In this section Cypress Foot and Ankle specialist Dr. Christopher Correa discusses lasers and their use in podiatry. The existence of lasers was first postulated by Albert Einstein in 1917 but the first functioning laser was not created until the 1960’s by Therdore H. Miaman. Since then, an explosion of uses has been found for lasers in a whole host of industries including medical, industrial, retail, gaming, weapons, computers and more. Since the latter portion of the 20th century, lasers have been used in podiatry to treat fungal nails, warts, pain, neuropathy and more. Lasers are generally classified into 4 levels with class 3b and class 4 lasers being commonly used in throughout podiatry. Both class 3b and 4 lasers are very powerful requiring eye protection for everyone in the room during operation. The major difference between class 3b and 4 is amount of energy produced over period of time. Class 3 lasers, otherwise known as "Cold Lasers" or Low-Level Light Therapy (LLLP) use machines that max out at 0.5 watts. These lasers do not generate heat on the skin and require longer treatment times to deliver the same level of energy a class 4 laser does. They are also not suitable to treat warts or fungal nails. Class 4 lasers such as The Remy, operate at significantly more wattage. In podiatry a 30-watt laser is commonly used for warts and toenail fungus and can be used for tendonitis, arthritis, and pain and inflammation. Class 4 lasers deliver more energy over a shorter period of time which means shorter treatments times (or the ability to treat more locations in less time) and the generation of heat at the treatment site. The generation of heat increased blood flow and healing factors which is something that Cold Laser does not do. The next paragraph will cover more in-depth detail of how lasers work in podiatry. If you are not interested in the nitty gritty of the biochemistry pertaining to how lasers effect changes on the human body, suffice it to say that lasers increase energy in the cell and skip the next paragraph.
The term L.A.S.E.R. is actually an acronym standing for “light amplification by stimulated emission of radiation”. While I am not qualified to expound in depth upon the physics of how lasers are formed, suffice it to say that lasers are a specific type of light emission where the photons are focused or converged down to a narrow beam which allows for concentration of that power over a longer distance. In the setting of podiatry / medicine It is postulated that this concentration of energy is what makes lasers useful by allowing for targeted focus of that energy to stimulate cells to produce more energy. This process is known as photobiomodulation and to explain what this term means we first need to delve into some basic biology. In the human cell a molecule known as adenosine triphosphate (ATP) serves as the major energy carrying molecules for all essential functions in the cell. It’s ability to convert from a high energy state (Adenosine triphosphate) to a lower energy state such as Adenosine Diphosphate (ADP) or Adenosine Monophosphate (AMP) effectively allows ATP to transfer its energy to other molecules driving reactions that otherwise would not occur without the input of energy. A simple way to think about is ATP is like a compressed spring in a pinball machine. When the ball is in the starting position it will not move until the plunger is pulled backward compressing the spring and then let go effecting the energy of the spring on the ball. When the spring is in its relaxed elongated state then it is like ADP or AMP, unable to drive the necessary reaction. When the plunger is pulled back that spring is compressed and now has energy to expend (ATP). Upon release of the plunger the spring automatically extends propelling the ball into the machine starting the game. ATP is generated in a place within the cell known as the mitochondria (Cellular power plant). The mitochondria convert ADP and AMP to ATP via the electron transport chain. The more ATP that is available in the cell means the more reactions can be done and at a faster rate. This is the basic premise for photobiomodulation. Lasers are thought to stimulate the electron transport chain which increases the rate of production of ATP creating a temporary focal increase in available energy in the cells where the lasers are used. This extra energy can be used to repair the cell via its natural processes but at an accelerated rate.
Laser Applications in Podiatry
Laser treatments for Pain and inflammation –
Increased energy in the cells serves to speed up the cell's natural functions for reduction in pain and inflammation. This stimulates healing and when class 4 lasers are used increased heat and blood flow. The is useful for arthritis, Plantar Fasciitis, ankle sprains, neuromas, hallux limitus, Posterior tibial tendonitis, Achilles tendonitis and muscle pain. The Remy is FDA cleared for the treatment of pain and inflammation.
Class 4 lasers can have an ablative and non-ablative roll in wart treatment. In the ablative roll the laser can be used to burn the base of the wart killing the infected cells and allowing for healing. This is the more traditional way lasers have been used in wart treatments. More recently a lower energy level has been used to stimulate the immune response and get the body to more quickly and efficiently eradicate the wart itself. This is often done with little to no pain. They Remy is FDA cleared for treatment of plantar warts.
Lasers increase the rate at which is natural processes of nail remodeling occur. This increases the recovery of the infected, misshapen nail and promotes clearing. Additionally, the lasers increase the oxidative stress on fungal cells leading to their death. Most nail laser devices such as The Remy are FDA cleared for temporary clearing of fungal nails.
Laser treatment has turned out to be a great adjunct treatment for pain, inflammation, fungal nails and warts for the podiatric patient. If you are experiencing any of these conditions do not hesitate to contact the experts at Select Foot and Ankle Specialists and schedule an appointment today.
