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Podiatry, orthotics and Snake Oil

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, May 9, 2011.


  1. Members do not see these Ads. Sign Up.
    Feeling somewhat augmentative today...........

    Admin - changed the front page re snake oil threads. There was a discussion re Salesmen selling orthotics at the show?

    What makes a snake Oil salesman re orthotics - clearly Droopy eyelids fixed with insoles does in my book. But what does ?

    Does not knowing how the device works or the results of said device having on the mechanics of the foot mean that they are a `snake Oil salesman`? - if we are discussing say plantar fascia related issues.

    Does not having a Podiatry or not studying a degree/diploma in related foot biomechanics course mean your a `snake Oil salesman`?

    Is a `snake oil saleman`someone who makes claims on how and orthotic works?

    or is it the statics of results that make someone a `snake oil salesman`?

    Is a ´snake Oil salesman`someone who believes that 1 device fixes all ?

    I leave the questions for now - but make this statement - 70 - 80 % of Podiatrists and related medical professionals who issue foot orthotics are ´snake oil salesmen/women`

    the views written in this thread may or may not be the views of me personally, but the thread has been started as a point of discussion.
  2. BEN-HUR

    BEN-HUR Well-Known Member

    Well I'm not feeling argumentative, but I'll put my neck on the line & be the first to answer... despite the ambiguity & controversy this topic can potentially create I'm sure responses/discussion can remain civil & constructive...

    Certainly in part related to the point highlighted (red bold) above... as well as including the targeting of a personal/individual condition (symptoms) of a patient of which do not have a direct correlation with an insole or orthotic type therapy. Also, in short... making unsubstantiated & exaggerated claims which are beyond reasonable doubt beyond the scope of the foot device issued &/or field of knowledge of the person issuing the foot device i.e. fertility issues, affecting cellulite, increased circulation, dramatic structural changes i.e. scoliosis etc... there have been other referenced wild claims but I'll leave it at that.

    Hence (depending on one's definition), I do not believe that anything near “70 - 80 % of Podiatrists” (working within the legal scope of practice) fall into the above category... due to a Podiatry based orthotic being issued in relation to a substantiated correlated/related lower limb condition (i.e. foot structure) which is also known/observed to have beneficial causative affects to the issue/symptoms of concern.

    I should also state that Podiatrist do not own the field of orthotic therapy, hence other professions/individuals trained in biomechanics as well as trained assessing causative effects within the realm of orthotic therapy can also partake in this field of treatment. Here where the criteria gets fuzzy (subjective).

    Anyway, that’s a starter... & yes, I can see some potential holes which could be opened up & further critique.
  3. So is it snake oil until proven to be correct. say we take TMJ pain, pronation and orthotics- most would claim it´s snake oil but many claim there is a link- so is it snake oil or not - who is the onus on to prove snake oil or not ?

    How many just use the same script for all their devices - alot I would say. Any lab owners care to help here. If by using the same bent bit of plastic and saying it will help condition a,b,c etc is that selling the good Oil ?

    It is a point of discussion as is the finger pointing I ´m a Pod so I´m superior re orthotic devices and thanks for the short Post I must have adhd when it come to the long post.

    The major point is that we don´t really know how an orthoses work - we are moving forward towards greater understanding ( I hope ) but we as a profession do not really have all the answers yet
  4. Griff

    Griff Moderator

    Interesting discussion.

    Mike you are right - currently none of us fully understand how orthoses actually 'work' (still work in progress). Does this make us snake oil salesmen? I don't think so. Because we know they do work, so we use a combination of our current level of knowledge and our clinical experience to prescribe what we believe will be an appropriate and beneficial device.

    Is the clinician who prescribes the same prescription for every patient a snake oil salesman if all of their patients get better? And what about if their patients don't get better? Grey area for me that one.

    To my mind, a snake oil salesman is one who knowingly dupes the public, usually for relatively inflated fees, by providing a service that they may well know is useless/worthless. Hopefully 70-80% of the Podiatric community do not fall into this description...

    When it comes to the validity of claims made in science, the burden of proof lay with those making the claims. So if someone claims that orthoses improve flatulence then it is up to them to design, implement and publish the study which confirms this. Until then we are well within our rights to be sceptical about it. (or call it BS...)
  5. I would add to this the willingness to change the prescription if the response is negative ( this is really what I think )

    What makes it different from a salesman at the show saying these OFC device will work for all conditions ?

    fair point so is being naive a good enough excuse ?

