appl-manual 1064nm nail-fungus 07.2014 e

Diode Laser

1064 nmApplication Manual

Nail Fungus / Warts / LLLT

2

© 2014 A.R.C. Laser GmbH alle Rechte vorbehalten. Namen anderer hier genannter Firmen und Produkte sind Marken ihrer jeweiligen Rechtsinhaber. Jede Nutzung des Materials, einschließlich der Vervielfältigung im Ganzen oder in Teilen, bedarf schriftlicher Genehmigung von der A.R.C. Laser GmbH. Es wurden alle Anstrengungen unternommen, um sicherzustellen, dass die in diesem Handbuch aufgeführten Informationen korrekt und auf dem neusten Stand sind. A.R.C. Laser übernimmt jedoch keine Gewähr für die Richtigkeit des Inhalts dieses Handbuchs und haftet nicht für persönlichen Schäden oder Verletzungen, die direkt oder indirekt verursacht werden, allein durch die Nutzung dieses Dokuments. Im Zweifelsfall wenden Sie sich bitte vor Benutzung dieses Geräts an A.R.C. Laser. April 2014

ENGLISCH

© 2014 A.R.C. Laser GmbH all rights reserved. Names other here named carrier companies or products are trademarks theirs respective holder of rights. Any use of the material, including reproduction in whole or in part, requires permission in writing from A.R.C. Laser GmbH. While every endeavour has been taken by the authors to ensure the information in this document is accurate and up to date. A.R.C. Laser shall not be liable for any personal damage or injury caused directly or indirectly, by solely using this document. In case of any doubt, please contact A.R.C. Laser before using the device. April 2014 July 2014

3© A.R.C. Laser GmbH

CONTENT

INHALT

Lasers Safety . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Device Overview . . . . . . . . . . . . . . . . . . . . . . . . .8

Handpieces . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Nail Fungus . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Warts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Surgical handpiece . . . . . . . . . . . . . . . . . . . . . . . 31

LLLT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

“FOX Laser“ and “WOLF Laser“ are Trademarks of A .R .C . Laser GmbH

4

LASERS SAFETY

5© A.R.C. Laser GmbH© A.R.C. Laser GmbH

LASER RADIATION & TEMPERATURE EFFECT

TEMPERATURE EFFECT

> 40° C Enzyme induction, membrane disaggregation, edema

45° – 65° C Tissue damage, irreversibility depends on irradiation time

> 65° C Coagulation

> 100° C Dehydration

> 150° C Carbonisation

THERAPY INDICATIONS

1 . This manual covers various podiatry applica-tions approved for use with the laser; manual is designed to assist both the “beginner” and “experienced” users .

2 . Clinical information detailed in this manual is intended to be used by a healthcare professional who posses relevant medical background, as well basic knowledge with medical lasers .

3 . In case of any doubt, it is strongly advisable to refer to appropriate literature relevant to the intended use . If no such literature is available, please contact your local A .R .C . Laser represen-tative for support .

4 . Laser parameters values are usually detailed with min /max values . These parameters were devel-oped based on the extensive use of the device by healthcare professionals .

5 . User is always required to common sense when using these parameters, taking into consideration relevant patient information . Neither the author nor the manufacturer will be liable for a treatment failure caused by misuse of the device .

MANAGING UNWANTED EFFECTS

Since safety goggles must be worn throughout the procedure, the operator must be aware that his/her vision is temporarily altered (color shades appear differently, contrast may be dimmed, etc .) - this can

lead to visual misjudgment . It is than recommended from time to time to turn off the laser, remove the goggles and inspect the treated area without gog-gles .

In case of any eye injury due to disregard of the eye protection by safety goggles, an ophthalmolo-gist hast o be consulted .

Laser radiation can cause immediate and unwanted tissue damage, therefore it is highly advisable to have within reach burns control measures (such as: ice or cooling pads, topical products, special dressings for burns, etc .) .

Laser radiation can cause unwanted Hemo-stasis and Coagulation damages . The extent strongly depends on the exposure time to the laser’s radiation .

Coagulated tissue is not harmful and normally will normally not cause issues . In case of overheating of temperature-sen-sitive areas, applying immediate local cool-ing should be done at treatment should be stopped and revaluated .

Discomfort from the heating which is generated by the laser may occur . To avoid this, the user should follow the application parameter guidelines . If possible, cooling can reduce patients dis-comfort after the treatment .

LASERS SAFETY

6

Manual FOX July 2014

File: User-Manual_Fox_III_EN 24

WARNING LABELS

Warning label fiber exit (Console top)

Warning label laser radiation (Cover stand top)




WARNING LABELS






WARNING LABELS






WARNING LABELS




Warning/Hazard labels found on the FOX Laser device - Similar for WOLF

Laser radiation emitted by the laser can cause seri-ous damage to the patient as well as to the operator and other individuals present near the device . The la-ser is classified as a Class 4 laser device, this means its laser beam can cause damage when pointed directly or indirectly (reflections) to human tissue .Most serious injuries may occur, if laser radiation is

targeted to the eyes . Even at low level laser power, the eye’s retina may suffer serious damage which could lead to blindness . Injury risk level depends on laser wavelength, distance, energy density, power (energy per time) and exposure time .

Laser radiation within the spectrum of 400nm and 1400nm poses the highest potential risk to the human eye . The cornea as well as the anterior chamber, the lens and the vitreous body of the eye contain mainly water, while other tissue components (mainly colla-gen) play a minor role for the laser tissue interaction .

Such radiation has very low absorption index in water, therefore is able to easily penetrate and reach the ret-ina, where it is absorbed by the blood and the retinal pigment epithelium .

Since the FOX laser emits infrared radiation and given its high intensity, it is absolutely necessary to wear safety goggles at all times while using the device . The infrared laser radiation can also be harmful to the skin and other body parts if not properly used .

In addition, laser radiation can ignite inflammable ma-terials, so such materials should always be stored, or kept away from the treatment room .

How the laser perform in a specific application is based on laser radiation and tissue interaction, as the laser radiation may be absorbed, scattered or re-flected by the treated area . Air has very little effect on the laser radiation so interaction between air and the laser radiation can be neglected . Reflection do plays a major role with metal, glass and other reflecting surfaces, but not so much when it comes to human tissue .

