Cold laser therapy is a relatively new technology (30 years old) when compared to acupuncture which has been used since 8000-3500 B.C. Just like the abacus evolved into the computer, slowly needles are evolving into light. Recent innovations in low-level lasers now make it possible for the average physician or consumer to own cold laser equipment. Cold lasers are sometimes called Low Level Lasers (LLL) or soft lasers.
In general, cold lasers can be used in 2 distinct ways:
Targeting acupuncture trigger points (similar to acupuncture but without the needles)
Broad coverage of deep tissue with laser photons to stimulate changes in the tissue
Cold Laser therapy offers a non-intrusive option to acupuncture and surgery. It also provides a non-addicting treatment that eliminates the complications of long-term drug treatment programs. Cold laser are widely use for treatment of:
Acute and chronic pain
Soft tissue injuries
Carpal Tunnel Syndrome
Healing With Cold Lasers
The cold laser produces an impulse of light at a wavelength (approximate 900nm) that maximized the energy (in photons) at a desire depth, usually 10-13cm (4-5 inches) deep. This may be combined with other laser diode with a shorter wavelength (875nm) to add photons to the shallower levels of tissue. In addition, red light diode with a wavelength of 660nm may be used to add energy to even shallower levels of tissues.
The goal of laser therapy is to deliver light energy units from infrared laser radiation, called photons, to damaged cells. It is the consensus of experts is that photons absorbed by the cells through laser therapy stimulate the mitochondria to accelerate production of ATP. This biochemical increase in cell energy is used to transform live cells from a state of illness to a stable, healthy state.
Over 4000 studies have been conducted in recent years to validate the effectiveness of cold laser therapy. Cold lasers treatment systems may be cleared by the FDA.
Benefit of Cold Lasers
Easy to apply
No side effects or pain
Cost effective for both the practitioner and patient
Highly effective in treating ailments (more than 90% efficacy)
Superior alternative to analgesics, NSAID's and other medications
Reduces the need for surgery
General Therapeutic Laser Biological Effects
Increased Cell Growth: Laser photons accelerates cellular reproduction and growth.
Increased Metabolic Activity: Photons initiate a higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells and thus greater production of the basic food source for cells, Adenosine Tri-Phosphate (ATP).
Faster Wound Healing: Cold laser photons stimulates fibroblast development and accelerates collagen synthesis in damaged tissue
Anti-Inflammatory Action: Laser photons reduce swelling caused by bruising or inflammation of joints resulting in enhanced joint mobility.
Increased Vascular Activity: Laser photons induce temporary vasodilation that increases blood flow to effected areas.
Reduced Fibrous Tissue Formation:Laser photons reduce the formation of scar tissue following tissue damage from: cuts, scratches, burns or post surgery.
Stimulated Nerve Function: Laser photon exposure speeds the process of nerve cell reconnection to bring the numb areas back to life.
Types of Cold Lasers
Class I - III continuous and modulated lasers
The fixed level of power is too low to deliver photons beyond the surface of the skin, making them ineffective in delivering photons to deep tissues. This includes laser pointers and other low cost laser diodes.
Class IV Continuous Lasers
The increase in the power of class IV continuous wave lasers increases the photon delivery to deep tissues. Unfortunately, it also increases the amount of the heat generated. This heat increases the potential risk of destructive thermal effects. Class IV laser may result in damage to the retina requiring clinicians to exercise additional FDA implemented controls to ensure patient and practitioner safety. This can include a safely lock on the device to prevent accidental exposure.
Modulated Lasers (Class II to IV) Modulating or super-pulsing the laser output power (turning it on and off in less than 1 billionth of a second) provides a unique combination of benefits. It allows the use of very high power levels (up to 50 watts) while insuring that there is no heat or damage. The ratio between the on and off times is call the duty cycle. In general a super pulsed laser class II laser can provide more power to the treatment area than a class IV continuous lasers without a risk of damage. Modulated lasers provide a good combination of safety and power.
Today, lasers are used extensively in the medical industry for everything from cosmetic surgery, eye surgery and heart surgery. The ability to put just the right amount of energy into a critical area of the human body has been a huge advancement in the medical field. Cold lasers are an important addition to these other established medical laser treatments and the recent development of low-cost professional cold lasers means that cold laser therapy will be a rapidly growing medical treatment option.
We have been able to reduce pain and inflammation of our foot and ankle surgery cases with the use of Platelet Gel. Orthopedic surgeons have been using this technology for joint replacements to decrease wound complications and decrease healing time, now this has been adapted for podiatric use. Our patients typically have less pain after surgery and less swelling as the Platelet Gel helps to decrease the time your body spends in the inflammatory phase of healing as well as provide a concentrated source of healing cells.
New procedures and applications include the use of Platelet Gel injections for chronic achilles tendonitis, wound care and plantar fascitis. Results have been extraordinary, please do feel free to talk to our doctors to see if this is right for your condition.
What is Platelet Gel?
"Autologous Platelet Rich Plasma" (Platelet Gel) was developed in the early 1970's as a by-product of multicomponent pheresis. Techniques and equipment have dramatically improved through the 1990's. This is a new procedure which utilizes the patient's own (autologous) platelets. Briefly, here's how the procedure works:
Approximately 150 milliliters is drawn, either pre-operatively or in the Operating Room, into a standard blood collection bag containing a citrate-phosphate-dextrose anticoagulant. There are also new machines that are able to utilize as little as 50 milliliters of blood to produce Platelet Gel. The blood is then centrifuged by using a variable-speed centrifuge autotransfusion machine or portable machine, to separate the buffy coat suspended in plasma from the red blood cell pack and platelet-poor plasma fraction. This is the platelet concentrate used for Platelet Gel. Depending on the initial platelet counts, it is common to achieve platelet counts in excess of over three to five (3-5) times baseline counts. Other important factors in quality of Platelet Gel are platelet viability and percent retained on the procedure. While white cell content increases 125% with selection for lymphocytes and monocytes, the inclusion of platelets and white cells appears have several beneficial aspects. White cells confer additional healing cytokines while providing antibacterial activity.
