Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Foot orthotics for growing pains

Discussion in 'Pediatrics' started by NewsBot, May 2, 2015.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

    Members do not see these Ads. Sign Up.
    Effect of Foot Orthoses on Children With Lower Extremity Growing Pains
    Hong-Jae Lee, MD, Kil-Byung Lim, MD, JeeHyun Yoo, MD, Sung-Won Yoon, MD, and Tae-Ho Jeong, MS
    Ann Rehabil Med. 2015 Apr;39(2):285-293
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. drhunt1

    drhunt1 Well-Known Member

    Appears that the Koreans are pursuing this problem wholeheartedly. A couple of comments are in order. First, I wonder if Angela Evans will attempt to discredit the researchers because they didn't R\O cancer or infection. Second, the researchers reported favorable results in 1-3 months. In our group of patients, symptoms resolved in 2-3 days with 100% resolution. They did, however, try to quantify their patients foot condition, which is helpful to the reader.
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    No need to discredit the authors; the study carries so little weight as there was no control group. All of the improvement could easily have been due to natural history/placebo.

    And this:
    Does not sound like typical growing pains. ie 7 subjects had the pain the the sole of the foot; six anterior knee pain!
     
  5. drhunt1

    drhunt1 Well-Known Member

    And what "control" group/methodology would you suggest?
     
  6. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Seriously? Research methods 101; you randomize the subjects to the intervention or a placebo/sham/no treatment so you can sort out treatment effects from natural history/placebo.

    There are a zillion examples in the literature of uncontrolled studies showing big effects, but when the controlled studies were done, the effect was not there or was very small.

    That does not mean that there was no effect in the above study. I would love it if foot orthotics work in growing pains; I just not going to hang my hat on the above study or base it on the wishful thinking fallacy.
     
  7. drhunt1

    drhunt1 Well-Known Member

    I like my idea better. Take subjects with GPs and treat them with proper orthotics. Then take the treatment, (orthotics) away and observe if the symptoms return, and if the symptoms are similar to what they experienced prior to treatment.
     
  8. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Nope; in the hierarchy of the quality of evidence from different study designs, withdrawal types of design are near the bottom. That type of design can not be used to distinguish causation from coincidence and it could still be due to placebo/Hawthorne type issues.
     
  9. drhunt1

    drhunt1 Well-Known Member

    And your approach makes absolutely no sense=Randomized tests on asymptomatic patients compared to those with GP's. Balderdash. Tell me how THAT works, Craig.
     
  10. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I have no idea what you are talking about. A randomized controlled trial on the use of foot orthotics in kids with growing pains would be easy!
     
  11. Rob Kidd

    Rob Kidd Well-Known Member

    It is at times like this, one has to remember that one does not represent the whole - or at least one hopes so. The lack of EVEN the most BASIC research knowledge in the last few post scares me. As Craig put it, this is research Methods 101 - that I had assumed that every university in the word taught its students. As it happens, at Curtin Uni, where I started in Australia 25 years ago, this was exactly what it was called and this was certainly a part of its content. What is worrying is this. One of my predecessors at Curtin had NOOSR (National overseas skills recognition... forgotten what R stands for) benchmark DPM against the "UK degree". The answer came back as "Postgraduate Diploma". And there in lies the worry - at two levels. First, We are seeing at least one example grad of a DPM course that has essentially no cognisance of research methods, and secondly, a profession at large that seems to think it superior to the "UK model". Drawing board time, I think.
     
    Last edited: May 3, 2015
  12. Bug

    Bug Well-Known Member

    Has to be said.

    [​IMG]
     
  13. drhunt1

    drhunt1 Well-Known Member

    Burdened by their Methodology 101, but unable to even take plain film radiographs on a rudimentary examination of any patient, The Land of Oz raises their collective heads and voices disdain towards others that can. Perhaps that's why no one from Australia figured out a problem that was 192 years old. Perhaps that's why a Yank did.
     
  14. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    WTF has that got to do with you not understanding how a randomized controlled trial for foot orthotics for growing pains would work?
     
  15. :D ....
     