When emitting laser radiation on human tissue, reflec-tion is minimal but not zero! Although laser radiation may be scattered on a tissue‘s surface, it does not influence much the overall energy absorption . Ab-sorption is mainly derived by the laser radiation phys-ical properties (wavelength) . Absorption defines how much of the laser radiation is converted into heat, which causes the desired clinical effects (coagulation / vaporisation) .

At low energy densities (large laser beam spot or low laser power), heat gradually built within the tis-sue . The smaller the beam spot size, or the higher the power, the faster heat will built . Above a certain limit, the tissue can no longer tolerate the amount of absorbed heat, proteins starts to denaturants and co-agulation occurs . If continuing to heat up the tissue, the tissue water (intra and extracellular water) will suddenly evaporates (> 300° C) . Tissue is fragmented and destroyed - cutting / evaporation is achieved .

LASERS SAFETY


© 2013 A.R.C. Laser GmbH FOX Laser is a trademark of A.R.C. Laser GmbH

© 2013 BritaMed Inc.

1. The FOX laser system should only be used by a trained personnel, undergone training by ARC Laser or ARC Laser approved trainer. 2. The room or area, where the laser system is used must be marked with the included warning signs in clear and visible way, to warn against entering the room/area without adequate protection while the laser is in use. 3. The laser system should never be used, in case of a doubt the device or any of its component are faulty. The fibre delivery system should periodically be tested, by aiming the beam to a flat surface (at approx. 5cm distance) and observing the spot shape. The spot should be well defined, no scattering or deep shadows should be present.

6. Special care should be taken to avoid irradiating reflecting materials, since reflected laser radiation can still cause serious harm. 7. Always switch off the laser from its "Ready" mode when not in use; e. g. during long pauses or at the end of the procedure.

BASIC LASER SAFETY INSTRUCTIONS

4. When the laser is placed on “Ready" mode (2 yellow LED lights on) any person present at the area where laser radiation can occur (laser treatment area / laser room) should wear laser safety goggles, to protect the eyes from laser radiation.

5. The laser device must be used only for its defined application; never irradiate other material / or areas not detailed in the application description.

At low energy densities (large laser beam spot or low laser power), heat gradually built within the tissue. The smaller the beam spot size, or the higher the power, the faster heat will built. Above a certain limit, the tissue can no longer tolerate the amount of absorbed heat, proteins starts to denaturants and coagulation occurs. If continuing to heat up the tissue, the tissue water (intra and extracellular water) will suddenly evaporates (> 300° C). Tissue is fragmented and destroyed - cutting / evaporation is achieved.

6

“Ready “ lights

LASERS SAFETY LASERS SAFETY

Ready lights FOX

Ready lights WOLF

BASIC LASER SAFETY INSTRUCTIONS

To avoid any injuries it is important to follow the laser safety instructions:

1 . The laser system should only be used by a trained personnel, undergone training by A .R .C . Laser or A .R .C . Laser approved trainer .

2 . The room or area, where the laser system is used must be marked with the included warning signs in clear and visible way, to warn against entering the room/area without adequate protection while the laser is in use .

3 . The laser system should never be used, in case of a doubt the device or any of its component are faulty . The fiber delivery system should periodical-ly be tested, by aiming the beam to a flat surface (at approx . 5cm distance) and observing the spot shape .

4 . The device indicats when the laser is placed on “Ready“ mode . Any person present at the area

where laser radiation can occur (laser treatment area / laser room) should wear laser safety gog-gles, to protect the eyes from laser radiation .

5 . The laser device must be used only for its defined application; never irradiate other material / or areas not detailed in the application description .

6 . Special care should be taken to avoid irradiating reflecting materials, since reflected laser radiation can still cause serious harm .

7 . Always switch off the laser from its „Ready“ mode when not in use; e . g . during long pauses or at the end of the procedure .

LASERS SAFETY

8

WOLF

FOX

DEVICE OVERVIEW

Touch Screen

“UP/DOWN” keys

Yellow light indicating laser is in“STAND BY” mode

Push Buttonputting laser into “STAND BY” mode

Red Light Indicating laser is being emitted

Power supply

Door interlock

AUX 1 AUX 2 Foot Switch

Green LED “READY” mode

Yellow LED Battery status

Red LED Interference/Error

Emergency Switch

Touch Screen

Button putting laser into “STAND BY” mode

Red Light Indicating laser is being emitted

Fiber socketfor U .C . Fibers

Fiber socketfor standard Fibers

Emergency Switch

Program Name

Settings Menu

Pulse Counter

Energy Counter

USB-flash drive Inserted Indicator

Battery Level

Power Indicator mW or W

Next Program

Power Adjustment

Pulse ON

Pulse OFF

Previous Program

Onychomycosis - Low

Onychomycosis - Normal

Warts (Coagulation)

Wireless foot pedal battery


OVERVIEW

10

WOLF

Fiber Coupling

Plu

g

Soc

ket

NEW A.R.C. LASER FIBERS

A .R .C . is updating its Fibers due to design reasons – all Fibers will be delivered with blue color .The color-coding for the plugs will stay the same . Yellow - Red - White and Green .

U.C. PLUG

The WOLF Universal Centering fiber socket comes in black . You easily can differ the fibers from the conventional ones . Whenever you see the black fiber protection you can be sure to work with a WOLF . Color coding of all the plugs will stay the same - despite of the tapered ones . The new system will not have tapered fibers any more .

FIBER COUPLING

The dimensions of plugs and sockets also stay the same . Left: Drawing of the conventional fiber connection .

All the order numbers will stay the same: LL110xx, LL130xx, LY110xx .

The new order numbers will start with the letter

code: LL280xx

The Wolf fiber socket is black – as well as the fiber protection .

Left: Drawing of the new U .C . Universal centering fiber con-nection .

The FOX fiber plug in yellow with 400 µm and silver with 300 µm – The fiber protection will be white .