    I agree, however how many studies are there that show x prescription variables work with x symptoms that you use daily ?

    playing lawyer for the devil
  6. DTT

    DTT Well-Known Member

    Mike et al

    I'm a Podiatrist not a Salesman !!!!!!

    I do not try and cold sell to the passing public.

    I am consulted by patients for my knowledge and expertise in providing them with an orthotic device (or not) to treat the symptoms they present with.

    I NEVER EVER SELL !! any patient that comes into me that I believe I can help will have all the reasons for that decision explained and all relevant information costs etc, and then told to go away and consider what I have said and if they want to proceed with that course of action.

    Then and only then will I proceed.

    Otherwise they will not get offered orthotics if clinically they don't require them.

    THAT IMHO is what separates me from a salesman they are there to flog you an orthotic at all costs whether you need them or not.
  7. BEN-HUR

    BEN-HUR Well-Known Member

    I presume you are not referring to Tarsometatarsal joint pain but referring to Temporomandibular joint disorder. Being a Podiatrist I have had nobody specifically come to me with this condition, & in the unlikely event they did (after say googling the possible orthotic linkage) I would refer them to someone like a Maxillofacial specialist (one of which has not long brought my old premises) & get his/her opinion first... & subsequent views of a possible link.

    If on the other hand someone like a Maxillofacial specialist referred to me for orthotic therapy & advised me of the possible link between the patient's TMJD & assumed evident pronated feet then I would think it worth a try.

    Also, I generally wouldn't regard this particular hypothesis as "snake oil" (at least not just yet)... only when it is beyond reasonable doubt that the conjecture has no validity what so ever.

    I don't. I presume you are referring to true custom devices - based on an impression/mold/scan of the individual's foot. Well by stating "using the same script" doesn't necessarily represent the same device i.e. same geometry (unlike off-shelf generic prefabs), shell deformation (due to MLA/ILA length) etc... Besides my scripts vary based on the circumstances associated with the individual before me (even if patient A & B had the same condition). Also the characteristics of some scripts may be similar because the management of the presumed underlying cause may be similar... the one presumed underlying cause may contribute to "condition a, b, c" etc...

    Not exactly sure what the above is meant to imply.


    I realize that you are probably playing the devil's advocate here (to some extent).
    Was the condition assessed by these salesman & an informed diagnoses given? Were other forms of treatment offered (other than orthotics)? I had four biomechanical assessments today - all of which had conditions which are targeted by the likes of the salesmen/company (i.e. "Foot Forward/ Alznner" devices) in question in that thread. None of these patients left my clinic with orthotics (i.e. prefab) or had a 3D model/prescription written for custom orthotics. That's not saying they may not in 2 -3 weeks time when we know the results of today's treatment & subsequently the possible effectiveness of orthotic therapy.

    The salesmen/company in question would sell you an orthotic/insole regardless (including the likes of my four patients today)... most likely even if someone was to walk up to them with TMJD (if they knew what it was) & gave the salesmen a clew with a suspected posture issue/linkage. I've seen the likes of this before.

    Good points.
  8. Matthew - where you ask not sure what this sentence imply I should have seperated them. Not saying anything about you as a Pod.

    Says more about my 2nd rate written skills.

    So it should have read . A poditry degree seems to make people believe they can finger point..... etc

    Thanks Matthew for the short post I tend to have adha with longer posts

    Sorry for the confussion no offence intended
  9. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks for the explanation - I was just curious (didn't want to misinterpret something).
  10. Greg Quinn

    Greg Quinn Active Member

    This is a really interesting thread. I suspect that as far as the UK is concerned there are a number of issues here.

    The profession of podiatry, despite honourable attempts, is not unfortunately strong enough to instill professional accountability when it comes to claims from its suppliers.

    Naturally enough, experienced clinicians adopt a healthy cynicism as a result. When products are claimed to have efficacy for particular conditions, this seems less than genuine as the variability of individuals responses may not always match those claims.

