Laser treatment Covid toes. Can low level lasers treat long Covid toes? There have been many reported cases of patients left with painful cold toes weeks after having Covid-19. It was first reported in 2021, that some Covid patients were experiencing mottle discoloration, rashes and swelling in their toes. On examination they looked to be chilled with classic chilblain presenation. In most cases the symptoms would resolve, but some patients long after recovering from Covid still experience uncomfortable toes.
Are long Covid toes chilblains? No, is the simple answer. The differential diagnosis is chilblains are caused by an abnormal response to changes in cold temperature. Cold makes the small blood vessels constrict, then they have a problem dilating when the temperatures become warmer. Tissues become irritated; an inflammatory response ensues resulting in itchy painfully sore toes. Chilblains will resolve within a few weeks, rarely leaving long-term complications as seen in long Covid toes.
Image of a man’s foot captured during the coronavirus pandemic. It has been documented that a foot rash is a common side effect of having the virus. The media refers to this as ‘Covid Toe’.
So, what are long Covid toes? It is thought to be caused by a ‘runaway immune response in which the body attacks its own tissues’. A type 1 Interferon response as seen by the body’s immune system responding to a virus. SARS-CoV-2 virus damages the small peripheral blood vessels. Circulation to the toes becomes impaired. Patients also report neuropathic symptoms of altered sensation in the toes primarily burning pain and throbbing.
Currently the treatment is to do nothing and hope the symptoms will go away. Steroids can also be prescribed to reduce the inflammation and discomfort. Are there other novel treatment options? Could low level lasers work at a cellular level to repair damaged vessels and nerves?
There is considerable evidence to demonstrate that low level laser light (3LT) energy can resolve chilblains. Near infra-red laser light energy with a wavelength between 600 – 1000 nm can precipitate vasodilation, open up blood vessels and improve circulation to tissues. 3LT is used therapeutically to safely treat tissue damage without any side-effects. Evaluation of Efficacy of Low-Level Laser Therapy – PMC (nih.gov)
Compleet Feet Treating Long Covid-Toes
Recently, Compleet Feet effectively treated a patient presenting with long Covid toes. A healthy and active female patient 55, post-pausal, developed painful neuropathic toes 2-3 weeks after testing positive for Covid-19. She had a mild case of Covid and recovered quickly except for her feet. She complained that her toes where now very sensitive to temperature change. Symptoms persisted even when external temperatures were warm. Her GP could offer nothing and had already tried vasodilator chilblain creams to nil effect.
This patient was in good health and on no medication. She had no history of any circulatory disorders. On examination the digits were purple/ dark pink in colour. Felt cold on touch and the nails were showing signs of nail growth disruption. There were horizontal lines appearing across the nail plate (trachonychia). Nails were thinning and there was no dorsal toe hair. Signs of poor nutrition and peripheral circulation to the toes.
Long Covid Toes. Note the purple pink discolouration distally. Linear striations demonstrating disrupted nail growth marked.
It was decided to give the patient an 8 week course of Lunula laser. One session a week would help stimulate healthy new nail growth and hopefully reverse the capillary damage. Each Lunula session would result in a transient opening up of blood vessels throughout the toes. The science proved it could help so I was confidant it would work.
The patient came weekly for her 12 minute Lunula laser sessions and after 2 weeks already began to note that her toes were less sore in footwear and to the touch. At the 4 week point her toes were back to normal colour and asymptomatic in nature. 2 more laser sessions were performed to encourage the nails to grow out stronger and healthier. At the end of 8 weeks the nails and the toes looked back to normal. She had even sprouted the odd dorsal hair. A good result.
This was a novel way to treat long Covid toes, for which nobody else has appeared to have tried? The Lunula laser is primarily used to treat fungal toes nails, but it’s use in this case was an interesting case study to demonstrate that podiatrists need to think outside of the box.
Post laser treatment for long Covid toes. Improved peripheral circulation and no neuropathic pain. Photograph taken after 8th Lunula laser session.
Should more research be done to investigate whether low laser therapy will help patients with symptoms of long Covid toes? The Lunula laser can do more than be used as adjunctive therapy in treating fungal nail disease. The Lunula laser can help to reverse the damage caused to capillaries caused by Covid, and help to regenerate damaged nerve endings. Could the Lunula laser be effective in helping to reduce the symptoms of chilblains?