Plugs

Plugs


OPTICAL HANDPIECES

OPTICAL HANDPIECES - SPOT SIZE Ø

Handpiece FOX . . . WOLF with 300µm Connector-Fiber

Blue HS11008 HS18002 Ø 0 .3 mm

Red HS11009 HS18003 Ø 0 .6 mm

Green HS11010 HS18004 Ø 1 .0 mm

Silver HS11014 HS18001 Ø 4 .0 mm

OPTICAL HANDPIECES

The optical hand pieces (Blue, Red, Green and Silver) are used for focusing/ parallelization the laser beam for different applications . They only work with the double sided connector fiber LL13002/LL28002 in 300 μm .

COAGULATION AND CARBONISATION

Are performed using the blue hand piece (0 .3 mm spot size) or the red hand piece (0 .6 mm spot size) .

NAIL FUNGUS

Treatment is performed using the silver hand piece (4 .0 mm spot size)

Focal Handpiece - the emitted laser beam is focussed to a certain spot size

Parallel Handpiece - the diameter of the emitted laser beam is constant .

12

OPTICAL HANDPIECES - SPOT SIZE ø

Handpiece with LL13002 [300µm]

Blue (HS11008) Ø 0.3 mm

Red (HS11009) Ø 0.6 mm

Green (HS11010) Ø 1.0 mm

White (HS11014) Ø 4.0 mm

COAGULATION AND CARBONIZATION

are preformed using the Blue handpiece - HS11008

(0.3mm spot size) or Red handpiece - HS11009 (0.6mm spot size).

HS11009, HS11010, HS11008 HS11014

LL13002 [300µm]

The ‘Optical handpieces' (Blue, Red, Green and White) are used for focusing the laser beam for different applications. They work only with the double sided fibre connector - LL13002 (300µm socket). The following table list their corresponding beam spot size:

The following table list their corresponding beam spot size:

NAIL FUNGUS

Treatment is performed using the White handpiece - HS11014 (4.0mm beam spot size).

OPTICAL HANDPIECES

FOX 300 µm

FOX 300 µm

WOLF U .C . Universal Centering

Handpieces

Verify the fibre plug is fully inserted into the socket and locked .

HANDPIECES ASSEMBLY

SURGICAL HANDPIECE

This hand piece (HS11018) is used for cutting, excision and cauterization . The hand piece uses disposable Bare Fibers (e .g . LL18001 - 300μm) and non disposable tips .

The fiber LL13002 (300μm socket) is required to use all optical hand pieces . The LL13002 fiber has one plug on each side, which can be either inserted into the laser fiber coupler or into the coupler of the hand pieces .


HS11018

2. JAZZ – Sapphire Scalpel(LL13020)

The JAZZ handpiece arrive pre-assembled with a sapphire blade and connecting fibre.

The blade and fibre are not replaceable, though the handpiece is designed for multiple uses, due to its extremely durable long lasting sapphire blade.

ZU01027 ZU01016 ZU01024

JAZZ (LL13020 )

LL13001 [300µm]

Incision / Excision / Cauterizing Applications

Two types of handpieces are available, for performing precise cutting and cauterizing:

1. Surgical handpiece (HS11018)

SS handpiece that uses disposable, and non disposable tips and the single connector type fibre LL13001 (300µm).

CONTACT HANDPIECES

ZU01044

HS11018




ZU01027 ZU01016 ZU01024

JAZZ (LL13020 )

LL13001 [300µm]





CONTACT HANDPIECES

ZU01044


NAIL FUNGUS

NAIL FUNGUS

14

NAIL FUNGUS

Deep yellowish ”oily” tone

White Superficial

Surrounding tissue effects

Distal and Lateral Subungual (DSO)

Total dystrophic (3 sites affected)

Proximal Subungual (PSO)

White Superficial (WSO)

CLASSIFICATION

COMMON PATHOGENS

Trichophyton rubrum(T. Rubrum)

DERMATOPHYTES

(Candida Albicans ;Candida Parapsilosis).These infections are lessfrequent thoughsymptoms are similar

Trichophytonmentagrophytes(T. Mentagrophytes)

YEAST



Photoinactivation: cytoplasmatic membrane damage

Heat: enzyme denaturing

Local white blood cells increment

Mycelium is the vegetative part of a fungus. It is through the mycelium that a fungus absorbs nutrients from its environment. The infrared laser radiation, affect the Mycelium in 2 ways: A. Photoinactivation: damage the fungi cytoplasmatic membrane. B. Heat absorbed in the fungi pigmented cell areas : denature its enzyme content. As a result the fungi metabolism slow down, as it is unable to digest the nail’s keratin protein. The infrared laser radiation also causes rise in white blood cells count in the capillaries, at the nail bed. This helps further in isolating and attacking the fungi.

HOW DOES THE LASER AFFECT THE FUNGUI PATHOGENS?

14

ONYCHOMYCOSIS








14

ONYCHOMYCOSIS


NAIL FUNGUS


Mycelium is the vegetative part of a fungus . It is through the mycelium that a fungus absorbs nutrients from its environment .

The infrared laser radiation affects the Mycelium in 2 ways:

• Photoinactivation: damage the fungi cytoplasmatic membrane .

• Heat absorbed in the fungi pigmented cell areas : denature its enzyme content .

As a result the fungi metabolism slow down, as it is unable to digest the nail’s keratin protein .

The infrared laser radiation also causes rise in white blood cells count in the capillaries, at the nail bed . This helps further in isolating and attacking the fungi .

Silver Handpiece

Onychomycosis treatment is performed with focus-ing hand piece HS11014 / HS18001 (silver), that produce a spot size of 4 .0 mm (at a working distance of about 1-1 .5 cm) .

PHOTOINACTIVATION

cytoplasmatic membrane damage

HEAT

enzyme denaturing

LOCAL white blood cells increment








14

ONYCHOMYCOSIS

16



Onychomycosis treatment is performed with focusing handpiece HS11014 (White), that produce spot size of 4.0 mm (at a working distance of about 1-1.5cm). Use the dual connector fibre (LL13002). This fibre has a plug on each side, which can be either inserted into the fiber coupler of the FOX laser or into the coupler of the handpiece

HS11014

LL13002 with HS11014

Verify the fibre plug is fully inserted into the socket and locked.

