Cath Lab Digest

Our annual roundup of innovations offers a closer look at an emerging ex-fix device, a laser that might be helpful in treating onychomycosis, and a variety of modalities that may facilitate optimal outcomes in wound care. For these bright ideas and more, this author talks to a variety of podiatrists about their experience with these products and their potential impact.

   As technology advances, podiatrists have even more options in their armamentarium to help facilitate optimal outcomes. This year’s list of emerging innovations include a novel option for hammertoe surgery, two new negative pressure wound therapy devices and a new onychomycosis treatment. With that said, here is what the experts had to say.

   1. Smart Toe (Memometal (MMI)). When surgeons remove K-wires after hammertoe surgery, maintaining correction may prove to be challenging and often deformities reoccur months to years later, frustrating patients and surgeons. Jason R. Miller, DPM, has seen many patients who presented after undergoing traditional arthroplasties or arthrodesis procedures with pin fixation that failed to maintain the desired correction.

    “Patients would emphatically express their dissatisfaction with the pins and ask if any new alternatives were available,” he recalls.

   Dr. Miller will offer such patients the Smart Toe, noting that it is the first implant that utilizes Nitinol technology to fixate a digital arthrodesis site permanently. He says the implant has solved “many, if not all” failure and implantation problems with the previous generations of in-dwelling implants.

    “The design is well thought out as it readily grasps the bone from within and expands after exposure to body heat to secure the digit in the surgeon’s choice of positioning,” says Dr. Miller, a Fellow of the American College of Foot and Ankle Surgeons.

   The Smart Toe is available as a neutral or angled implant, according to MMI. It says the one-piece implants do not require connection. The company adds that there is no post-op implant exposure and no disruption of healthy joints.

   Dr. Miller has used the Smart Toe for close to a year and says it “prevents all the issues associated with external pin fixation,” such as lost pin caps, pin infections and patient adherence dilemmas. He says there are instances (prior history of infection, MPJ contractures, etc.) in which traditional pin fixation is superior.

    “In general, however, the Smart Toe form of fixation offers a persistent internal beam, which maintains the correction even in instances in which complete arthrodesis has not been achieved,” explains Dr. Miller, who is in private practice at the Pennsylvania Orthopaedic Center in Malvern, Pa.

Inside Insights On A New Plantar Fasciitis Treatment

   2. NeuroTherm NT250 RF Generator (NeuroTherm). For plantar fasciitis patients who do not respond to conservative treatment, a new advance in radiofrequency nerve ablation (RFNA) may provide relief.

   NeuroTherm says the NT250 RF Generator can treat inferior heel pain and neuritis, and one can use the device in an in-office setting. The company notes the device can reduce heel pain by using radiofrequency nerve ablation to interfere with the pain signal. NeuroTherm cites a 92 percent success rate with RFNA therapy in achieving complete relief of pain from plantar fasciitis.

   Doug Richie Jr., DPM, has used the NeuroTherm device on about 50 patients. As he notes, the NT250 RF is the first device that selectively isolates the nerve that transmits pain from the planar fascia.