  16. Craig Payne

    Craig Payne Moderator

    Articles:
    8
  17. drhunt1

    drhunt1 Well-Known Member

    Oh, please! While I can easily imagine how a study comparing GPs vs non-painful subjects could be conducted to test symptoms, the whole idea of testing efficacy of orthotics on that same cohort escapes me...way too many variables. Even Angela Evans didn't have a control group in either of her published articles in 2003 or 2008. The inability of any of you defending her to address her written concerns towards my article when she brought up the potential for practitioners to miss Pediatric cancers, (even though she didn't discuss them either), is the reason I mentioned Australian Pods not having radiographic capabilities. Hope this helps.
     
  18. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    ..and Angela's studies get weighted accordingly because of that. What is wrong with that?

    I still do not understand why you think its not possible to do a RCT on foot orthotics in growing pains?
     
  19. Bug

    Bug Well-Known Member

    While I have no desire to move this off it's current topic, I feel the need to correct your misunderstanding. Not only do Australian podiatrists have the ability to refer for x-rays, we can refer for films up to the hip (long leg films) at no cost to the patient under the Australian health system (MBS). We can refer for ultrasounds under the same scheme and we can also refer for MRI's however these did attract a patient charge.
     
  20. I was really confused as well , When I left OZ 9 years ago all of that was available but thought best not to comment without doing any research
     
  21. drhunt1

    drhunt1 Well-Known Member

    So what does orthotic therapy "treat" in an asymptomatic foot? You claim you can easily create a control group to test orthotic therapy. OK, so what does that prove? These are not double blinded tests used by Big Pharma where a placebo can be utilized to test efficacy. And even in those studies, the researcher(s) gather subjects that ALL have the symptoms, eg., HBP, etc. Utilizing mechanical devices to test/treat pain does not lend itself to the same criteria as those used in other studies. But I'll bite...tell me/us how you would set that up...better yet, do it yourself...I already stated in my article that more data points are needed...this is your chance to test my hypothesis.
     
  22. drhunt1

    drhunt1 Well-Known Member

    So, did Angela Evans order lower extremity radiographs on all of her ~180 test subjects prior to measuring navicular drop to R/O cancer? Did she order CBCs on these same test subjects prior to including them in her 2008 paper to R/O infection, (I'm assuming from a hematogenous source)? Why do I speculate she did not?
     
  23. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    But they are NOT asymptomatic --> they have growing pains!!!!!

    Here is what one would probably have to do:

    1) Recruit kids with growing pains; there is a pretty good consensus around the clinical criteria for them, but it would need to be tightened up compared to the study above, as I suspect a lot of there subjects were not classified a true growing pains; a sample size calculation would need to be done (without doing so, but my best guess is that you would need around 60 - 30 in each group)

    2) They would be assessed on the primary outcome measure and maybe some secondary and social/demographic data. The primary outcome measure would have to measure pain intensity, duration and frequency - and maybe impacts on QoL. It would be good if a preliminary study could look at the psychometric properties, reliability and sensitivity to detect change of these measures.

    3) They would then be properly randomized to one of two interventions:
    a) A foot orthotic with design parameters that induce the kinematic and kinetic changes that are speculated to be associated with the growing pains.
    b) A sham/placebo foot orthotic that does not have the design features that induce kinetic or kinematic changes (this group would be "lied" to to make them believe that a "special" insole is being tested - all participants need to believe that they are in the treatment group ie they are blinded to the intervention)

    4) At a couple of selected endpoints (eg 1 month and 3 months) they are reassessed on the primary outcome measure - this is preferably done by someone who is not familiar with which intervention group they are in; ie they are blinded --> study is double blinded

    5) Analysis starts with comparing all measures between the two groups at baseline to assess success of randomization. Primary outcome measure is then compared doing a between groups analysis at the selected endpoints.

    I do not see what is difficult to understand about that?
    It will 'prove' if orthotics work or not in growing pains!
    It is double blinded!
    Yes; but they only mainly focus on the primary outcome measure.
    Yes it does! There are plenty of studies that have used placebo/sham/orthotic with minimal effects as a placebo. Have you read those studies?
     