SETUP

LL13002 [300µm]

15

ONYCHOMYCOSIS



Onychomycosis treatment is performed with focusing handpiece HS11014 (White), that produce spot size of 4.0 mm (at a working distance of about 1-1.5cm). Use the dual connector fibre (LL13002). This fibre has a plug on each side, which can be either inserted into the fiber coupler of the FOX laser or into the coupler of the handpiece

HS11014

LL13002 with HS11014

Verify the fibre plug is fully inserted into the socket and locked.

SETUP

LL13002 [300µm]

15

ONYCHOMYCOSIS

OPTICAL HANDPIECES - SPOT SIZE ø

Handpiece with LL13002 [300µm]

Blue (HS11008) Ø 0.3 mm

Red (HS11009) Ø 0.6 mm

Green (HS11010) Ø 1.0 mm

White (HS11014) Ø 4.0 mm

COAGULATION AND CARBONIZATION

are preformed using the Blue handpiece - HS11008

(0.3mm spot size) or Red handpiece - HS11009 (0.6mm spot size).

HS11009, HS11010, HS11008 HS11014

LL13002 [300µm]

The ‘Optical handpieces' (Blue, Red, Green and White) are used for focusing the laser beam for different applications. They work only with the double sided fibre connector - LL13002 (300µm socket). The following table list their corresponding beam spot size:

The following table list their corresponding beam spot size:

NAIL FUNGUS

Treatment is performed using the White handpiece - HS11014 (4.0mm beam spot size).

OPTICAL HANDPIECES

WOLF U .C .

NAIL FUNGUS

SETUP

Use the connector fiber LL13002 / LL28002 .This connector-fiber has one plug on each side, which should be either inserted into the laser fiber coupler or into the coupler of the hand pieces .


PROGRAMS

Select one of the pre-installed Nail Fungus programs

During the treatment the device indicate how much laser energy was delivered . It is important to monitor this figure; in order to reach the needed amount of energy per nail . Af-ter each treated nail, it is advisable to reset the automatic energy counter .

FOX




NAIL FUNGUS

ONYCHOMYCOSIS - 1064 nm - STANDARD - per Treatment

Size of toe nail Power (W) Pulse ON (ms) Pulse OFF (ms) Energy (J)

Big Toe 8 60 - 80 90 - 110 500 - 550

Middle Toe 8 60 - 80 90 - 110 120 -150

Small Toe 8 60 - 80 90 - 110 75 - 100

ONYCHOMYCOSIS - 1064 nm - HIGH - per Treatment

Size of toe nail Power (W) Pulse ON (ms) Pulse OFF (ms) Energy (J)

Big Toe 10 10 4 - 5 500 - 550

Middle Toe 10 10 4 - 5 120 -150

Small Toe 10 10 4 - 5 75 - 100

• Avoid using the laser on inflamed tissue at treatment area .

• Avoid using the laser on over or close to tattoos .

• Avoid single spot overheating .

PATIENT ASSESSMENT

• Obtain a medical history and signed consent .

• Patients which are afflicted with neuropathy (e .g . based on wound healing disorder or circulatory disturbance; maybe also diabetic) can‘t be treated .

• Using the laser on inflamed tissue or expanded foot fungus around the treatment area

• Onychomycosis could be caused by different patho-gens e .g . Dermatophytes, the pathogen should be microbiological analyzed before laser therapy

• In the presence of hyper-keratotic infections, the infected nail residues should be removed mechan-ically – it is not necessary if an atrophic infection is present

• The thickened portions of the nail should be debrided

• Projecting infected nails or applied nail polish has to be removed in any case

• Assess treatment area for decreased sensation/numbness prior to treatment

• Topical anesthetic is strongly not recommended because patient feedback during the treatment is important

• Advise patient to bring fresh socks, to be worn immediately after the treatment

TREATMENT PARAMETERS

The duration of the treatment is directly affected by the size and thickness of the toenails .

After the treatment, there will be a lingering sensation of heat below the nail . This sensation will dissipate within 1 - 2 hours .

Treat your patients with 2 – not more than 3 passes per Session!

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1.0 cm -1.5 cm

Cover the ENTIRE nail, including the area proximal to the Eponychium, In order to allow the laser to penetrate into the matrix.

The laser beam should be guided at a slow speed (approx. 2 mm/s) over the nail bed, so that the complete nail (nail plate, nail wall and Eponychium) is repeatedly irradiated reticular or spiral-shaped.

• Point the handpiece perpendicular to the nail plate.

• Maintain a working distance of approx. 1cm to 1.5 cm; A distance deviants of ± 0.25cm have No effect of the spot size and as a result the applied power density.

• Avoid making contact between the handpiece and the nail

18

ONYCHOMYCOSIS



1.0 cm -1.5 cm

Cover the ENTIRE nail, including the area proximal to the Eponychium, In order to allow the laser to penetrate into the matrix.

The laser beam should be guided at a slow speed (approx. 2 mm/s) over the nail bed, so that the complete nail (nail plate, nail wall and Eponychium) is repeatedly irradiated reticular or spiral-shaped.

• Point the handpiece perpendicular to the nail plate.

• Maintain a working distance of approx. 1cm to 1.5 cm; A distance deviants of ± 0.25cm have No effect of the spot size and as a result the applied power density.

• Avoid making contact between the handpiece and the nail

18

ONYCHOMYCOSIS

1,0 - 1,5 cm

NAIL FUNGUS

TREATMENT

• The laser beam should be guided at a slow speed (approx . 2 mm/s) over the nail bed, so that the complete nail (nail plate, nail wall and Eponychium) is repeatedly irradiated reticular or spiral-shaped .

• Cover the ENTIRE nail, including the area proximal to the Eponychium, in order to allow the laser to penetrate into the matrix .

• Point the handpiece perpendicular to the nail plate .

• Maintain a working distance of approx . 1 to 1 .5 cm; A distance deviants of ± 0 .25 cm have NO EFFECT ofthe spot size and as a result the applied power density .

• Avoid making contact between the hand piece and the nail/ patient . The hand piece can be wipe disinfected with a alcohol- containing disinfectant solution .

Ensure that the required total energy is introduced into the treatment area .

