Verrucae are extraordinarily common, yet they are also one of the most mismanaged conditions in podiatry. The over-the-counter freezing kits, the salicylic acid plasters, the repeated cryotherapy at the GP — these treatments work for some people and fail for many others. If yours has persisted for a year or more, if it is painful, if you have several of them, or if you have already been through multiple rounds of conventional treatment without success, verruca needling may be the approach that finally resolves it.
Why Verrucae Persist: The Immunology Behind the Problem
Understanding why verrucae are so tenacious requires a brief explanation of where they live and how the immune system works.
Verrucae are caused by human papillomavirus — HPV — which infects the keratinocytes of the skin's outer layer, the epidermis. The epidermis is an avascular tissue: it has no direct blood supply. Blood vessels, immune cells, and the immune surveillance mechanisms the body depends on to detect and respond to infection are located deeper, in the well-vascularised dermis below.
This anatomical reality is the key to understanding the whole problem. HPV lives in a compartment of the skin that the immune system cannot easily reach. Because the virus is confined to the epidermis and the immune system's detection apparatus is in the dermis, the body can harbour an active HPV infection for years without mounting any significant immune response to it.
The virus is also remarkably adept at immune evasion. It replicates within the keratinocytes without triggering the normal alarm signals that would alert immune cells to its presence. It does not cause cell death — the very process that usually signals an infection — and it suppresses local inflammatory responses that might otherwise draw immune attention to the infected tissue.
Conventional treatments — salicylic acid, cryotherapy, silver nitrate — work primarily by destroying the surface layers of the verruca, removing infected tissue, and causing local inflammation. For patients with a healthy immune system and a recent or superficial verruca, this can be enough to tip the balance. But for many patients, particularly those with longstanding lesions, the immune response these treatments provoke is insufficient. The virus remains in the surrounding tissue, the verruca regrows, and the cycle continues.
What Is Verruca Needling?
Verruca needling — also referred to as Falknor's needling or dry needling — is a procedure that takes a fundamentally different approach to this problem. Rather than working on the surface of the skin, it works from the inside out.
The procedure was first described by Edmund Falknor in 1969 and has since been studied in a number of clinical trials and case series. The principle is straightforward: by using a sterile needle to repeatedly puncture the verruca and the tissue immediately surrounding it, the clinician deliberately drives HPV-infected material through the epidermis and into the dermis below — the vascularised, immune-active layer where the body's immune cells live and where an effective immune response can be mounted.
The procedure is carried out under local anaesthetic. A local anaesthetic block is administered to the foot before any needling takes place, so the procedure itself is not painful. Once anaesthesia is confirmed, the podiatrist uses a sterile hypodermic needle to penetrate the verruca and the surrounding tissue repeatedly, in a controlled and systematic way. The session typically takes around 30 minutes from administration of local anaesthetic to application of dressing.
After the procedure, the foot is dressed, and the patient is able to walk out of the clinic the same day — though some discomfort and bruising in the area are expected for several days as the immune response begins.
The Systemic Benefit: Why Needling One Verruca Can Clear Them All
One of the most clinically significant aspects of verruca needling is what happens beyond the treated lesion.
When HPV-infected tissue is introduced into the dermis, the immune system is exposed to the virus in a way it has never encountered it before. Antigen-presenting cells in the dermis process the viral particles, triggering an adaptive immune response. T-lymphocytes are activated and — crucially — they become sensitised to the specific strain of HPV responsible for the infection.
Because this is a systemic immune response, it does not remain localised to the needled verruca. The immune system now recognises and targets the HPV strain wherever it is present in the body. This means that lesions elsewhere on the foot — or even on a different foot — that were never directly treated may resolve at the same time as the needled lesion.
This is a well-documented and reproducible finding in the verruca needling literature. In clinical studies, clearance of untreated satellite lesions has been consistently reported alongside resolution of the primary treated verruca. For patients with multiple verrucae, this systemic effect is one of the strongest arguments for choosing needling over other modalities — particularly destructive treatments that would need to be applied to every individual lesion.
“Needling one verruca can resolve multiple untreated lesions — because it is not the lesion being treated, but the immune system being activated.”
Who Is Verruca Needling Suitable For?
Verruca needling is not the first-line treatment for every patient with a verruca. It is a clinical procedure carried out under local anaesthetic, and patient selection matters.