  24. drhunt1

    drhunt1 Well-Known Member


    Most competent Podiatrists KNOW that orthotics successfully treat growing pains...you would be hard pressed to find an astute Podiatrist here in the States that didn't agree with that. The big change that my study produced, (besides the cutting edge manner in which I approached the description), is now we know WHY they occur and from WHERE. Further, my study draws the direct pathologic/neurologic/anatomic line between GPs in children to RLS in adults...something that has never been accomplished previously.

    Tell you what...go ahead and create your own study on this subject and use your own approach/study criteria...it seems as if you've nothing better to do. Think of how much credibility on these boards you'll attain, (don't forget to order X-Rays and CBC's on all your subjects, otherwise you might be vilified by Angela Evans). Good luck with that, Craig...let me know how it works out.
     
  25. J.R. Dobbs

    J.R. Dobbs Active Member

    Ain't he just the best. That's my boy.
     
  26. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Your failure to grasp research methods 101 is astounding; as is your use of the whole gambit of logical fallacies! I repeat what Cylie posted above:

    [​IMG]
     
  27. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    To expand on this with an eg; to claim this:
    ..is not evidence! It is the logical fallacy of Argumentum ad populum.
    Orthotics may or may not work with growing pains (I really hope they do), but to apply the Argumentum ad populum to support it is an epic fail, and is NOT evidence.

    All homeopaths think homeopathy works and that water memory is real. The evidence says otherwise.
     
  28. drhunt1

    drhunt1 Well-Known Member

    Read my article....then formulate your own study and follow suit by whatever means that floats your boat. I've given the world a viable explanation, and in doing so, given you a target by offering the diagnostic tools to prove me right, or wrong. Go big, or stay on the sidelines.
     
  29. drhunt1

    drhunt1 Well-Known Member

    Did you ever answer the question I posed to you? Didn't think so. Oh well....just another day in the trenches.
     
  30. You keep making these claims, so far many have been shown to be false and basically made up on the spot.

    Craig has even given you the study design, you need to test your hypothesis and publish the results in a peer review journal.

    If they prove the hypothesis you have stable ground to back up some of your claims, now your head is covered by quicksand and everyone has moved on.

    Shouting and making made up claims doesn't work.

    Now I expect a strawman response to keep the theme going so I will repeat the basis of the post

    Go and test your hypothesis in the study design Craig has set out for you
     
  31. Ros Kidd

    Ros Kidd Active Member

    Craig would you need Ethics Committee approval for that design?
    Regards
    Ros
     
  32. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Yes........
     
  33. drhunt1

    drhunt1 Well-Known Member

    Craig has merely given ONE study "design" approach to solve the mystery...there are others. However, I don't like his suggestion that "placebo" orthotics are used for treatment. WTH is a placebo orthotic? In many of the cases I have seen in my office, generic/pre-fab insoles can be effective in treating these pains...and I wrote to that effect. In my pilot study, I took a more direct route and am comfortable suggesting that no matter what the design may be, the results would be quite similar. Most people have not moved on, btw, (The Myth of Growing Pains thread with over 3600 hits)...and the simple fact you're still here arguing about the process is indicative of the push-back I predicted. You suggest that I'm "making stuff up on the spot". Really? Tell me where I've done that? Tell me when/how I appear to be making it up, and I'll address your concerns in a, hopefully, professional manner, at least more so than writing, (one cannot 'shout' on the IT), drive-by criticisms as many have done here.

    You seem to forget that this article was 5 years in the making...the data collection ended years ago, (one follow-up interview was two years after the original). Further, the content was reviewed by Dr. Valmassy, of which no further introduction/explanation is required. Yet it appears you want ME to use Craig's design to further the study? LMAO! I've had dozens of patients since I concluded writing the article...all with the same positive results. My name is forever attached to this work...and its findings, and I am completely comfortable with that. But let me offer another perspective from a Podiatrist here in the States when he responded to Angela Evans' 'genuflex' reply on PMN:

    [RE: The Myth of Growing Pains (Angela M. Evans, PhD)
    From: A. James Fisher, DPM

    “Growing pains” is a misnomer, and in my opinion, a myth. Dr. Sciaroni does a pretty good job introducing the subject, giving credit to those who have actually researched it. Dr. Sciaroni even says that more research needs to be done; he even has a suggestion for a biomechanical treatment—a treatment that I personally have used on myself (so I do not have to use oral meds now) and found it very helpful in patients (they do not need meds now either). This so criticized paper is just the beginning of a discussion.