A total energy of approx . 500 J (big toe) should be delivered within 2 .5 to 3 minutes an 100 J (small toe) within 1 minute .


500 - 550 J 120 -150 J 75 - 100 J

1ter Durch-gang

NAIL FUNGUS

POST TREATMENT CARE

• Advise patient to wear fresh / new socks immediately after treatment .

• Advise patient to spray anti-fungal medication in the shoes .

• Advise patient to apply anti-fungal cream 2x per day for approximately one month post treatment .

• Nails should be kept trimmed and cleaned; all nail care tools should be disinfected prior use .

• Nail polish may be applied approx . 24 hours after the treatment .

To avoid unwanted thermal effects and pain, cool the treatment area with cooling pads or cooling gel after the treatment .

Allow a few minutes for the nail to cool down, and repeat the treatment a second time .

Energy (J)per pass per pass per pass

Big Toe Middel Small

RE-TREATMENT

2nd pass

20

NAIL FUNGUS

GENERAL NOTES

• Treatment desired outcome usually reached by multiple sessions were overall treatment duration depends on the severity of the fungal infection, patient general health and patient age .

• Despite the high success rate with laser treat-ment, it is not a definitive cure for Onychomyco-sis .

• Patients should be advised that the expected outcome will never be visible immediately after the 1st treatment .

• Patients should be advised that in order for the

treatment to succeed, it is of high importance to follow post treatment instructions .

• The period between treatment sessions should be 3 - 5 weeks .

• The ultimate result should be visible in approxi-mately 10 till 15 month depending on the initial status .

ALL people in the treatment room must wear safety goggles .

First aid kit containing burns control, as well as frozen gel pack other rapid cooling product should always be within arms reach .

21© A.R.C. Laser GmbH© A.R.C. Laser GmbH



31

WARTS WARTS

WARTS

22

WARTS

BACKGROUND

Warts are caused by the Human Papilloma Virus (HPV); The virus causes skin to grow faster than usual, forming a bump . Though HPV is contagious touching someone with warts does not mean the other person will definitely catch the virus . It depends on the particular strain of HPV and on the strength of a person immune system . Breaks or cuts in the skin may make infection more likely .

Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot . Plantar warts grow deep into the skin, usually this growth occurs slowly .

There are two types of plantar warts:• A solitary wart is a single wart . It often increases in size and may eventually

multiply, forming additional “satellite” warts .

• Mosaic warts are a cluster of several small warts growing closely together in one area . Mosaic warts are more difficult to treat than solitary warts .

SYMPTOMS

The symptoms of a plantar wart may include:• Thickened skin

Often a plantar wart resembles a callus because of its tough, thick tissue .

• Pain Walking and standing may be painful . Squeez-ing the sides of the wart may also cause pain .

• Tiny black dots These often appear on the surface of the wart . The dots are actually dried blood contained in the capillaries .


WARTS

DIAGNOSIS AND TREATMENT

Although plantar warts may eventually clear up on their own, most patients desire faster relief . Common treatments include the use of topical or oral products , laser therapy, cryotherapy (freezing), acid treat-ments, or excision .Regardless of the treatment approaches undertaken, it is important that the patient follow the surgeon’s instructions, including all home care and medication that has been prescribed, as well as follow-up visits with the surgeon . Warts may return, requiring further treatment .

If there is no response to treatment, further diag-nostic evaluation may be necessary . In such cases, the surgeon can perform a biopsy to rule out other potential causes for the growth .Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous . Patients should never try to remove warts themselves, as this can do more harm than good .

Illustration of small capillaries within a wart

LASER TREATMENT

Pulsed laser radiation target the blood vessels sustaining the wart . Upon intense laser irradiation, a wart should dry out and its entire capillaries chains fully coagulated . This will appear as a color transformation from pink to light grey .

24

X

(J) (J) (W) (W) (s) (s)

J W T

WARTS

LASER SETTINGS CONSIDERATIONS

Same amount of energy delivered in different ways, can lead to completely different results:

Energy = Power x Time

High Power - Short Time

Energy = Power x Time

Low Power - Long Time

Increased vaporization

Extra caution must be made during the first time of a patient treatment . intermediate pauses are advised, to observe the progress of the procedure .

Increased coagulation

E N E R G Y POWER TIME

Tempe

rature

tem

per

atur

e ri

se Pulse M

Pause U

Tempe

rature

tem

per

atur

e ri

se Pulse M

Pause U

Tempe

rature

tem

per

atur

e ri

se

Pulse M

Pause U

Tempe

rature

tem

per

atur

e ri

se

Pulse M

Pause U


WARTS

LASER SETTINGS CONSIDERATIONS (CONT’)

Since laser radiation is absorbed also in the skin‘s melanin, it is important to apply fine adjustments to the laser energy profile settings based on the patient skin type .

longer pulses on darker skin, more rapidly increase skin’s surface temperature

With the these considerations, typical penetration depth of a 1064nm laser in aqueous tissue could reach 4mm with enough energy to coagulate warts’ capillaries .

The table below details Fitzpatrick classification of skin types, also identified in this document as:

LASER RADIATION & TEMPERATURE EFFECT

TYPE I Always burns, never tans

TYPE II Usually burns, difficult in tanning

TYPE III Sometimes burns, average tan

TYPE IV Rarely burns, tans with ease

TYPE V Very rarely burns, tans very easily

TYPE VI Never burns, tans very easily

It is advisable to follow common skin tones scales such as Fitzpatrick classification of skin types .



31

WARTS

26

WARTS

Coagulate

or

Carbonize



31

WARTS


WARTS COAGULATION

Start with low power and short pulses to observe laser-tissue interaction . Adjust to patient tolerance .

Sensitive areas, darker skin types, and areas with recent sun exposure may require lower power or shorter pulse rate .

WARTS COAGULATION

VERRUCA VULGARIS; VERRUCA PLANTARIS ; VERRUCA SENILIS

PATIENT ASSESSMENT

• Obtain a medical history and signed consent

• Contraindications for this treatment are: Skin Cancer


WARTS - COAGULATION - 1064

Hand Piece Skin Type Power (W) Pulse ON (ms) Pulse OFF (ms)

Red I-IV 8-10 160-200 200

V-VI 6-8 140-180 200

Blue I-IV 7-10

120-160200

V-VI 5-7 100-140 200

Coagulate

or

Carbonize

28

WARTS COAGULATION

PREPPING THE PATIENT

• Clean skin .