    The truth of the matter seems to be that many products do work extremely well and there are many credible and responsible companies that operate an EBP approach to their marketing claims. Others, incorrectly or inappropriately supplied, may offer no benefits or worsen pathology.

    Collectively we just don't seem to have sufficient evidence, as yet, to accept or absolutely reject apparently spurious claims. Sadly, supported by a general lack of professional understanding, some (few) companies will continue to exploit 'traditional' understanding of 'abnormal' foot posture to justify product claims. As with all health messages, filtering down to the general public involves a simplification to a straight forward message. That simplification is often perceived as a professional threat, particularly when it is not held up to scrutiny... introduce sales people with little or no substantial clinical experience and just a sales patter to follow... snake oil accusations are bound to follow.

    We all feel that for many patients, most products offer a potential advantage provided that they offer design features that configure with the needs of the patient... consequently, we use them and are correctly reluctant to reject their presence in the market. We just feel uncomfortable that they are marketed as a sinecure for all problems.
  11. That's a biggy. Although I'd say "if clinically I don't believe they need them.

    Here's my spotter guide for snake oil orthoses, some of which others have already mentioned.

    1. One design fits all. The "every foot needs supinating" or "pronation bad supination good" claims. People have different problems. It is not logical that every problem has the same solution. I'm reminded of my favourite piece of Orthoses marketing BS of all time, "over supinators are actually overpronators in disguise." No, no they're not.

    2. Claims for cure with no solid rationale / evidence. For eg, one can make a solid deductive case for, say, use of orthoses in knee pain, even outside the inductive evidence. The TMJ thing, although there is a link, has never been inductively shown and the kinematic data is simply not there to support a curative effect.

    3. Creating the need where none exists. You know the thing, "your child is fine now but they'll be in a wheelchair by 14 if you don't buy these". People who make claims for prevention of pathology where no evidence or rationale exists for its formation. Treating problems which don't yet exist.

    4. Excessive claims of certainty. As Simon often says, sometimes we get it wrong and don't know why. While there is a balance to be struck with maintaining patient confidence, I believe that people who make absolute claims of certainty of success are guilty of this one.

    They're mine. Just opinion.
  12. [​IMG]

    Saw this on another forum. Seemed relevant.
  13. Mike there are a number of issues here, not least:

    1. there appears to be an assumption that "training" yields better outcomes.

    As far as I am aware, this is untested.

    Despite their varying levels of "training" how many people can tell you definitively how foot orthoses work? Few, if any. If someone can't tell you how they work, how can they presume to know how to prescribe them? Moreover, how can they possibly know which clinical measures are needed to prescribe them? They may still pretend they do though. Is pretence a nice word for lying? If practitioners are unconsciously lying are they "selling snake oil"? "This foot orthosis will change the position of your foot"- really?

    A classic example of practitioners pretending to know what they are doing is the concept that heavier individuals require orthosis constructed from higher Young's modulus materials or greater shore/ durometer. Really? Then we have the premise that skeletal alignment predicts pathology. Except when it doesn't. "You are pronating by X degrees, so I need to use Y degrees posting" This is non-science. We also have the premise that foot orthoses do and/ or need to alter skeletal alignment to be efficacious. Except when they are efficacious without changing kinematics. All these are ideas that are commonly employed by "trained" practitioners. Yet all are questionable premises. I'm sure we could add to the list. In reality, the patient only needs to believe that the foot orthoses will help with their problem, in order for the foot orthosis to help with their problem.

    Psychological effects aside, foot orthoses can only work by altering the magnitude, distribution and timing of reaction forces acting at the foot-orthosis interface. They can only achieve these effects via three mechanisms: altering the geometry at the foot-orthosis interface; altering the load/ deformation characteristics at the foot-orthosis interface; altering the frictional characteristics at the foot-orthosis interface. These three factors are the design variables within a foot orthosis.

    Hands-up all those that understand the inter-relation of these design variables with the net ground reaction force vector? So, if you don't know how the design variables influence the net ground reaction force vector, how can you pretend to know how best to design foot orthoses to control the vector? Better yet, hands up how many people measure these 3 design factors within the devices they sell? How then can you compare the design characteristics of one device with another? I am not aware of any studies which have attempted to do this.

    Why does the same prescription in two different people sometimes have four different effects?

