At Shellharbour Podiatry’s Shellharbour City clinic, we have seen a noticeable increase in referrals for patients with chronic midfoot and ankle osteoarthritis.

These are often patients who have exhausted traditional conservative care, have been told surgery is their next step, or have been advised that there is little more that can be done beyond ongoing symptom management.

Increasingly, they are being referred specifically for assessment and treatment with our recently introduced HIRO TT Laser Therapy System.

While surgery remains an important option for many patients, particularly those with severe structural degeneration, our experience is demonstrating that there may be another step worth considering before proceeding down that pathway or for those who have already undergone surgery without achieving the desired outcome.

The Challenge of Midfoot and Ankle Osteoarthritis

Midfoot and ankle osteoarthritis can be particularly debilitating.

Unlike larger joints, these regions are subjected to repetitive loading throughout the day with every step. Even relatively small changes in joint health can result in significant pain, stiffness, reduced walking tolerance, impaired balance, and loss of independence.

Many patients describe a gradual reduction in activity levels. They stop walking for exercise, avoid social outings, withdraw from family activities, and begin planning their lives around pain.

While imaging often confirms arthritic change, the severity of symptoms frequently exceeds what would be expected from structural findings alone. In many cases, persistent inflammation, altered biomechanics, soft tissue dysfunction, and sensitised pain pathways all contribute to the patient’s presentation.

Introducing the HIRO TT

The HIRO TT represents a significant advancement in therapeutic laser technology.

Developed by ASA Laser, the system delivers up to 3000 watts of peak power through a crystal-focused Nd:YAG laser platform combined with an integrated Smart Cooling system.

Importantly, this is not about suggesting that lower-powered laser therapy does not work. Photobiomodulation has an established role in musculoskeletal care.

Rather, the HIRO TT allows treatment to be delivered more efficiently, at greater depth, and across larger treatment areas than many conventional systems.

From a clinical perspective, this enables us to address not only the arthritic joint itself, but also the surrounding structures that commonly contribute to ongoing symptoms, including:

• Joint capsule inflammation
• Synovitis
• Tendon overload
• Muscle guarding
• Bone marrow stress responses
• Neurogenic pain components

What We Are Seeing Clinically

The early results have been encouraging.

Patients who have been living with persistent pain for years are frequently reporting meaningful improvements in walking tolerance, standing tolerance, activity levels, and overall quality of life. This is all happening within two to three weeks, not months, and with no pain or recovery required.

Importantly, our goal is not always complete pain elimination.

For many patients, reducing pain from an eight out of ten to a three or four out of ten can be life changing.

Being able to walk around the shops again, spend time with grandchildren, return to golf, maintain employment, or simply participate more fully in family life can have a profound impact on wellbeing.

These are the outcomes that matter.

These patients still have arthritis on imaging.

They still have structural changes.

What has changed is their ability to function.

Integrating Technology with Comprehensive Care

The HIRO TT is not used in isolation.

Every patient undergoes a comprehensive assessment, with treatment plans often incorporating:

• Biomechanical assessment
• Footwear modification
• Orthotic management
• Rehabilitation and strengthening
• Load management strategies
• Injection therapies where indicated, including PRP, prolotherapy, peri-neural injections, and corticosteroid injections

Our objective is to identify the factors driving symptoms and provide the most appropriate combination of interventions.

A Referral Option Before Surgery

Perhaps the most exciting aspect of what we are seeing is that some patients who believed surgery was inevitable are now able to delay, defer, or reconsider that pathway.

This does not mean surgery is unnecessary.

Rather, it provides another option for patients seeking symptom relief and functional improvement before committing to a surgical intervention.

As clinicians, we recognise that not every patient will respond.

However, the consistency of the improvements we are observing in complex midfoot and ankle osteoarthritis cases has strengthened our resolve to share these outcomes with GPs, physiotherapists, allied health practitioners, and medical specialists throughout the region.

Looking Forward

Chronic osteoarthritis management remains challenging. Yet advances in technology continue to create opportunities to improve patient outcomes.

The introduction of the HIRO TT at Shellharbour City has added another valuable tool to our chronic pain management pathway, particularly for patients who have exhausted traditional conservative options but are not yet ready, willing, or suitable for surgery.

For referrers managing patients with persistent midfoot or ankle osteoarthritis, we welcome discussion regarding whether this approach may be appropriate.

Sometimes the goal is to avoid surgery.

Sometimes the goal is simply to help a patient walk further, move more comfortably, and regain part of the life that pain has taken away.

Both outcomes are worth pursuing.