• Take pre-treatment photographs for future reference

• Warts may need to be debrided prior to treatment

• Target area should be clearly marked with a medical marker pen

• Topical anesthetic is often required

ALL People in the treatment room must wear safety goggles

PROCEDURE

1 . Mark the warts edges/superior layer

2 . Hold the handpiece perpendicular to skin’s surface while slightly touching the skin

3 . Irradiate the entire wart area, using a spiral motion

4 . Pulses can be overlapped slightly by around 20% : meaning its important to complete “painting” the wart in a fluid motion

5 . Do not treat outside the wart’s marked border

6 . The wart may become ashen or dusky immediately after or during the treatment

7 . Use cooling (frozen gel pack, etc .) periodically to help with patient comfort

POST TREATMENT

• Warts usually have develop grey crusty appearance within 24 hours after treatment and usually slough off in 1-2 weeks

• Use ointment of choice and non-stick dressing for patient comfort

• If a blister develops, treat as a wound

• More then 1treatment may be necessary (3-4 weeks apart)

DEEP CARBONIZATION - FOX 980/1064

Handpiece Skin Type Power (W) Pulse ON (ms) Pulse OFF (ms)

Blue (HS11008) I-VI 8-12 CW --

SUPERFICIAL CARBONIZATION - FOX 980/1064


Red (HS11009) I-VI 9 max 140-230 180-300

Blue (HS11008) I-VI 9 max 120-200 150-300

HS11009 HS11008

DEEP CARBONIZATION - FOX 980/1064


Blue (HS11008) I-VI 8-12 CW --

SUPERFICIAL CARBONIZATION - FOX 980/1064


Red (HS11009) I-VI 9 max 140-230 180-300

Blue (HS11008) I-VI 9 max 120-200 150-300

HS11009 HS11008


WARTS CARBONIZATION


Extra caution must be made during the first time of a patient treatment . intermediate pauses are advised in order to control the progress of the procedure

WARTS CARBONIZATION

GENERAL

Carbonization is ablative treatment, achieved by applying focused laser radiation, that result in burnt tissue (carboni-zed) . The burned tissue will later separate from the healthy tissue underneath and fall off .In this method, laser radiation removes the whole wart as well as some of the surrounding tissue to make sure the wart, its roots and blood supply are completely eradicated .

PATIENT ASSESSMENT

• Obtain a medical history and signed consent .

• Contraindications for this treatment are Pregnancy and Skin Cancer

SUPERFICIAL CARBONIZATION - 1064 nm

Hand piece Skin Type Power (W) Pulse ON (ms) Pulse OFF (ms)

Red I-IV 9 140-230 180-230

Blue I-IV 9 120-200 150-300

DEEP CARBONIZATION - 1064 nm

Hand piece Skin Type Power (W) Pulse ON (ms) Pulse OFF (ms)

Blue I-IV 8-12 CW --


30

WARTS CARBONIZATION

PREPPING THE PATIENT

• Clean skin .

• Take pre-treatment photographs for future reference

• Warts may need to be debrided prior to treatment

• Target area should be clearly marked with a medical marker pen

• Local anesthetic is usually required

• Superficial lesions can be done with topical anes-thetic skin refrigerants

• Deeper / wider area lesions may require Lidocaine injections

TREATMENT GUIDELINES

• Warts are burned out on the surface, resulting in a carbonized surface . The burned tissue will separate from the healthy tissue underneath and fall off during the following days .

• Use a medical marker pen, to fully cover the target surface . This will increase laser absorption and will both shorten the treatment time as well as minimize unnecessary deep tissue over heating .

• Always start with lowest laser settings and gradual-ly increase when necessary .

• Smoke evacuator and laser plume masks (filters to 0 .1µm) are recommended .

POST TREATMENT CARE

• Applying cooling post treatment (e .g . frozen gel pack), may help with patient comfort .

• Within a few days the area will transform to eschar neoplasm .

• Tissue will slough off in 1-2 weeks post treatment .

• Use ointment of choice and non-stick dressing for patient comfort .

• If blisters develop, they should be treated as wounds .

• More then 1 treatment may be necessary (3-4 weeks apart) .

WOUND CARE - GUIDELINES

• Cleanse the wound with diluted HYDROGEN PEROXIDE twice daily for five days and then once daily until complete healing .

• Gently lift the remove loose crust . These are formed of dead tissue and dried inflammato-ry exudate; they prevent epidermal bridging across the surface of the wound .

• After each cleansing, apply a thin coat of ANTIBIOTIC ointment such as: POLYSPORIN, BACTROBAN, FUCIDIN, or BACIGUNET over the wound .

The ointment will clear any possible bacterial contamination or infection, prevent scab formation, loosen adherent crusts, and keep the wound moist for faster epithelialization .

• In many cases, it helps to wear a BANDAGE over the wound, this should be changed daily .


SURGICAL HANDPIECE

SURGICAL HANDPIECE

32

SUPERFICIAL LESIONS

The Surgical handpiece is used for applications requiring maximum cutting ability, along with constant coagulation . The handpiece works with a bare fibre and various tips / cannula design .

LENGTH

Keep at least 3 mm distance between the fibre and tip/ cannula . This is important especially for the disposable plastic tip, that otherwise may deform due to the heat radiated from the fibre .

TIP BLACKENING

The fibre’s tip should be initialized in order to provide maximum energy dispersion, especially when the target area cannot absorb the energy (i .e . Skin with minimal melanin, no pigmentation, no blood, etc .) .

REGULAR FIBRE

BLACKENED FIBRE

SURGICAL HANDPIECE

HS11018




ZU01027 ZU01016 ZU01024

JAZZ (LL13020 )

LL13001 [300µm]





CONTACT HANDPIECES

ZU01044

HS11018




ZU01027 ZU01016 ZU01024

JAZZ (LL13020 )

LL13001 [300µm]





CONTACT HANDPIECES

ZU01044

+ΔT

+ΔE

1 2

43


SURGICAL HANDPIECE


Use any type of absorbent surface (e .g . wood) and activate the laser . Choose 4 - 6 Watt, cw .

