The APMA are taking some heat for this advice on childrens shoes and its hard to defend

On the website of the American Podiatric Medical Association, is this advice regarding children’s footwear with this graphic provided by the children’s shoe manufacturer, StrideRite.
children's shoes
It is not too dissimilar to the advice that I have seen being widely given for the use of children’s shoes. Where a problem arises is that I periodically come across comments in social media calling out the APMA on what they are advising, asking how robust the advice is and what is the evidence supporting the advice that they are given. I have yet to ever see the APMA respond. Here the most recent couple that I have seen:

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Who are these fan boys that one does speak about?

There is no doubt that I regularly poke fun at what I call the “fan boys”, or more correctly the “fan boi’s”, in blog posts and lectures. It is hard not to resist those who paint such targets on themselves. I have had some enquiries as to who are these “fan boys” (and not to mention, the “fan girls”). This what I wrote elsewhere about what a “fan boy” is:

A fan boy (or fan boi) is a slang term for someone who is considered very devoted to a single subject, often to the point where it might be considered an obsession. It is a term reserved for when the obsession or passion is beyond what just being a typical fan might be considered as being.

Traditionally they were a passionate fan of something in geek culture such as a sci-fi genre, comics or specific video games, but more recently it has been expanded to include non-geek niches. It is also considered to be a type of insult or put down and is somewhat derogatory.

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Do you have time to read 3000 research papers a year?

3000 is almost how many that were published of relevance to podiatry and related topics in 2016. Did you read them all? On top of that, there are social media and blog posts about relevant topics. That is a lot if you want to stay up-to-date.

How did I work out it was almost 3000? Newsbot is the username over at Podiatry Arena that is used to post all the research, news, press releases, etc that are relevant to Podiatry. In 2016, Newsbot posted an average of 7.6 times a day. That is 7.6 bits of new research, news, reviews and commentary of relevance to Podiatry every single day (ie 2774 posts in 2016). Admittingly some of that is bad research and commentary and a lot of it is certainly not directly relevant to all areas of clinical practice for everyone, but it does give you an idea of the magnitude of what is published.

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Sometimes academics do overthink things

I have to be careful what I say here as I am criticizing my professional colleagues, but …

A while back there was this a couple of studies on proximal changes in those with Achilles tendinopathy. I blogged about one of them here and the other one is here. Both studies found those with Achilles tendinopathy did have change in proximal function such as muscle activity and hip motion. Both studies did lead the author to discuss the role of the proximal structures in Achilles tendinopathy. This lead to responses in social media on how important the hip and core are and that we need to focus the treatment interventions there. This was despite that this is not what the studies showed as correlation is not causation.

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The models, paradigms or frameworks that underpin the clinical practice of biomechanics*

Clinical practice is always going to be underpinned by models, paradigms or frameworks. Life is underpinned by such approaches, so there is no reason to assume that clinical practice isn’t as well, despite what we might believe of the role of evidence based practice. For example, in politics there has always been and always will be the left/liberal approach compared to the right/conservative approach. Models, paradigms or frameworks are really coloured lenses that we view the world through. A scientific fact may be, for example, the unemployment rate (if we accept the shortcomings of how it is actually measured). That fact will be interpreted by a left wing liberal as something bad that needs something done about it, whereas a right wing conservative probably sees it as nothing more than the markets working efficiently. So it is with clinical practice, we all have lenses that which we view the same thing through. Members of different health professions will look at the same thing differently because of the models, paradigms or frameworks that they are viewing it from. This may be as wide as the traditional ‘medical’ model vs the ‘psychosocial’ model vs the attempt to integrate them as the ‘biopsychosocial’ model.

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