A Retrospective Study of Non-thermal Laser Therapy for the Treatment of Toenail Onychomycosis.

Objective: The objective of this study was to assess the efficacy of non-thermal laser therapy for treating toenail onychomycosis. Design: This retrospective study analyzed the results of three nonrandomized, open-label studies. The device used was a 635nm/405nm dual-diode laser. Affected toenails were treated for 12 minutes weekly for 2 or 4 weeks. Setting: Treatments occurred in clinic and private office settings. Participants: Subjects with onychomycosis-infected toenails were enrolled. Measurements: Fifty great toenails were included in the analysis based on visually identifiable onychomycosis; thickened, discolored nail plate; and confirmed etiology of onychomycosis. Changes in the extent of clear nail bed was measured using multi-platform image manipulation software. The primary outcome measure was the percent of toenails attaining ≥3mm of clear nail growth during the six-month post-treatment period. Overall study success was defined as ≥60 percent of treated toenails meeting the individual success criteria. The secondary outcome measure was change in the length of clear nail bed. Results: Most treated toenails (67%) achieved individual treatment success. The extent of clear nail at baseline increased by a mean of 5.18 (4.76) mm after 6 months (p<0.0001). In addition, 89 percent of treated toenails demonstrated an increase in clear nail across the six-month study period. No adverse events were reported. Conclusion: Non-thermal laser therapy is safe and effective for increasing the extent of clear nail in onychomycosis-infected toenails following one weekly treatment for four weeks. ClinicalTrials.gov Identifier: NCT02588599.

A Step Forward: The Use of the CrossLock Catheter in a Patient With Critical Limb Ischemia and a Popliteal Occlusion.

A 75-year-old diabetic female presented with resting pain in her left foot. Her resting ankle-brachial indexes were 1.25 on the left and 1.22 on the right. We accessed the right groin and passed an Omni catheter (AngioDynamics) to access the contralateral common femoral artery. An angiogram revealed that the common femoral, deep femoral, and superficial femoral were patent, but the popliteal was 100% occluded. We utilized the 0.014" Command wire (Abbott Vascular), and after the extension was passed, inflated the CrossLock balloon. With the balloon inflated, we crossed the total occlusion and passed the wire into the peroneal vessel. Through the CrossLock, we then performed a kissing-balloon technique with a 3.5 mm Chocolate balloon (Cordis Corporation) and a 4.0 mm Chocolate balloon in the peroneal. We individually stented the anterior tibial artery with a 3.5 x 28 mm Alpine stent (Abbott Vascular) and a 4.0 x 23 mm Alpine stent in the peroneal artery. Angiography confirmed excellent patency of the popliteal, peroneal, and anterior tibial with two-vessel run-off. The CrossLock has a distinct advantage of keeping one central in the lumen and also has very firm support to allow passage of a balloon catheter or other device.

Low-Level Laser Therapy at 635 nm for Treatment of Chronic Plantar Fasciitis: A Placebo-Controlled, Randomized Study.

Plantar fasciitis affects nearly 1 million persons in the United States at any one time. Conservative therapies have been reported to successfully treat 90% of plantar fasciitis cases; however, for the remaining cases, only invasive therapeutic solutions remain. This investigation studied newly emerging technology, low-level laser therapy. From September 2011 to June 2013, 69 subjects were enrolled in a placebo-controlled, randomized, double-blind, multicenter study that evaluated the clinical utility of low-level laser therapy for the treatment of unilateral chronic fasciitis. The volunteer participants were treated twice a week for 3 weeks for a total of 6 treatments and were evaluated at 5 separate time points: before the procedure and at weeks 1, 2, 3, 6, and 8. The pain rating was recorded using a visual analog scale, with 0 representing "no pain" and 100 representing "worst pain." Additionally, Doppler ultrasonography was performed on the plantar fascia to measure the fascial thickness before and after treatment. Study participants also completed the Foot Function Index. At the final follow-up visit, the group participants demonstrated a mean improvement in heel pain with a visual analog scale score of 29.6 ± 24.9 compared with the placebo subjects, who reported a mean improvement of 5.4 ± 16.0, a statistically significant difference (p < .001). Although additional studies are warranted, these data have demonstrated that low-level laser therapy is a promising treatment of plantar fasciitis.