Stop when the tip become black .

34

INCISION - EXCISION

Handpiece Power (W) Pulse ON (ms) Pulse OFF (ms)

HS11018 Steel Cannula

9 - 10 CW --

HS11018 Plastic Cannula

7 - 9 CW --

THE TREATMENT

Allow a direct fibre – tissue contact, which maximize energy transfer . Laser setting is always cw (Continues Wave), and output should be adjusted based on the conditions .The bare fiber end hast o be in contact with the tissue . The cutting procedure is nearly similar to a knife cutting, except that the bare fiber end should only be moved over the tissue in one direction with an angle of less than 90° .

HS11018 shown with 2cm cannula

SURGERY WITH HANDPIECE

Allow a direct fibre – tissue contact, which maximize energy transfer. Laser setting is always cw (Continues Wave) , and output should be adjusted based on the conditions.

INCISION / EXCISION

Handpiece Model Power (W) Pulse ON (ms) Pulse OFF (ms)

Surgical (HS11018) SS cannula

1064 9-10 CW --

980 9-12 CW --

Surgical (HS11018) Plastic cannula

1064 7-9 CW --

980 9-10 CW --

(shown with 2cm cannula)


Allow a direct fibre – tissue contact, which maximize energy transfer. Laser setting is always cw (Continues Wave) , and output should be adjusted based on the conditions.

INCISION / EXCISION

Handpiece Model Power (W) Pulse ON (ms) Pulse OFF (ms)

Surgical (HS11018) SS cannula

1064 9-10 CW --

980 9-12 CW --

Surgical (HS11018) Plastic cannula

1064 7-9 CW --

980 9-10 CW --

(shown with 2cm cannula)

SURGERY WITH HANDPIECE

SUPERFICIAL LESIONS

• Carbonization can be used to remove superficial warts or lesions, such as skin tags, moles, etc .

• The use of a medical marker (preferred black dye) significantly shorten treatment time, and prevent unnecessary deep tissue heat buildup .

• Apply the medical marker (preferably black ink) at the base of the superficial lesion, and target the laser to the marked area .

The laser will cut off the blood supply to the super-ficial wart or lesion allowing clean removal without bleeding .

Similar practice can be used with various types of superficial lesions and to vaporize thin layers of the epidermis .Always use the black medical marker to minimize deep heating effect, and maximize laser absorption .

36

LLLT

LLLT


Neuroma

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma.

“Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Causes

Morton's neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to the toes

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities – bunions, hammertoes, flatfeet, or more flexible feet – are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.

Symptoms

Typically, there's no outward sign of this condition, such as a lump. Instead, patient may experience the following symptoms:

• A feeling as if he is standing on a pebble in his shoe• A burning pain in the ball of the foot that may radiate into the toes• Tingling or numbness in the toes

NEUROMA

NEUROMA

A neuroma is a thickening of nerve tissue that may develop in various parts of the body . The most com-mon neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes . It is sometimes referred to as an intermetatarsal neuroma .

“Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones . Neuromas may also occur in other locations in the foot .

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve . This compression creates en-largement of the nerve, eventually leading to perma-nent nerve damage .

CAUSES

Morton‘s neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to the toes Anything that causes compression or irritation of the nerve can lead to the development of a neuroma . One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box . People with certain foot deformities – bunions, hammertoes, flatfeet, or more flexible feet – are at higher risk for developing a neuroma . Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports . An injury or other type of trauma to the area may also lead to a neuroma .

SYMPTOMS

Typically, there‘s no outward sign of this condition, such as a lump . Instead, patient may experience the following symptoms:

• A feeling as if he is standing on a pebble in his shoe

• A burning pain in the ball of the foot that may radiate into the toes

• Tingling or numbness in the toes

DIAGNOSIS

Obtain medical history and examine foot throughout to rule out other possible causes . A typical exam is to press on the foot to feel for a mass or tender spot . There may also be a feeling of „clicking“ between the bones of the foot . In addition, diagnostic imaging such as x-rays ultrasound or MRI might be used to help rule out other conditions that can cause similar symptoms .

THE PROCEDURE

The Procedure should take approximately 5 minutes .1 . Set laser to 10 W / CW

2 . Without using any handpiece, defocus to approx . 2cm beam spot size .

3 . Point laser perpendicular to the target area, and apply laser in spiral motion . Use both Dorsal and Plantar approach (see photos) .

4 . Apply laser for approx . 2 min in short intervals of ~10-15secs to avoid overheating .

5 . In between laser pauses intervals, apply pressure/massage to the area .

6 . Typically, total energy delivered would be 2,000J-2,500J .

38

NEUROMA

POST TREATMENT CARE

• Rest and footwear change may assist with expediting the heeling process

• It is recommended to have a treatment every 1 to 2 weeks, were usually 4-6 treatments will be required

LLLT*


LL13002 (FOX 300 µm) LL28002 (WOLF)

9 - 10 CW --

* The information detailed in this chapter is for practitioner reference . Diagnostic, condition assessment and treatment should

always be done based on practitioner prior knowledge and practice .

Defocus beam to approx . 2cm beam spot, perpendicular to the surface


Do not treat areas that have metal implants .

Pay attention to skin areas covered with tattoo; these may require surface cooling during the procedure .


Plantar Fasciitis

Plantar fasciitis

is an

inflammation of the band of

tissue (the plantar fascia)

that extends from the heel

to the

toes. In

this

condition, the fascia first

becomes irritated and then

inflamed, resulting in heel

pain.

Heel pain may also be due

to other causes, such as a

stress fracture, tendonitis,

arthritis, nerve irritation, or,

rarely, a cyst.

Symptoms • Pain on the bottom of the heel

• Pain in the arch of the foot

• Pain that is usually worse upon arising

• Pain that increases over a period of months

• People with plantar fasciitis often describe the pain as worse when they get up in

the morning or after they’ve been sitting for long periods of time.

