A Closer Look At Emerging ‘Gadgets’ That May Help Reduce Post-Op Pain And Edema

Stephen Barrett DPM FACFAS

I love gadgets. Admittedly, with most of them, I can only achieve about 10 percent functionality after my struggling ascent up the learning curve after purchasing them. However, I do love to buy them. Gadgets are opiates for some.

   In your debriefing of your surgical cases, you should always ask yourself: Is there any equipment that could have helped me today make my job easier, provided less intraoperative time for the patient and helped minimize tissue disturbance during the case? We know all these things increase surgical outcomes and are good for the patient. I also like postoperative gadgets. Many professionals refer to them as “physical therapy.” Anything that gets the patient moving quickly without disruption to our surgical reconstruction improves podiatric surgical outcomes by an incalculable factor.

   The TEC Thermoelectric Cooling System (Maldonado Medical) and Horizontal® Therapy (Hako-Med) are two gadgets that may help achieve this sacred principle by reducing pain and edema after surgery, which is POM (postoperative management) in the aforementioned surgical formula I proposed in my first blog (see www.podiatrytoday.com/blogged/proposing-a-mathematical-equation-for-surg... ).

   The TEC machine is excellent and is the only iceless cold therapy compression/deep vein thrombosis (DVT) prophylaxis machine available, which can also provide heat. It is limited to a cold temperature of 49ºF to minimize the potential for frostbite. You can also perform contrast therapy with this device. This technology needs little further explanation. Just check it out. Your patients will be the proof (evidence-based medicine).

   Horizontal Therapy, which I have been utilizing for over a year now, is also an excellent postoperative modality. It is a type of electrical nerve stimulation that has helped patients postoperatively with pain management and swelling. I have found it especially helpful for patients in whom we have performed endoscopic gastrocnemius recessions (EGR).

   This is a great way to speed up recovery in these patients and there is some real science behind it. Zambito and colleagues conducted a randomized, double blind clinical study of patients with chronic low back pain.1 They showed that Horizontal Therapy was significantly effective in decreasing pain and disability in comparison to the placebo group.

   The EGR technique is excellent in addressing an overwhelming amount of pedal pathology in a very minimally invasive manner with minimal postoperative morbidity. However, there is a subset of patients who have more swelling and calf pain than expected from the minimal amount of tissue disruption. Since we have implemented the use of Horizontal Therapy via the Hako-Med machine, we have noticed much less swelling and a decrease in pain, which leads to a much faster recovery. Interestingly, most patients have little discomfort after the surgery but a small percentage of them do have moderate pain. This is especially true in adult patients. For some reason, the pediatric patients are speeding around so quickly that they never seem to have a problem.

   While I have no science to prove this next statement, I will proffer it anyway: This technology may prevent that rare occurrence of DVT in patients who have any type of foot surgery.

   OK, so to wrap this up—be redundant, plan more than ever for those upcoming surgeries, criticize yourself after every case, and buy some cool gadgets. Oh, and if you don’t know how to fly—learn. It will increase your SCλ more than you could ever dream.

   Financial disclosure: I have no financial interest in the TEC Thermoelectric Cooling System by Maldonado Medical, and have received an unrestricted research grant from Hako-Med, Inc., for ongoing research.


1. Zambito A, Bianchini D, Gatti D, Viapiana O, Rossini M, Adami S. Interferential and horizontal therapies in chronic low back pain: a randomized, double blind, clinical study. Clin Exp Rheumatol. 2006 Sep-Oct;24(5):534-9.


I'm all for gadgets. They have to improve things for me though. There are plenty of gadgets available for all facets of our art. However, I've only found a very few that actually improve outcomes, make it easier to perform the proposed procedure and also help patients to manage themselves better postoperatively.

Patients are also very money savvy these days and in my research, cold therapy and compression DVT prophylaxis are not covered services under most insurance carriers. It is certainly reasonable to offer this as a potential postoperative management option, but until it is covered by the carriers, most patients just won't bite in my experience.

There are many products out there that claim to improve pre/peri- and postoperative management and outcomes. As you mentioned, the evidence-based medicine is just not out there to concretely support these claims. I base products on their outcomes in my hands until proven otherwise. If it is the latest and greatest, prove it to me. Many, many products have failed me in this regard.

As a prior patient of Maldonado Medical I can say that the insurance was not a problem at all. They used a great appeal company that ensured the insurance covered the TEC as prescribed by my doctor. Due to my interest in Maldonado's ability to deal with the insurance I was told that they are capable of getting reimbursed regardless of the insurance provider due to their use of federal laws to govern the insurance claims process. I got to use the the TEC without having to fill a bucket of ice and didn't even have to worry about my insurance...

"Compression DVT prophylaxis are not covered services under most insurance carriers"

I do know that Medicare covers the above ... Medicare is considered the base line coverage for DME ... must not know how to appeal a claim denial

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