Tag Archives: pseudoscience

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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Natural History vs Clinical Evidence

This is a topic that I have blogged about so many times, but it came up for me with a patient I looked at a few weeks ago. The previous posts included topics like: But…but…it worked for me!, Anecdotes are not evidence, and Why Ineffective Treatments Sometimes Work. I won’t be litigating all those issues again here.

I never cease to be amazed just how many people are more trusting of anonymous anecdotes from fellow sufferers of conditions than they are of evidence-based health professionals. From time to time I hang out in social media groups of people who have a particular condition (eg comments here on a plantar fasciitis support group). So many seem to be so accepting of this advice from well-meaning people who can not be held legally accountable for the advice if it goes wrong or does not work. Health professionals who are licensed/regulated can be held accountable.

Often you see advice that is just not plausible. There is no mechanical, physiological or whatever mechanism that the treatment or advice being given can actually work. Yet you see it recommended and you see people advocate for it and claim it cured them. Yet you know that there is no way that it could or would have worked.

The most recent patient that brought this to my attention in a big way was not initially a patient. I was actually treating her mother for an ingrown toenail. The 11 year old daughter came in with her as her heel was too painful for her to go to school that day. While treating the mother I enquired why she was not at school. Pretty obvious to me that it was calcaneal apophysitis (Severs disease). This was on a Thursday; I was too busy to look and assess her properly then or do anything, so made an appointment for her to come back Monday for a proper consultation. Monday came around, she was back to school and the pain was 70-80% better. I had done nothing. They had done nothing. The pain had just naturally improved as part of the natural history of the condition.

What would have happened if they had followed some really bad online advice on the Thursday? Or if I had actually treated them with an effective treatment (or even an ineffective treatment)? No matter what, they were going to get better. Whatever was done on the Thursday would have been credited as the reason no matter what. Imagine trying to convince them that it wasn’t the treatment, but was just the natural history. Thats not going to happen. They are going to turn into an advocate for that intervention when it may or may not be effective. Can you see where this is heading?

This is why proper clinical trials are needed, so that we know a particular intervention is better than doing nothing or better than a placebo or better than the natural history.

This is also why there needs to be a better teaching of critical thinking skills and science education so that the general public (and some health professionals) understand these issues (and do not send me hate mail for pointing out that a particular intervention for calcaneal apophysitis/severs disease does not work and can not work and the reason it appears to work is because of placebo or natural history!) and are more understanding of advice for interventions that have been shown to actually work.

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