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Breaking 'heel spurs'

Discussion in 'Biomechanics, Sports and Foot orthoses' started by house, May 21, 2014.

  1. house

    house Member

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    Hi there, havent posted much but quite enjoy following the threads here!

    Recently I've had a few patients go and see a 'sports' massage therapist in Echuca (Victoria) who touts wonderful claims of being able to 'break heel spurs' and heal chronic heel pain.

    Now, I'm sure some of these patients never had spurs anyway, but this doesnt seem to bother the guy. Using a solid wooden rod type thing, he puts deep pressure into the area of most pain :craig: which he claims breaks the spur and solves the heel pain. Of course there's no radiolologic evidence is there?

    This just sounds downright false to me, but the guy has his supporters ("it worked for me") who keep referring people to this quack masseuse. Are massage therapists registered or under some governing body that could deal with this guy?

    This is may be more of a grumble but also wondering how you might best deal with these kind of 'practitioners'.. I considered posting a google review for him warning people off..

    Anyway, thanks for reading my rant!
  2. The late Jack Morris, DPM, one of my Biomechanics Professors at CCPM during my Biomechanics Fellowship, said he used the round end of a ball-peen hammer to break heel spurs in patients. I saw him do it once at the CCPM clinic (after I bugged him for months to try one out at CCPM so I could see it). This was many years before Extra Corporal Shock Wave Therapy came to become popular for treating proximal plantar fasciitis. By the way, the patient he did this on was pain free in about a month. Certainly wouldn't rule trying to "break heel spurs" since it may work in some patients....but if it makes it worse, you may want to have a good attorney close by.....;)

    Here is what a ball-peen hammer looks like (don't know if this term translates across the Big Ponds).
  3. Craig Payne

    Craig Payne Moderator

    This might explain it:

    Dunning–Kruger effect

    In the field of psychology, the Dunning–Kruger effect is a cognitive bias wherein people of low ability suffer from illusory superiority, mistakenly assessing their cognitive ability as greater than it is. The cognitive bias of illusory superiority derives from the metacognitive inability of low-ability persons to recognize their own ineptitude; without the self-awareness of metacognition, low-ability people cannot objectively evaluate their actual competence or incompetence.[1]

    Conversely, highly competent individuals may erroneously assume that tasks easy for them to perform are also easy for other people to perform, or that other people will have a similar understanding of subjects that they themselves are well-versed in.[2]

    As described by social psychologists David Dunning and Justin Kruger, the cognitive bias of illusory superiority results from an internal illusion in people of low ability and from an external misperception in people of high ability; that is, "the miscalibration of the incompetent stems from an error about the self, whereas the miscalibration of the highly competent stems from an error about others."[1]

    1. ^ a b Kruger, Justin; Dunning, David (1999). "Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments". Journal of Personality and Social Psychology. American Psychological Association. 77 (6): 1121–1134. CiteSeerX accessible. doi:10.1037/0022-3514.77.6.1121. PMID 10626367. 
    2. ^ Burson, Katherine A.; Larrick, Richard P.; Klayman, Joshua (2006). "Skilled or unskilled, but still unaware of it: How perceptions of difficulty drive miscalibration in relative comparisons". Journal of Personality and Social Psychology. American Psychological Association. 90 (1): 60–77. doi:10.1037/0022-3514.90.1.60. hdl:2027.42/39168. PMID 16448310. 
  4. Orthican

    Orthican Active Member

    "Dealing" with these type practitioners is a bit of a double edge sword.
    For you to be irritated at the audacity of his claims and voicing it publicly means downplaying his supporters and alienating them and suggesting his claims that they who feel better and do are in fact not or are mislead somehow. Can we blow off easily those who were helped?

    But No, I do not cater to the confirmation bias inherent in the testimonial either. But to those lucky enough to feel better post treatment how can we the critic after the fact say it was wrong for them? I see the folly in it too but also see the point Kevin was making.

    Who are any one of us to determine the be all end all that is curative of problem and symptom in every individual? There is always as I have come to know something to be learned in even the most asinine of assertions. For with every assertion there was impetus. And in that there is always reasoning behind it looking for a solution to something. It just depends on how we the onlooker choose to see it.
  5. house

    house Member

    I can just imagine how my patients might look at me when say "Now, I'm just getting the hammer out from my workshop to fix your heel spurs" ;)

    I like your observations on the situation Todd- quite philosophical! I guess people with debilitating foot pain will try (almost) anything to get relief.. Wonder why so many are so reluctant to get orthotics then...
  6. Orthican

    Orthican Active Member

    Yes they will try anything. It is the main reason for the multi million or billion dollar? internet foot orthosis market and by the way Dr. Scholl's has made a killing in this very market by providing off the shelf widgets for the self diagnosing individual with foot pain.