    2. there is an assumption that we have evidence that foot orthoses are efficacious.

    We have limited studies of good quality here. While positive outcomes may be obtained through the application of orthoses, these outcomes may be related to psychology (e.g. placebo and Hawthorn effects), and/ or the natural history of the pathology in question as much as they have to mechanical effects of the orthoses. Yes often they do work, but how? If it's just a case of the patient believing that they will work, then how does "training" come into it? How many studies "prove" that it is the foot orthosis which is efficacious and not some other factor?

    Indeed, if foot orthosis work as defined above, how can you study their efficacy in a controlled manner? Very difficult.

    3. there appears to be some assumptions of amorality in those selling foot orthoses at country shows.

    This is untested, as far as I am aware. If they believe the orthosis increases blood flow... then maybe they should prove it. And, if you prescribe an orthosis to reduce the mechanical stress on a specific tissue, then maybe you should prove that too.

    Moreover, several pharmacists sell foot orthoses without an assessment of the patient- are pharmacists "snake oil salesmen" too? Only if the patient doesn't get better- right?

    4. define selling?
    Orwellian language not withstanding: if somebody pays you for something, then you've sold them something- end of story.

    All I have time for.
  14. DTT

    DTT Well-Known Member


    Your back :D

    How are things ????
    Is mum ok ??
    Pm me and let me know mate many concerned by your absence
    Last edited: May 9, 2011
  15. Griff

    Griff Moderator

  16. DTT

    DTT Well-Known Member

    Sorry isnt that the same thing ????.....:D

    And my measure is by outcomes, I make people better , is there any better measure of outcomes??

    So I must be doing something right dont you think??

    Perhaps the research should focus on WHY that works rather than why we dont know ???

    Just a thought

    Last edited: May 9, 2011
  17. Joe Bean

    Joe Bean Active Member


    Tell the truth you have a machine that goes 'ping', Si told you it may all be about psychology, the ping effect.

    These county fair sales people have the same pinging machines.

    The purveyors of the pinging machines bombard pods in the UK trying to get them to sign up for a pinging machine.

    Obviously it would be incorrect to name the pinging machine.

    As far as 'proof of the way orthoses work 'WELL' any learned Pod graduate would understand?

    So how is the needling research going?
  18. DTT

    DTT Well-Known Member

    Hey Joe Troll :bang:

    the two scanners I have that I use for assisting in diagnosis are, a 3D optical Laser scanner made by Sharpe Shape and a Vertical loading pressure system made by RS Scans

    There is probably no point in trying to explain the usage and benefit to you as it would obviously be beyond your comprehension but if you have issues with either system perhaps you would like to waste their time by submitting more inane questions to them :wacko:

    Tell me my outcomes are different to the inuendo you suggest after one or the other or both have been in constant use for the last 8 years !! Oh have you bean qualified that long??? :rolleyes:

    Yep needling research is going well in the multicentre trial and is expanding to other centres ....sorry if your not included..but ....well .. no offence but im sure you understand :sinking:

    Last edited: May 9, 2011
  19. Can you tell me then?

    My mother is stable at present, difficulties with medication as the prescribed drugs are inducing migraines. Thanks for the thoughts.
  20. DTT

    DTT Well-Known Member


    Hey Buddy, good news she is recovering :drinks

    Bloody side effects of all these generic drugs :mad:

    If they used the full monty patient comfort would increase, BUT as usual its all about money:hammer:

    Keep me posted mate and if there is any questions you think I can help with ( from my former life) that your not sure about , please PM or ring me and I'll help all I can.
    My thoughts are with you.
    D ;)
    I'm down your way in a few weeks time... A pint or 3 ?????:drinks
  21. No, there isn't. Patients generally present with pain. Not a forefoot valgus, ankle equinus nor even posterior tibial tendon dysfunction, nor plantar fasciitis. They usually present with pain. Therefore the outcome measure of importance to them (patient centred approach- remember!) is a reduction in their pain.

    Practitioner: "Mrs Smith I can see that when you wear the orthotics your rearfoot pronation during gait has decreased by 4 degrees, your centre of pressure has moved 2mm medially during initial contact and the range of motion at your ankle joint has increased by 5 degrees in the sagittal plane at this time".

