Original Research Effect of Pulsed Nd:YAG Laser in the Treatment of Neuropathic Foot Ulcers in Children with Spina Bifida: A Randomized Controlled Study Anwar Abdelgayed Ebid, PhD, PT, 1 Ehab Mohame Abd El-Kafy, PhD, PT, 2 and Mohamed Salaheldien Mohamed Alayat, PhD, PT 3 Abstract Objective: This study assessed the effects of pulsed Nd:YAG laser treatment of neuropathic foot ulcers in children with spina bifida. Background data: Children with spina bifida face increased risk for developing neuropathic foot ulcers. Methods: In a randomized controlled trial, 39 children and adolescents (ages 6–15 years) with spina bifida and stage III neuropathic foot ulcers were randomly assigned to the laser group or the placebo laser group. The former received pulsed Nd:YAG laser treatments (i.e., total energy of 300–350 J during three sessions/week) plus standard wound care, and the latter received sham laser treatments plus standard wound care. Wound size and wound appearance were assessed for all patients at the beginning of the treatment, after 5 weeks, and after 10 weeks. Results: The decrease in wound surface area at 5 and 10 weeks post- treatment was significantly greater in the laser group (i.e., 2.44 – 0.33 and 0.29 – 0.25 cm 2 , respectively) than in the placebo group (i.e., 3.81 – 0.18 and 3.24 – 0.44 cm 2 , respectively). Also, the decrease in the total score for the Pressure Sore Status Tool (PSST) at 5 and 10 weeks post-treatment was significantly different for the laser group (i.e., 32.76 – 2.30 and 17.52 – 1.66, respectively) than for the placebo group (i.e., 46.50 – 2.12 and 38.11 – 3.17, respectively). Conclusions: Treatment with pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser combined with standard wound care decreases wound size and improves wound appearance for stage III neuropathic foot ulcers in children with spina bifida. Introduction S pina bifida is a congenital birth defect in which the caudal neural tube fails to develop or close properly in the fetus during the first trimester of pregnancy; this condition is related to multiple causes and encompasses a broad range of abnormalities. 1 Children with spina bifida often have difficulty with lower body mobility, loss of bowel and bladder control, hydrocephalus, learning disabilities, and latex allergies. 2 Neuropathic ulcers are typically painless skin lesions or ulcers that often develop on weight-bearing surfaces (e.g., the feet) and are usually associated with loss of feeling in the lower extremities with such conditions as spina bifida, lep- rosy, diabetic neuropathy, and spinal cord injuries. Although these ulcers arise in a variety of unrelated disorders, all of these conditions involve a neurological disorder that results in loss of feeling in the sole and paralysis or weakness in the intrinsic muscles of the foot. Neuropathic ulcers can be deep or shallow and acute or chronic ulcers. 3,4 If left untreated, neuropathic ulcers can lead to serious consequences. The body’s wound repair process is not a simple linear process in which growth factors released by physiological events acti- vate parenchymal cell proliferation and migration. Instead, it is an integration of dynamic interactive processes involving soluble mediators, formed blood elements, the extracellular matrix, and parenchymal cells. 5 Lasers are sometimes used as unique tools for medical therapy and surgery. The laser application is useful because of its monochromaticity, which allows efficient coupling to the peak absorption of chromophores, thereby enabling maximal photoactivation and stimulation of biological processes. 6 Lasers produce photons, that is, packets of light energy, which are absorbed by photoacceptors on cell membranes. The neodymium:yttrium aluminum garnet (Nd:YAG) laser is used to provide high intensity laser therapy (HILT) and emits light at 1064 nm, within the invisible infrared part of the electromagnetic spectrum. This wavelength is highly absorbed in blood than in the surrounding tissue. As a result 1 Department of Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt. 2 Department of Physical Therapy for Disturbance of Growth and Development in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt. 3 Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt. Photomedicine and Laser Surgery Volume 31, Number 12, 2013 ª Mary Ann Liebert, Inc. Pp. 565–570 DOI: 10.1089/pho.2013.3533 565