After a few minutes of walking the pain decreases, because walking stretches the

fascia. For some people the pain subsides but returns after spending long periods of

time on their feet

Causes The most common cause of plantar fasciitis relates to faulty structure of the foot.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on

the plantar fascia and can also lead to plantar fasciitis. This is particularly evident

when one’s job requires long hours on the feet. Obesity may also contribute to

plantar fasciitis.

Because there are several potential causes, it is important to have heel pain properly

diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities

and determine the underlying source of your heel pain.

PLANTAR FASCIITEIS

PLANTAR FASCIITIS

A Plantar Fasciitis Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes . In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain . Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst .

Because there are several potential causes, it is im-portant to have heel pain properly diagnosed . A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain .

CAUSES

The most common cause of plantar fasciitis relates to faulty structure of the foot . Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis . This is particularly evident when one’s job requires long hours on the feet . Obesity may also contribute to plantar fasciitis .

SYMPTOMS

• Pain on the bottom of the heel

• Pain in the arch of the foot

• Pain that is usually worse upon arising

• Pain that increases over a period of months

• People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time .

After a few minutes of walking the pain decreases, because walking stretches the fascia . For some peo-ple the pain subsides but returns after spending long periods of time on their feet

DIAGNOSIS

Obtain medical history and examine foot to rule out other possible causes for heel pain than plantar fas-ciitis . In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain . Some-times heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain . When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome .

THE PROCEDURE

The Procedure should take approximately 5-7 minutes .1 . Set laser to 10 W / CW

2 . Without using any handpiece, defocus to approx . 2 cm beam spot size .

3 . Point laser perpendicular to the bottom of the heel and apply laser in sweep motion toward the arch; Repeat on the inner side (see photo 1) .

4 . Apply laser for approx . 3 minutes in short intervals of ~10-15secs to avoid overheating .

5 . In between laser pauses intervals, apply pressure/massage to the arch area (see photo) .

6 . Typically, total energy delivered would be about 3,000 J .

As the underlying causes that led to this condition may remain, patient need to continue with preventive measures (wearing supportive shoes, stretching, and using custom orthotic devices, etc.).

It is recommended to have a treatment every 1 to 2 weeks, were usually 4-6 treatments will be required

Post Treatment Care

Without using any handpiece, defocus to approx. 2cm beam spot size.

Point laser perpendicular to the bottom of the heel and apply laser in sweep motion toward the arch; Repeat on the inner side (see photo).

Apply laser for approx. 3 minutes in short intervals of ~10-15secs to avoid overheating.

In between laser pauses intervals, apply pressure/massage to the arch area (see photo).

Typically, total energy delivered would be about 3,000J.

Defocus beam to approx. 2cm beam spot, perpendicular to the surface, apply pressure/massage to the arch area.

As the underlying causes that led to this condition may remain, patient need to continue with preventive measures (wearing supportive shoes, stretching, and using custom orthotic devices, etc.).

It is recommended to have a treatment every 1 to 2 weeks, were usually 4-6 treatments will be required

Post Treatment Care

Without using any handpiece, defocus to approx. 2cm beam spot size.

Point laser perpendicular to the bottom of the heel and apply laser in sweep motion toward the arch; Repeat on the inner side (see photo).

Apply laser for approx. 3 minutes in short intervals of ~10-15secs to avoid overheating.

In between laser pauses intervals, apply pressure/massage to the arch area (see photo).

Typically, total energy delivered would be about 3,000J.

Defocus beam to approx. 2cm beam spot, perpendicular to the surface, apply pressure/massage to the arch area.

1

2

40

PLANAR FASCIITEIS

LLLT*


LL13002 (FOX 300 µm) LL28002 (WOLF)

9 - 10 CW --

POST TREATMENT CARE

• As the underlying causes that led to this con-dition may remain, patient need to continue with preventive measures (wearing supportive shoes, stretching, and using custom orthotic devices, etc .) .





Defocus beam to approx . 2cm beam spot, perpendicular to the surface, apply pressure/massage to the arch area .

* The information detailed in this chapter is for practitioner reference . Diagnostic, condition assessment and treatment should

always be done based on practitioner prior knowledge and practice .


Achilles tendinitis

Achilles tendinitis is an overuse injury of the Achilles tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It's also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends

Causes

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. The structure of the Achilles tendon weakens with . age, which can make it more susceptible to

Symptoms

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur after prolonged running, stair climbing or sprinting.

Patient might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.

Achilles tendinitis can weaken the tendon, making it more vulnerable to a tear (rupture), a painful injury that usually requires surgical repair.

injury — particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.

ACHILLES TENDINITIS

ACHILLES TENDINITIS

Achilles tendinitis is an overuse injury of the Achilles tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone .

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs . It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends .

CAUSES

Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone . The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury — par-ticularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs .

SYMPTOMS

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity . Episo-des of more severe pain may occur after prolonged running, stair climbing or sprinting . Patient might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity . Achilles tendinitis can weaken the tendon, making it more vulnerable to a tear (rupture), a painful injury that usually requires surgical repair .

DIAGNOSIS

Obtain medical history and examine foot throughout to rule out other possible causes . A typical physical exam, is to gently press on the affected area to de-termine the location of pain, tenderness or swelling, as well as evaluate the flexibility, alignment, range of motion and reflexes of your foot and ankle . In addi-tion, diagnostic imaging such as x-rays ultrasound or MRI might be used to help rule out other conditions that can cause similar symptoms .

THE PROCEDURE

The Procedure should take approximately 5 minutes .

42

ACHILLES TENDINITIS




1 . Set laser to 10W/CW (continues),

2 . Without using any handpiece, defocus to approx . 2cm beam spot size .

3 . Point laser perpendicular to the target area; apply laser in linear or spiral motions .

4 . Apply laser for approx . 3 minutes in short intervals of ~10-15secs to avoid overheating .

5 . Apply massage to the area, between laser intervals .

6 . Typically, total energy delivered would be about 3,000J .

POST TREATMENT CARE

• Rest and foot elevation may assist with expediting the heeling process .



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Block_A4_2012.indd 1 29.08.2012 10:34:47

NOTES

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