On activation with thrombin/calcium to form a coagulum, the platelets interdigitate with the forming fibrin web, developing a gel with adhesiveness and strength materially greater than the plasma alone. Thrombin/calcium also causes platelets to immediately release highly active vasoconstrictors, including beta thromboxane, serotonin and PDGF.
In addition, platelets contain many tissue growth factors. These predominant growth factors are:
PDGF (Platelet Derived Growth Factor) - PDGF is a very powerful regulatory growth factor and a sentinel growth factor that begins nearly all wound healing. PDGF's main function is to stimulate cell replication (mitogenesis) of healing capable stems and premitotic partially differentiated osteoprogenitor cells which are part of the connective tissue-bone healing cellular make-up. PDGF also causes replication of endothelial cells, causing budding of new capillaries (angiogenesis). PDGF exists in three forms: PDGFaa, PDGFbb, PDGFab.
TGF (Transforming Growth Factor) - TGF regulates proliferation and differentiation of multiple cell types. TGF found in platelets is subdivided into TGFB1 and TGFB2, which are the more generic connective tissue growing factors involved with matrix formation influencing osteoblasts to lay down bone matrix through the process of osteogenesis. Also cells activated by TGFB1 and TGFB2 include fibroblasts, endothelial and osteoprogenitor cells, chondroprogenitor cells and messenchymal stem cells. A chondoroprogenitor cell will further differentiate and produce the matrix for cartilage. A messenchymal stem cell stimulated to mitose provides wound healing cells.
Other important growth factors in platelets are:
EGF (Epidermal Growth Factor) - EGF is responsible for cell differentiation and stimulates re-epitheliation, angiogenesis and collangenase activity.
IGF (Insulin Growth Factors) - IGF is also important in wound healing, and stimulates both proliferation and differentiated function in osteoblasts.
Autologous Platelet Gel is the Perfect Operating Sealant!
Autologous Platelet Rich Plasma (Platelet Gel), on activation with thrombin/calcium, is a fibrin tissue adhesive, having hemostatic and tissue sealing properties, is the perfect surgical sealant.
There are over 30 known growth factors to date. These Platelet Growth Factors :
Increase tissue vascularity through increased angiogenesis - This enhances wound healing
Are chemotactic for monocytes, macrophages, and fibroblasts - This improves the ability to fight infection
Enhance collagen synthesis - Again enhancing wound healing
Increase the rate of epitheal and granulation tissue production - As above
The high concentration of leukocytes in the buffy coat add an antimicrobial effect, while wound hemostasis and lymphatic sealing provide an opportunity to eliminate post-operative drains and reduce pain
Provides watertight seal for dural closures
When mixed auto/allograft bone fragments, it forms a putty-like consistency ideal for packing of structural reconstructions
Provides for an immediate surgical hemostatic agent that is biocompatible, effective and safe.
Autologous Platelet Gel:
is non-toxic to tissue
is easily prepared
is readily available
is cost effective
promotes a firm seal in minutes
is reabsorbed by the body in days to a few short weeks
For those suffering from ankle pain, every step is debilitating. The fact that the ankle is a pronatory / supinatory joint versus a hinged joint of the knee has made the treatment and replacement of ankle joint deformities difficult. Treatment varies by the stage of disease. Initial stages can be treated with steroid injections, therapy, bracing and change of shoe wear to a rocker bottom shoe.
Moderate stage disease can be treated with arthroscopic surgery, open ankle surgeries, ankle stabilization procedures, visco replacement (not currently FDA approved). During late stage disease however, treatment protocol varies by physician's experience / preference. At the Family Foot and Leg Center, we offer the latest developing areas of ankle joint salvage. First is a procedure called , arthrodiastasis, which is when the ankle is placed in an external fixation device and the joint is literally stretched to allow for cartilage like material replenishment. Typically along with the arthrodiastasis procedure, an ankle arthroscopy is done along with a microfracture technique. This technique helps induce the body to heal with fibrous cartilage like material, which in turn can help to reduce pain and friction within the diseased joint. Immediate weight bearing with the external fixation device is allowed for quick rehabilitation. Dr. Lam not only performs this procedure but also trains surgeons nationwide.
Another great technique is a procedure that has been around for the last 30 years, the total ankle replacement (TAR). But only in recent years do we finally an anatomical designed ankle implant that is available for selected surgeons to use. Dr. Kevin Lam is one of a few Podiatrists along with Foot and Ankle Orthopedists at leading institutions nationwide that has been handpicked by the inventor to be certified in the use of this amazingly accurate TAR. Surgery is done on an outpatient basis, and weight bearing is allowed at six weeks with about a month of rehab and gait training. Life of any implant is about 15-20 years, but with this new natural design it is anticipated to last longer.
Ankle fusion is a tried and true way of eliminating ankle pain but does cause limitations as the name suggests. It is highly effective in reducing pain in the ankle by removing the problematic joint. Although most ankle fusions are permanent, some are being converted back to new generation ankle implants such as the In Bone system.
Factors that can potentially complicate any Ankle Arthrodiastasis, TAR and Ankle Fusions are: diabetes, autoimmune disease, obesity, smoking history, osteoporosis, etc. If you are a smoker, you must consider quitting such prior to any attempted ankle salvage procedures. For diabetics, your diabetes must be under control prior any surgical planning.
If you are interested in discussing your ankle condition and treatment options, call our office for a consultation with Dr. Kevin Lam: (239) 430-3668.