During this morning live broadcast on Facebook of PodChatLive (and its on YouTube) we were discussing paediatric flatfoot and paediatric foot orthoses with Helen Banwell, a question from came in from Marc Barton that got me thinking.
I have to be honest and admit that the use of platelet rich plasma (PRP) for plantar fasciitis is something that I have had no more than a superficial interest in. I pretty much scanned the abstracts of the studies and systematic reviews as they are published of it in this thread and the one comparing it to other interventions on Podiatry Arena. I also note comments in social media on it from those whose views I respect. From my superficial understanding, it works, it does not work, it works, it does not work … a lot of the studies that compare it to other treatments do not do the “other” treatment very well (ie wrong dosing), which can easily bias the study to PRP being better. Some of the comments in social media from people who I consider real experts, especially in the context of tendinopathy are that it does not work, yet a lot of people claim it does. Yes, I know that the “plantar fasica” is not a “tendon” and it may or may not be appropriate to translate “tendinopathy” research to “plantar fasciitis” (not that this stops people doing so or not doing so if the research on it matches their pre-conceived biases!).
Today, Google scholar came out with their 2018 update to their ranking metrics. No point in me re-litigating what Google says about them, so read Google info. The rankings are not without some controversy and there are competing ranking metrics of journals. Each different ranking method put emphasis on different criteria and weight different criteria differently.
I checked their database for the ranking given to the podiatry and related journals and compiled this list:
When you are busy and have so much important stuff to write about, it is so much easier to go after the ‘low hanging fruit’. Much less effort is needed and when it so easy, you don’t need to think too hard about it. Research on reflexology never fails to deliver on that count.
Reflexology is total bunk; it is made up pseudoscientific bullshit that has no basis what-so-ever. There is absolutely no known physiological mechanism linking areas on the foot to different organ systems and not one clinical trial that stacks up to scrutiny shows that it works. Every single clinical trial on it either shows it does not work or if it shows it works, it has fatal flaws in the methodology (and as such should never have been published, let alone carried out) or more often than not, was not even a clinical trial on reflexology, but a clinical trial on a damn good foot massage. Almost everyone is going to feel better after a damn good foot massage, so measures of anxiety etc are going to improve, especially if a chronic illness is present. Being more relaxed after a damn good foot massage is going to affect a number of psychosocial factors as well as some physiological parameters. BUT, that is not evidence for the junk that is reflexology, that is evidence for a damn good foot massage.
The concept of foot orthotic dosing is something that has been bubbling away under the surface for a long time now, but for some reason, not a lot of noise gets made about it, or when noise is made about it, tends to get dismissed by those who want to protect the way they did things.
To introduce the concept, consider this hypothetical analogy: what if a really well conducted clinical trial was done on a very low dose of an anti-hypertensive drug and it shows that the drug does not work at that dose. Should that be used as evidence that the drug is not effective? Of course it shouldn’t, but that is exactly what is done with clinical trials of foot orthoses at low doses. As the methodology and analysis of that hypothetical drug trial was sound, should it be included in the systematic reviews and meta-analyses? It will meet all the textbook criteria to be included in a systematic review and meta-analysis, but, of course, it should not be included as the dose was low. To include it would probably be unethical as it would unreasonably bias the systematic review and meta-analysis in the direction of the drug not working (unless the review stratified the study results into different doses). It makes sense to exclude that study because of the low dose. So, why then is it acceptable to do exactly that in systematic reviews and meta-analyses of foot orthoses?