This is something I have a lot to say about and talk about a lot during the Clinical Biomechanics Boot Camps. The main reason I like talking about it is that it is something I used to hate seeing. The % of successful outcomes with conservative treatment was almost always pretty close to 100% failure. Surgery was always a good option to send these people of to. That was until this study and discussion here. Transitioning a runner from a heel strike to more of a forefoot strike and shortening the stride length to increase cadence now has a pretty close to 100% success rate! I like talking about that.
However, what makes it interesting is considering this in the context of how much evidence is needed to change clinical practice. As all we have is that one small study, which has no control group (but the results were dramatic) and a biologically plausible and theoretically coherent mechanism. I like to ask people is that sufficient to change clinical practice? Theoretically it should not be. In a perfect world, clinical practice does not change until there is enough randomized controlled studies to be combined into a meta-analysis to show that we should change practice. Unfortunately, the real world and clinical practice does not work that way. This study on anterior compartment syndrome makes for an interesting discussion point on my courses.
I have been talking about this as part of the Clinical Biomechanics Boot Camps for many years now. What is really flattering is when a participant in one of those courses contacts me down the track to say they tried what I suggested and it works. I like talking about that.
This is something I find myself writing about a lot (here, here and here)
In a lot of those articles I refer to Kevin Kirby’s excellent video and you really can’t go past it for a description and an explanation:
It is a common finding, commonly associated with overpronation and also commonly confused with a medial heel whip. There is a lot of confusion between the abductory twist and the medial heel whip, especially in social media commentary. They are not the same thing. They are two very distinct and different phenomenon. The abductory twist is what is in the above video. A medial heel whip is something that occurs after the foot is off the ground.
I have actually given up responding in social media to those who are confused between the two. Move on.
Like the overpronation nonsense that I seem to be fighting all the time, ‘plantar fasciitis’ is another one of those topis that has no much pseudoscience, quackery and mythology associated with it. Not a day goes by in which I do not come across something on plantar fasciitis that is just plain made up nonsense.
Why so much nonsense? My theory is that you can pretty much try anything for plantar fasciitis and due to the nature of the natural history of it, there is a good chance there can be an improvement in symptoms at around the same time the nonsense treatment is used. To try and convince people that their symptoms improved because of the natural history and nothing to do with the quackery is an exercise in futility. I blogged about this issue here: The Problem with the Treatment of Plantar Fasciitis.
This is something that I write about a lot and debate about a lot on social media. It is something that I do not like writing about. It is something that I should not have to write about. It is something that just will not go away. The myths keep on being perpetuated. It does get boring and tiresome.
‘Overpronation’ is a meaningless nonsensical term. It is mostly used by people suffering from the Dunning-Kruger effect who want to pretend that they know what they are talking about when they clearly have no clue. Pronation is normal. We have no idea what is “over” or abnormal. It used to be considered a big risk factor but it was so poorly defined that we really have no idea.
One does get frustrated with not a day going by in which I come across someone talking about “overpronation” in a nonsensical way. When I get time, I will finish on the PodiaPaedia page on overpronation for a ‘fair and balanced; view (as that is the purpose of that website).
Please: it is time for all this to stop (though I know my pleas are not going to make any difference)