The procedure is most appropriate for patients who meet one or more of the following criteria:
- Persistent verruca lasting one year or longer, particularly where it shows no signs of spontaneous resolution
- Failed conventional treatment — the patient has already completed one or more courses of salicylic acid, cryotherapy, or other podiatric treatments without achieving clearance
- Multiple verrucae, where needling a single lesion may clear the entire cluster through the systemic immune response
- Pain or functional impact — verrucae that cause significant discomfort during walking, standing, or activity
- Mosaic verrucae (large, spreading plaques of verruca tissue), which are notoriously resistant to surface treatments
There are also patients for whom the procedure is not appropriate. Verruca needling is not suitable for patients who are immunocompromised — whether through medication such as immunosuppressants, or through underlying health conditions that affect immune function. The mechanism of the procedure depends entirely on the patient mounting an adequate immune response, and in immunocompromised individuals this cannot be guaranteed.
The procedure is also not appropriate for children below a certain age, for patients with uncontrolled diabetes, or where there is active infection or significant vascular compromise in the foot. A thorough consultation is always carried out before the procedure is offered, to confirm that the patient is a suitable candidate.
What to Expect: The Full Process
Before the Procedure
A consultation appointment always takes place before any needling is carried out. At this appointment, the clinician will take a full clinical history, examine the verruca or verrucae, review any previous treatments and their outcomes, and assess overall health and suitability for the procedure. Medical conditions, medications, and any factors affecting immune function will all be considered. You will have the opportunity to ask questions and understand exactly what the procedure involves before making a decision.
On the Day of the Procedure
A local anaesthetic block is administered to numb the affected area of the foot. The type of block used will depend on the location of the verruca — a digital nerve block, a ring block, or a more proximal block to the foot. Once the anaesthetic has taken full effect, the podiatrist will confirm that the area is completely numb before proceeding.
The needling itself involves the systematic puncturing of the verruca and surrounding tissue using a sterile hypodermic needle. The needle is used to disrupt the lesion, break up the tissue, and drive infected material into the dermis below. The procedure is thorough — the aim is to expose the immune system to sufficient viral material to provoke a reliable immune response. The session typically takes 20–30 minutes.
Following needling, a sterile dressing is applied. You will be given aftercare instructions covering what to expect in the days following the procedure, how to care for the treated area, and when to return for review.
After the Procedure
Some bruising, soreness, and swelling in the treated area are normal in the first few days. Most patients are able to walk the same day, though the foot may be uncomfortable for several days as the local immune response builds. Normal activity can usually be resumed within a day or two.
The immune response that drives resolution takes time to develop. Resolution of the verruca — and any associated lesions — typically occurs over a period of six to twelve weeks, though this varies between patients. In some cases, full resolution may take longer. This is not a failure of the procedure; it reflects the time the immune system requires to mount, consolidate, and complete its response.
Published evidence for verruca needling reports resolution rates of approximately 60–80% in immunocompetent patients. Where the initial response is incomplete, a second treatment session may be considered.
Verruca Needling at Revive-Restore Skin and Joint Clinic, Bedford
Revive-Restore Skin and Joint Clinic is based at The Village Medical Centre in Great Denham, Bedford. The clinic is led by Sarah Treliving — an HCPC-registered extended scope podiatrist and independent prescriber with 24 years of clinical experience in a podiatric surgery setting within Bedfordshire and Northamptonshire NHS Trusts.
That background is directly relevant to verruca needling. Working for over two decades alongside a consultant podiatric surgeon — across clinics dealing with complex foot pathology, injection therapies, nail surgery, and post-operative care — Sarah brings a depth of clinical knowledge to even straightforward-sounding procedures. The assessment process at Revive-Restore is thorough: we take time to understand your treatment history, examine the lesion carefully, and confirm that needling is genuinely the right approach for your situation before it is offered.
All procedures are carried out in a clean clinical environment with full attention to sterile technique. Local anaesthetic is administered with care, and the needling is performed methodically to maximise the likelihood of provoking an effective immune response. Aftercare guidance is provided in full before you leave.
If you are based in Bedford, Great Denham, Kempston, Wootton, or the wider Bedfordshire area and have been struggling with a persistent verruca, we would be glad to help. No GP referral is required. You can book directly online for a consultation appointment.
Is Verruca Needling Right for You?
If any of the following applies to your situation, a consultation to discuss verruca needling is worth considering:
- Your verruca has been present for more than a year
- You have tried salicylic acid products and/or cryotherapy without success
- You have more than one verruca
- Your verruca is painful during standing or walking
- You have a mosaic verruca covering a large area of the foot
- You are otherwise healthy and your immune system is not compromised
Verrucae do not always resolve on their own, and the longer a lesion has been present, the less likely spontaneous resolution becomes. For patients who have already spent months working through conventional treatments without result, continuing down the same path is unlikely to produce a different outcome.
Verruca needling changes the mechanism. Rather than attacking the lesion from the outside, it recruits the immune system — the only mechanism that can produce lasting, systemic clearance of the underlying HPV infection.