    When I did cancer research, a study as low as five was common; and decisions on vital, life-saving treatments were at stake. I am not saying that we should not criticize, because we should always be skeptical; but at least Dr. Sciaroni addressed a problem, developed a viable hypothesis, and produced a study, however small, that supported his hypothesis. The big sin is he had the temerity to publish it knowing, and even hoping, that he would be criticized.

    A. James Fisher, DPM, Crescent City, CA]
    _____________________________________________________________________________________________________________________________

    Positive patient outcomes...isn't that why we are practicing, or is it more important for you to pick apart the work of others while sitting on your derriere? Read Dr. Fisher's last line...he, indeed, is correct.
    __________________
     
  34. Ben Lovett

    Ben Lovett Active Member

    Hi Dr Hunt, forgive me if you've addressed this elsewhere but I'm at a loss to understand why you didn't publish in JFAR, JAPMA or even JBJS if the work is so seminal and the methodology so robust.

    It seems to me that part of the point of publishing in a peer reviewed journal is that you don't get to choose who reviews your work (or even find out) and they in turn don't feel obliged to tell you what you want to here. Therefor review by your mates (even if they are Ronald Valmassy) just dosn't carry the same weight.
    It just seems a shame that having expended so much time, effort and money on this project that by publishing in a management magazine as opposed to a peer reviewed journal the work simply doesn't carry the weight that it perhaps otherwise could. I would guess, for instance, that it would be unlikely to alter the outcome of any systematic review of the management of GP as the lack of (proper independent) peer review would suggest that the risk of bias would be too high for inclusion.

    Regards

    Ben
     
  35. drhunt1

    drhunt1 Well-Known Member

    Ben-good question. It was on the advice of my other reviewer, a Vascular/Thoracic Surgeon that became CEO/President of the largest hospital organization in central California that I chose the PMM forum. It was his thought that I should get the info in the "public" domain as quickly as I could. Having had experience with the Journals you mentioned, I knew that it would take too long. Had I begun that process sooner, I would've had the info published long before now in a peer reviewed Pub Med Journal. You must also realize that I had intended for this project to be targeting medical gatekeepers, ie., Pediatricians, GPs, IM Specialists, Neurologists, etc, that could/would eventually funnel patients into Podiatry offices.

    One more thing...prior to my contacting Dr. Valmassy to review this work, I had seen him only one time at a conference in Squaw Valley...so it's not as though we were on any terms other than student/teacher. While that may not fit the criteria for true peer review, it allowed me to move forward to have the article published. I only wish I had moved quicker...I've had this info and made the connections YEARS ago. However, having Valmassy's "seal of approval" earlier would've meant sending the article to someone unknown to fit the peer review criteria with a lot more confidence. Sometimes being 'first to market' trumps the venue.
     
  36. drhunt1

    drhunt1 Well-Known Member

    As I have stated before: case studies are pretty much middle of the road science...but in the case of biomechanics, it is what is prudent, necessary and available. IMO, biomechanic studies are not amenable to research heirarchies above this approach. In my case study: The independent variable is the use of orthotics, the dependent variable is resolution of symptoms, the control is taking the orthotic away and documenting that the symptoms return. Pretty straight forward, actually.
     
  37. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Letter to the Editor:
    Growing pains in children: solved and resolved.
    Simon MW.
    Clin Pediatr (Phila). 2015 Jun;54(7):706
     
  38. drhunt1

    drhunt1 Well-Known Member

    "I have observed that children with growing pains uniformly
    have flexible flat feet. The pain resolved with the
    combination of a full length arch support and calcium
    supplementation. Insoles may improve the mechanical
    instability that may contribute to growing pains."

    The full length arch support is the answer, (depending, of course, on the degree of correction)...the calcium supplementation is unnecessary, IMO. Further, most kids at 6 years of age have flexible feet, so without being able to access the article, (and refusing to buy it), I can't determine by what method the author categorized pes planus. Even Evans, in her follow-up study results in 2008, refuted her previous findings of pes planus being the causative factor after viewing 8 cases, published in 2003.
     
Loading...

Share This Page