    "That's great sunbeam, but my pain has increased ten-fold".

    Practitioner: "But my training says I need to reduce you pronation, I reduced you pronation... I'll get my training manual".

    Patient: "you're a wanker, can I have my money back?"
  22. Admin2

    Admin2 Administrator Staff Member

    Snake oil (cryptography)

    In cryptography, snake oil is any cryptographic method or product considered to be bogus or fraudulent. The name derives from snake oil, one type of patent medicine widely available in 19th century United States.

    Distinguishing secure cryptography from insecure cryptography can be difficult from the viewpoint of a user. Many cryptographers, such as Bruce Schneier and Phil Zimmermann, undertake to educate the public in how secure cryptography is done, as well as highlighting the misleading marketing of some cryptographic products.

    The Snake Oil FAQ describes itself as, "a compilation of common habits of snake oil vendors. It cannot be the sole method of rating a security product, since there can be exceptions to most of these rules. [...] But if you're looking at something that exhibits several warning signs, you're probably dealing with snake oil."

  23. DTT

    DTT Well-Known Member

    Si you could have a row in an empty room :D:D

    How about :-

    Patient comes in in pain with any of the conditions you quote.

    Me, I boil them down into words THEY can understand so they have the idea of what I am trying to achieve.


    I give them all the options available to them ( in terms THEY can understand) and tell them to go away and consider where THEY want to go with it.=

    Patient : I do want to go ahead = they get the best I can give and leave here pain free. UNLESS I cant achieve that after exhausing everything I can offer ( happened 3 times in 20 years ) in which case I have refunded their money on the grounds "they pay me to make them better not to fail"

    Patient = I don't want to go ahead = their choice reiterate the other options and await their response

    Thats the way I do it so......

    Cheers Fella
  24. Griff

    Griff Moderator

  25. Single word answers tonight then, Griff? So, if you don't know how they work, how can you prescribe them with any degree of certainty to the outcomes that they might produce? Because your "trained"- right? How silly of me.
  26. I do, with myself on most evenings- just to try to work it out. Yet, you missed the bit where you take the money off them whether they buy the orthoses or not. You sell them your time and knowledge-right?;):drinks I'm with you though Del, try to be honest and upfront; make a reputation by making people better. Work as hard as you can to make them better. Admit defeat as a last resort. But give them their money back, if they ask for it.

    BTW, how do we know whether the knowledge we are selling them is worth it? The same way we "know that a custom device will be more effective than some generic off-the-shelf device"- Because we've been trained- right? Not for you Del http://www.youtube.com/watch?v=8vYeWckTc3c
  27. DTT

    DTT Well-Known Member


    Thats exactly the way I do it and I'm sure you and many other "professional" podiatrists go about thier daily working lives coz, aint we about making people better ? to get rid of their pain and improve quality of life ???

    If not

    WTF are you doing in this or any other health profession at the sharp end ??

    Outcomes as you rightly say are the ONLY palpable measure of performance which is :- to get rid of the pain !!

    Cheers Fella
  28. Lab Guy

    Lab Guy Well-Known Member

    I NEVER EVER SELL !! any patient that comes into me that I believe I can help will have all the reasons for that decision explained and all relevant information costs etc, and then told to go away and consider what I have said and if they want to proceed with that course of action.

    Then and only then will I proceed.

    Will you have patients if you come to work with yellow teeth, stained clothes, poor attitude, lack of knowledge, et? No, patients will leave your office.

    When you come to work looking and acting like a professional and exhibiting confidence in your ability and have the intent to help your patient then patients will come back to you. In effect, you have sold yourself to your patient.

    We are all salesmen and the most important thing we sell is ourselves. It is fine as well to sell products that we believe in to ensure our patients get the proper products. Salesman is not a dirty word.

  29. DTT

    DTT Well-Known Member

    I treat ALL my patients with the respect they deserve and communicate with them at a level they understand, and have done so for 23 years in this profession

    I practice at a professional level in all aspects and yes research the market for the best available products...to assist me in treating that patient, NOT to sell them anything apart from my knowledge and expertise, which I suppose is "selling myself" if that is the interpretation you wish to put on it, which has no bearing on the basis of the thread IMHO and does not make any practitioner that does that a Snake oil salesman!!

