Are Podiatrists snake oil salespersons?

by admin on February 2, 2010

One thing you quickly learn about the barefoot running community, in general, is that they are very sensitive to criticism and cannot engage in rational discussion about the issues (more on that later). Instead they resort to name calling and use other diversion tactics, which is a classic sign of people arguing from a position of weakness. One classic line I came across recently was a barefoot runner trying to defend barefoot running from a criticism by calling Podiatrists the biggest snake oil salesmen of all time (they should have said salespersons!). Typically, they could not defend the criticism and had to introduce this attack rather than deal with the actual issue. See the Wikipedia entry if you do not know what is meant by snake oil.

What intrigues me is that what if Podiatrists are snake oil salespersons or not, what has that got to do with barefoot running?

There are podiatrists who are even barefoot runners and even promote barefoot running! (see this). Are they also snake oil salespersons? A look at some of the discussion on podiatry forums will show that podiatrists are not opposed to barefoot running. However, most podiatrists seem to take the position I take here and that is they have a problem with the intellectual dishonesty in the barefoot running community, the misrepresentation of research by the barefoot running community and the non-scientific nonsense that they espouse. Just becuse a Podiatrist (or for that matter, any other type of health professional) point this out, rather than deal with the issue raised, they come out with a criticism of Podiatrists.

Podiatrists are really good at critical self analysis of the underpinnings of their professional work. For more see these discussions on snake oil and their criticisms of their own. I do not see the barefoot running community doing the same self critical analysis. For example, is the barefoot running community going to hold accountable the two barefoot running websites that blatantly lied about the Kerrigan research? (see Hook, line and sinker).

However, I still do not see what all this has to do if barefoot running is good or bad and why some in the barefoot running community try to defend barefoot running by attacking podiatrists. It’s really a nonsensical argument.

But anyway, lets address the concept of Podiatrist’s being snake oil salespersons. I assume they are saying this as Podiatrists use foot orthotics as one tool of many in their armamentarium used to treat overuse injuries in runners. Physical therapists, orthopaedic surgeons, chiropractors, pedorthists, etc also use foot orthotics for the same reason. Are they also snake oil salespersons?

Do foot orthotics work? I challenge anyone to find me one (just one will do) study that shows foot orthotics do not work (I know they cannot, as there are none!). Every single study that has looked at this (and there are over 200) has shown foot orthotics work. Most of those studies were not even done by Podiatrists! Even the ones with bad methods and flaws still showed they work. The ones with good methods and minimal or no flaws still showed they work. Have those who choose to call podiatrists snake oil salespersons read any of these? I doubt it.

The patient satisfaction studies show people are satisfied with their foot orthotics; the outcome studies show people get better with foot orthotics; even the well designed randomised controlled trials show that those in the foot orthotics treatment group get better. Most of the results of these studies show that there are 70-80-90% satisfaction, improvement in outcomes etc with foot orthotics. Where does anyone ever get the impression that foot orthotics do not work? There is certainly more evidence accumulated for the use of foot orthotics than there is evidence for the benefits of barefoot running.

As the numbers show 70-80-90%, that’s still 10-20-30% of the time that they were not helpful. But those figures are pretty consistent with most medical interventions. For example, surgical procedures do not work all the time; antibiotics do not work all the time. Are surgeons and family practitioners snake oil salespersons because their surgery or antibiotics did not work 100% of the time?

Why do foot orthotics not work in those 10-20-30% of the time? Could be they were the wrong prescription; could be due to biological variation (i.e. antibiotics do not work all the time); could be that they should not have been used in the first place; could be a failure of the runner to follow instructions; could be any number of reasons. At the end of the day, there is a failure rate for every medical, surgical, pharmaceutical, mechanical or physical therapy. Should they not be used because of that reason?

My advice to the barefoot running community: Stick to the issues; discuss and debate the issues and stop throwing up nonsensical oneliners when you feel you are backed into a corner. You are only showing the weakness of your position when you resort to those tactics.

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