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The son of one of the authors came home from school with a letter explaining that prior to swimming each term, children would have their feet checked for verrucas. School policy stated that if a verruca was discovered a protective sock must be worn.
Many public swimming pools have no restrictions on children swimming with verrucas, and in view of conflicting policies we wondered whether verrucas were transmitted during swimming and if wearing verruca socks was a necessary intervention.
Structured clinical question
In a child [patient] with a verruca (plantar wart), does wearing an occlusive dressing or sock while swimming [intervention] reduce transmission [outcome]?
Search strategy and outcome
Secondary sources: Cochrane—none.
Primary sources: Medline 1966 to present (verruca OR plantar wart) AND swim LIMIT to “English language”.
Embase: same search strategy—no additional papers.
Search results—7 articles, 2 relevant plus 3 from manual search. See table 2.
The Department of Health Guidance on infection control in schools and nurseries1 suggests that affected children may go swimming but that verrucas should be covered.
Our search revealed little up to date information on the prevalence of verrucas in schoolchildren, or the effectiveness of preventive measures. One paper studied protective footwear, but this study looked at the role of protective footwear in preventing the acquisition of plantar warts in unaffected individuals. It did not examine the prevention of spread by affected individuals wearing footwear.2 There were no studies looking at the effectiveness of simply covering a plantar lesion with an adhesive dressing in the prevention of spread.
Only one study looked at the prevalence of plantar warts in swimmers compared to non-swimmers.3 This study found that adolescents who used locker rooms plus communal showers at a swim club had a significantly higher prevalence of warts than young people using only locker rooms.
Three studies looked at the prevalence of verrucas in swimmers. One4 found a greater prevalence of warts in those swimming in heated covered pools compared to uncovered pools, concluding that this difference may be accounted for by a differing period of exposure. Another5 found a positive correlation between the amount of swimming and the incidence of warts. The third6 found a higher incidence of verrucas in those swimming during a school session than during a free-swimming session.
CLINICAL BOTTOM LINE
Swimming is part of the national curriculum up until the end of key stage 2, by which time children are expected to be able to swim 25 metres.
Although studies have shown an association between verrucas and swimming, none have looked at the increased risk of verruca acquisition with swimming.
No studies have considered the effectiveness of protective socks/dressings in preventing transmission.
Expecting children to wear protective socks, without evidence of their effectiveness, may stigmatise children and put them off swimming altogether.