment remains appropriate and you will have an opportunity to ask any questions before deciding whether to proceed.

If needling has been recommended but you have not yet booked

You can book your Verruca Needling (Falknor's Needling) appointment when you are ready to proceed.

Treatment package: £425

Important information

This information sheet is intended to support the discussion you have already had with your podiatrist and help you make an informed decision about treatment. It does not replace individual clinical advice or the consent discussion before your procedure.

Published studies have reported complete resolution in approximately 65–71% of patients following Falknor's needling, although results vary and complete clearance cannot be guaranteed.

Before treatment, your podiatrist will confirm that needling remains appropriate, explain the procedure and give you the opportunity to ask questions before deciding whether to proceed.

The Podiatry Clinic