Falknor's needling
Falknor’s needling is an established treatment for verrucae (plantar warts), which are benign skin lesions caused by certain types of human papillomavirus (HPV). The technique was first described in 1969 and aims to stimulate the body’s immune response to the virus through controlled puncturing of the affected tissue.
The procedure creates a local inflammatory response that may help the immune system recognise and clear the infection. As with all verruca treatments, success cannot be guaranteed.
Suitability Assessment
Before undergoing verruca needling, a pre-operative assessment is required to ensure the treatment is safe and suitable for you. This includes reviewing your medical history, medications, circulation and nerve function, alongside a detailed discussion of the procedure, local anaesthetic options, potential risks and expected outcomes. Needling may not be suitable for children, patients with poor circulation, uncontrolled diabetes, neuropathy, impaired healing, certain medical conditions or those taking particular medications. Each patient is assessed individually, and alternative treatments will be discussed where appropriate.
Tibial Nerve Block
A tibial nerve block is a way of numbing the sole of your foot before verruca needling. A small amount of local anaesthetic is injected near a nerve on the inside of your ankle. This stops pain signals travelling from the sole of your foot, allowing treatment to take place without injecting directly around the verruca. You may feel a brief sting during the injection, but your foot will gradually become numb. The numbness lasts for several hours.
Local Anaesthetic Infiltration
Before verruca needling, a local anaesthetic is injected into the the verruca to numb the treatment area. This temporarily blocks pain signals from the nerves, allowing the needling procedure to be carried out comfortably. You may experience a brief stinging or pressure sensation during the injection, but once the anaesthetic has taken effect, the area should be numb. The anaesthetic gradually wears off over the following few hours, and some mild soreness or tenderness may occur afterwards.
Needling Treatment
Once your foot is completely numb a fine, sterile needle is then used to puncture the verruca repeatedly, passing through the affected skin into the tissue beneath. This is designed to expose the virus to your body's immune system, encouraging it to recognise and fight the infection. The procedure usually takes around 20–30 minutes, and you may feel some pressure, but you should not experience pain.
Following treatment, the area is cleaned and covered with a sterile dressing and protective padding to cushion the foot and reduce pressure when walking. The dressing should be kept clean and dry for the first 24 hours. After this, you can usually shower as normal, and the dressing can generally be removed after 48 hours, provided there is no bleeding or discharge. Some mild tenderness, bruising or swelling is normal and usually settles within a few days.