    I firmly believe people are reluctant to get foot orthoses because of confirmation bias. If someone else has a bad experience then foot orthotic must be bad is the type of thinking. And if you really think on it what is the most numerous foot orthosis use out there that people use to gauge foot orthosis success on? I can tell you it is not my group and it is not yours. The vast majority of people will use everything from drug store inserts to home show know it alls to chiropractors looking to pad a bottom line. People try that stuff first it seems before seeking anyone out with some actual specific training and expertise in this area. I used to think cost was part of the issue. But then I see the home show guy selling pre fab 3/4 inserts of polyethelene and calling them "custom" and selling them for four hundred dollars. Appalling yes but the interesting bit is people are willing to pay it. So I do not feel cost is the factor driving reluctance in the bigger picture. I feel perception might be a branding issue with the rest of us. People need to know a podiatrist can help them better than self diagnosis or the druggist.
  7. Lab Guy

    Lab Guy Well-Known Member

    I believe a deep penetrating (but painful) massage to the plantar heel with a wooden roller is a great idea as it has the potential to convert a chronic injury to an acute injury and therefore activate healing (much like extra corporeal shock wave therapy that costs thousands).

    If the massage does not work, what is the chance that the patient will be worse off for it? If I had chronic heel pain, I would try the massage versus a plantar fascia release (or the extra corporeal shock wave therapy to save money).

    In an n=1 study, I had chronic rotator cuff syndrome for two years until I had a deep but painful massage from a sports massage therapist. It has been over a year and my shoulder is still feeling so much better.

  8. Ian Drakard

    Ian Drakard Active Member

    I don't necessarily have a problem with the treatment- use soft tissue work all the time for heel pain caused by FDB, QP etc. I mostly use my hands but then I'm going to be crippled by 50 so the wooden roller probably quite smart ;)

    Just don't see why they'd think this is to do with 'breaking' heel spurs. As a massage therapist they must have experience of using this type of technique in other areas of the body where there is no question of a spur exisiting, so why propose this as a method of action in this case?
  9. Lab Guy

    Lab Guy Well-Known Member

    don't see why they'd think this is to do with 'breaking' heel spurs. As a massage therapist they must have experience of using this type of technique in other areas of the body where there is no question of a spur exisiting, so why propose this as a method of action in this case?[/QUOTE]

    I think its just marketing lingo to grab the attention of laypeople and increase business but at the expense of his integrity. If the powers to be found out, I am sure they would put a stop to the therapist saying he is breaking spurs. The therapist also sets himself up for possible lawsuits and should be stopped from giving an erroneous explanation.

  10. PodAus

    PodAus Active Member

    Traditional Chinese Medicine 'cure' for Heel pain... hit it with a hammer...

    Along, long time before shock wave 'hammers'... and PRP...
  11. Paul Bowles

    Paul Bowles Well-Known Member

    We are just putting together some data to publish on this from 2012/2013 - all were prescribed stretching and what I would call "massage" techniques, rolling foot on frozen plastic bottle, rolling pins, golf balls, tennis balls etc..... I'm not going to give away the punchline suffice to say all may not be what it seems - very large proportion who had pre intervention US (same radiologist) showing no intrasubstance tear showed a positive intrasubstance tear on US (by same radiologist) post 8-12 weeks.

    So you ask what chance will the patient be worse off after deep tissue massage to the fascia ? I would say alot......

    So much so in fact clinically we have gone away from research recommendations about stretching and have not introduced it as a first line treatment. We still do use some techniques later down the track but initially its become a no go zone in our clinic.
  12. PodAus

    PodAus Active Member

    Interesting Paul.
    Any idea where it will be published?

    'Before - After' Imaging really is kicking goals with assisting the re-implimentation of natural medicine.... helping us understand the Biologics of it all.

    Looking forward to the revision of appropriate clinical evidence-based protocol.
  13. Ian Drakard

    Ian Drakard Active Member

    This might count as giving away the punchline but what were the symptom changes over that time and beyond, and was there further US follow up after the 8 weeks?


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