    Sorry I cant have the salesman bit...If they need it I provide it but only through the above, if they dont need it..they dont get it
  30. I've seen you work. The main thing you use in diagnosis is a helluvalot of experience, clinical judgement, and above all else, the fact that you actually listen to, and care about, what the patient is telling you rather than trying to cram them into a paradigm they don't fit into. That's a very important and often neglected part of a biomechanical assessment. As Simon said, too interested in measurements we don't understand and not interested enough in what the patient is telling us.
    But what they lack is the knowledge to use the data the force plate gives them, nor any other kind of knowledge or training. That's the difference, as you would know if you'd ever seen Mr Harland practice biomechanics, or knew anything of the amount of post graduate level training he has undertaken. Your post skates just this side of slander and is made without any actual knowledge of the practice you are so swift to criticise. As such you are wise to post anonymously.

    I wish I could properly express my contempt, but I'm tired, hungry, and very sore so I'll simply call you a cock and wish you good night. Please don't bother replying, I have no time to waste on you.

    Glad to hear your mum is stable Simon, sorry about the migraines. I can sympathise, I really can. Best wishes to all of you.
  31. LuckyLisfranc

    LuckyLisfranc Well-Known Member


    Round and round the mulberry bush we go again.

    I think we have beaten this issue to death now...for the nth time.

    I know there are many significant posters on this thread that have a bee in their bonnet about unscroupulous practitioners, podiatrists that prescribe the same device for everyone, and anon. But hey! look at the rest of organised health care.

    There are dodgy doctors, dentists, chiropractors - you name it. Welcome to the bell-curve of human behaviour as it applies to health care.

    Why does this forum frequently persist in this negative mindset of self flagellation! It makes it seem that 90% of podiatrists are 'dodgy' and 10% do the best they can - when the reverse is more likely the case.

    I am tired of hearing that we lack enough evidence to support claims around orthotics. This point was pretty clear 20 years ago when I graduated. Let's move on.

    I would be flat out even thinking for a moment that more than 1% of podiatrists in Australia could be considered 'snake oil' salesman. The vast majority are extremely capable, can actually make a proper diagnosis without resorting to fancy machines, and rarely use orthotics in isolation to other adjunctive forms of care. Perhaps this is a UK thing?

    Yes, we know other 'people' provide orthotics, even if they don't exactly know what they are doing. Every 2nd shoe store seems to these days. They have for 100 years. Next?

    Can we stop beating ourselves up and talk about something more productive, preferably more stimulating than the merry-go-round of orthotics can/can't do this or that. There's a lot more to clinical care than bits of plastic and EVA.

    Sorry, but Podiatry Arena is just becoming increasingly a negative experience for me....

  32. We may never know exactly how an effective medical treatment works. However, if we know the medical treatment does work with good predictability and it does work with few side effects then that medical treatment will still be considered to be safe and clinically effective by the majority of ethical and intelligent medical practitioners.

    Even though we may not know exactly how a medical treatment works, that should not preclude us from using that medical treatment for the benefit of our patients. In fact, not knowing exactly how a medical treatment works should place more pressure on the profession using that treatment to perform the necessary scientific reasearch that helps to illuminate the etiology of the beneficial therapeutic effects of the medical treatment in question. This is a sign of a mature and responsible medical profession.

    However, to make the claim that a medical practitioner is a "snake oil salesman" just because they don't know exactly how an effective treatment works, which is commonly used for their patients, is ridiculous. Does the medical profession know exactly how acetaminophen works to reduce pain in the body? No. Are all doctors who recommend acetaminophen for pain relief "snake oil salesmen"? No. They do know that acetaminophen in the correct dose can be a relatively safe and effective means by which to relieve mild pain. The medical profession has developed hypotheses that are scientifically coherent and are consistent with the known pharmacological characteristics of acetaminophen and the known physiological properties of the human species. However, the medical profesision is still not 100% sure of how acetaminophen exactly works, but we do know it does work well for most people for the relief of minor pain.

