Category Archives: Musculoskeletal

Bunion corrector gullibility

Some people must think some people are really stupid. I recently screen shot some pictures posted on a website that I stumbled across and has now been taken down. They must think that people really are that stupid. It was from a website promoting and selling a “bunion corrector”.

Here is the first image. This was the bunion allegedly before the use of the bunion corrector:

before the bunion corrector

Here is the image with the bunion corrector applied to the foot:

bunion corrector applied

And here is the image they posted after the alleged use of the bunion corrector:

The bunion after using the splint

They went on to say how incredible these bunion splints, braces or correctors are. You do not have to be Einstein to see that all the photos were taken on the same day (notice the shoe in the ground) and the before shot is the left foot and the after shot is the right foot … seriously?

That does not mean that there is anything wrong with them. From what I understand the evidence is that after a month of wear, they can reduce the angle of hallux valgus by a few degrees. I use the ones like these to help with that deeper pain you can often get inside bunions and find they are also useful at keeping the joint mobile which is probably a good thing.

Even though the evidence does show they can induce small changes in the angle of the hallux with regular use over a month, I am also realistic with patients and point out that during the day there is a lot of force produced from the footwear and biomechanics creating the lateral deviation. Is it really possible for wearing the splint at night undo all that? I have no idea if it does or does not, but need to question if it can and instil realistic expectations into patiensts when discussing this.

I have nothing against trying these bunion correctors. Its just the critical thinking skills needed for all the over hyped and nonsensical marketing claims that get made for them. The one above is obvious, others not so obvious.

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Cannabis Oil for Plantar Fasciitis

There seems to be increasing advocacy for the use of cannabis oil (medical marijuana) for plantar fasciitis recently, mostly from what I can see, from those who sell it. If you hang out in some of the online communities for those with plantar fasciitis, you see a lot of very bad advice being given, mostly based on anecdotes. In the last year or so, the most popular advice was to use magnesium supplements to cure plantar fasciitis. This was all the rage for a while with an extraordinary number of people advocating its use based on it working for them (when we have no idea if it actually worked or not or if it was just a placebo or just part of the natural history or any other explanation). There is no mechanism that I could find by which it could affect plantar fasciitis. More recently, the volume of advice for the magnesium supplements has started to drop off but is being replaced with an increasing amount of advice for the use of cannabis oil to treat plantar fasciitis. Some of the testimonials are quite compelling … if they are true.

Cannabis oil for Plantar Fasciitis

I have not paid much attention to the medical uses of cannabis oil or marijuana and the evidence for that use. I do watch and read the news stories about how it should be legalized. Those news stories almost always tell a compelling story of someone who is sadly very ill and not much available to help them, but the cannabis oil did miraculous things for them. Many jurisdictions are starting to legalize it and the commercial legal sales of the product are proving quite lucrative. Personally, I have a neutral opinion on if it should be legal or not. I see the superficial arguments in news stories that it should be and see the equally superficial arguments of the dangers of it. Sound bites for the news do not lend themselves to deeper analysis, but unfortunately, play a big role in informing public opinion and inspiring politicians to act.

Given all the attention that it was getting, the strength of the arguments to legalize it and politicians who are passing laws to legalize it, I assumed that there must be some pretty good evidence supporting its use in a number of medical conditions. After all, politicians would not be legalizing it unless there is good evidence it that it helps … wouldn’t they? 😉 ?

When I started to see the advice come up to use it for plantar fasciitis, I thought I would do a hunt for the actual evidence for its use to treat different medical problems. After all, there would have to be some evidence that it cures cancer as why would there be so many claims that it did. Surely, people would not make shit up about it wouldn’t they? 😉 ?

I was genuinely quite shocked to find just how little evidence there is for the medical use of cannabis oil or marijuana to treat anything. It certainly does not cure cancer. There is a summary of the systematic reviews and meta-analyses on it at the Science-Based Medicine blog from Steve Novella (link). Yes, there are some good early results in a very limited range of medical conditions. It is very clear, however, that the claims for the benefits massively outstrip the evidence for those claims. I really was quite surprised at the lack of evidence to support its medical use (and I know I am probably going to get anecdotes in the comments below about how it worked or me … blah, blah, blah. Please do not waste your time posting a comment about that as it won’t be approved. Suggest you read this instead: But, but … it worked for me).

Back to its use for plantar fasciitis. There is no evidence that it helps (anecdotes are not evidence). There is no pathophysiological mechanism by which it could help. Plantar fasciitis is a mechanical problem. Pharmacological interventions (eg cannabis oil) do not help mechanical problems and only may mask the symptoms (which is not always necessarily a bad thing). The only way that cannabis oil could help plantar fasciitis is by helping those with a chronic pain problem feel better about themselves. It is not a treatment for plantar fasciitis.

One irony in all this is that those who are mostly advocating the use of cannabis oil, tend to be those into “natural” therapies (another bogus claim to be addressed another time) and tend to advance the argument that the “medical establishment” do not know how to treat the root cause of problems (another bogus claim to be addressed another time) who just use drugs to mask the real problem (another bogus claim to be addressed another time). Is that not exactly what they are doing in advocating cannabis oil for plantar fasciitis?

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