Laser Therapy in Podiatry

Laser therapy has come along way in the profession of podiatry. Lasers in medicine have a multitude of uses.  In a podiatry practice there are several uses for a laser. There are various lasers for wart therapy. Laser treatment for wart therapy are classified in two categories. The first is needing to excise or remove the warty lesion. There are two types of lasers that can treat this type of wart. One is a surface laser, which does not require injecting the patient to treat the wart.  Surface lasers for warts on the foot and ankle are performed in an office or hospital setting, depending on the case.  Surface laser is provided in multiple treatments. With surface lasers, in addition to no injection or numbing, the patient also has no postoperative healing period.   The other form of wart therapy starts with excising the wart on the foot or lesion with a scalpel blade and then using the laser on the affected area.  This is a one shot deal where after you excise the wart, it is eliminated.  When removing a wart with a laser on the foot; the postoperative course depends on how big a lesion is and how many.  Sometimes if the area removed is very large the postoperative healing can be considerably longer.  With this type of laser you can also remove scars that develop in different parts of the foot and ankle.

 The other form of lasers podiatrists use is a laser used for fungal nails.  Fungal nails are also known as onychomycosis.  Years ago there were not many affective remedies. These included completely removing the thick fungal nails permanently, taking liver toxic antifungal medications, and a daily application of topical medication that never truly penetrated the nail to kill the fungus.  In this new technological age many foot doctors are using this kind of laser to eradicate nail fungus. Patients typically have to come in for about 3-5 treatments.  The laser has a beam that sweeps over the toenails and pours oxygen into the nail and nail tissue.  Lasers oxygenate the tissue, which effectively kills the fungus in the toenail.  Podiatrists specialize in the care and treatment of toenails and have found that this is a safe and effective way of treating onychomycosis. 

Other things that need to be considered are shoe gear that is too tight or does not have enough depth for the toes to lie comfortably inside.   Evaluation by a podiatrist can help to ensure that the shoe you are wearing lets the foot rest comfortably in the shoe. If the foot is too crowded in the shoe it is likely that the toenails will get damaged.  The main reason for nail fungus is trauma, so if we remove the trauma that the shoe inflicts on the nail, we have a better chance of stopping recurrence of the nail fungus. 

Lastly there are a few other things that a podiatrist can give to their patients to put inside their shoes.  Feet sweat constantly and the sweat that builds up can cause fungus in the skin. It is important to treat the shoe and prevent the spread of fungus from the skin to the shoe and back to the skin again. As you can see it is quite important to have a qualified podiatrist evaluate your nail problems completely.  In our office we evaluate the nail, the skin of the foot, the shoe gear,  and the inside of the shoe gear to effectively treat onychomycosis of the toenail. To date laser is the most effectively nontoxic way of treating nail fungus. 

My Child Has Heel Pain. Is This Normal?

Heel pain in a child, contrary to popular belief, is not  normal and should be evaluated by a podiatrist promptly.  Heel pain in a child is usually due to an injury  in the heel. As a child grows the heel bone is not completely fused.  The area of injury in the heel bone is where the two pieces of bone fuse to become one. This is where injury occurs for children.  Typically, heel pain in children occurs in girls between 8 and 10 and in boys at 10 to 12 years of age. It is not until an adolescent turns around sixteen that the area completely fuses.  When an adult presents with this type of pain, it is more of an inflammation of the heel area and not a disruption or injury to the cartilage in the heel bone area. 

Sever’s diseases or  calcaneal apophysitis is often the cause of heel pain in children.  The typical pain is around the the sides of the heel, back of the heel, and on the bottom of the heel.  We will note if the pain increases with activity; especially during sporting activities.  The pain  will lead to tightness of various muscles because the body is compensating for the heel pain.  Achilles tendonitis commonly occurs along with the heel pain in the foot . The Achilles can get so tight that pressure of this extremely strong tendon against their heel  bone can traumatize the bone. This causes an injury of the growth plate of the foot. 

Treatment promptly by a podiatrist is necessary for heel pain in children. This will decipher whether there is an interruption in the growth plate or a real fracture, which is quite rare.  A foot specialist will take an X-ray and evaluate the bony structures of the foot and ankle area.  Once they are diagnosed with Severs disease or osteochondritis; the main focus is to decrease activity.  We typically don't recommend a complete cessation of activity but a decrease in physical sporting activity.  Icing the heel area for intervals of twenty minutes three times a day is very helpful.  Heel cups which are shock absorbers may be of some benefit.  In our practice we recommend custom orthotics  for this, which if casted correctly will effectively control the foot and ankle motion and decrease pressure in the heel area. Custom orthotics can also effectively decrease the pressure of the Achilles tendon on the heel bone.