    In much the same way, the change in the magnitude, temporal patterns and locations of ground reaction force that result from placing foot orthoses inside shoes can be effectively used to explain the vast majority of known therapeutic applications for both over-the-counter and custom foot orthoses. Even though we don't know exactly how much of the known therapeutic effect of foot orthoses is a direct mechanical, a neuromotor or a psychological effect, I do believe that those of us who have speculated on this important topic within the scientific literature over the past two decades have as much of a firm scientific basis for our hypotheses as do the medical doctors who have hypothesized about the mechanisim of action of the pain-relieving effects of acetaminophen.

    In conclusion, I suggest that instead of worrying about what percentage of "snake-oil salesmen" are present within our profession, we would be better off spending our time reviewing the scientific literature for research studies that describe the therapeutic benefits and possible mechanisim of action of foot orthoses for our patients. Then, as ethical and responsible medical professionals, we should be using this time in a positive fashion to go out and educate the podiatry profession, the rest of the medical profession and the public on this scientific data and on the most likely hypothoses as to how foot orthoses provide their therapeutic benefit for our many patients. Don't you all think that this would be a more productive use of your "free time" than worrying about how many of your colleagues are "snake-oil salesman"??
  33. BEN-HUR

    BEN-HUR Well-Known Member

    Good points LL. Yes, I understand... "Podiatry Arena is just becoming increasingly a negative experience for me"... starting to feel this way myself. However, I'll keep following (when time permits) & choosing who's comments to take note of, who's comments (questions) to let slide by the wayside... as well as having the audacity contributing my non-evidence based opinions when questions of interest are asked on this education based forum. Heaven forbid if all ideas/hypotheses/theories had non-evidence base premises to work off & still survive in the daunting world of academia – oh hang on; there is... a popular one relating to the origin/development of life... & it’s survived for over 200 years! Crikey, if only this "world view" (conjecture) was allowed to have applied the same degree of scrutiny we see with orthotic therapy. Maybe there is still hope for orthotic therapy (custom & prefabs) to survive a bit longer. Anyway, now that I have probably ostracized myself a bit further away from the club, there may be a subconscious tendency in future to focus my energy & time to more rewarding/uplifting endeavours.

    I'll speak frankly. I quickly browsed through this thread before I rushed to work & based on what I read since my last contribution (along with experience in another related thread) I thought for a moment... what the @#$%!! am I doing with my working life? Is it just one big bl@@dy con? Am I really lying/deceiving people? Is it worth continuing down this path of therapy? Should I just ditch my clinically expensive custom orthoses practice & buy a big batch of prefabs (it would on paper be a lot cheaper).

    I saw my morning patients... each one walked out extremely appreciative of what I have done (albeit, a few were G.T's). My spirit was lifted... maybe I do have an impact... maybe there is some undiscovered wisdom in my methodology... maybe I have a lucky strike rate... or maybe I just fluked it... but where's the damn evidence that will satisfy the chronic naysayers :boohoo: who seem intent to question the integrity of the profession (& the members thereof) at the sake of their own ego. Maybe, we just need to be patient, ask the right questions & wait for research technology to catch up to find the pieces which fit the puzzle.

    I'm sure (confident) clearer evidence will come in the future. In the mean time I'll keep positive, be sure to do the best I can & keep up with the research... & one day maybe partake in it myself. Instead of criticizing, using generalised fictitious scenarios to substantiate one’s agenda & nit picking known ambiguous areas of which there are yet no clear answers to; why not as has been stated (from DTT)... “focus on WHY that works rather than why we don’t know” (p.s. careful with the use of caps there DTT, unless you’re given deemed appropriate forum etiquette leniency).

    My afternoon patient today (who is a regular G.T client) told me that his heel remains pain free. Not wanting orthotics due to a pass experience, I advised him over the course of a few regular G.T treatments of non-orthotic ways to alleviate the pain – none seem to work. Subsequently I later issued orthotics & the pain was gone within 36 hours (he even called me up to state it). Being an educated person, a bona fide sceptic & one I can speak quite openly to; I relayed to him the expressed views found on this thread pertaining to i.e. “no evidence”, “snake oil” etc... He couldn’t care less – his pain was gone thus “hardly snake oil”... & my approach & reasoning behind the therapy sounded quite logical to him. Yet I understand this has little credence to some (many); however, it at the very least tells me that those customised “pieces of plastic” (with EVA) did something beneficial (or did they?). Hence I think I’ll continue to take my chances in this mysterious realm of therapy.

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