FitOldDog’s Junk Science, Epicycles, Sample Bias, And The Ongoing Mystery Of Plantar Fasciitis

Epicycle math of planets

Some people call the epicycle attempt to explain planetary motion (appearing to go ‘backwards sometimes’) as bad science. This is actually great science, based on an apparently false assumption, that the earth lies at the center of the Universe – an understandable mistake. Watch this explanation as a little movie.

Plantar fasciitis treatment data from 200 cases

FitOldDog’s junk science pie chart, working to solve the mystery of plantar fasciitis one case at a time, as explained in this blog post on our research.

A friend of mine, a scientist I respect, took a look at my recent investigations of the underlying basis of plantar fasciitis, and declared that I was doing junk science, my data were riddled with sample bias, and there were better, scientific ways of doing this. He proceeded to cite an article on the subject, as an example of how the mystery of plantar fasciitis should be investigated, through logical experimental design.

Whatever! To use current American vernacular.

I did find his line of reasoning interesting, so I carefully read the referenced article in the British Medical Journal, entitled “Ultrasound guided corticosteroid injection of plantar fasciitis: randomised controlled trial.” Sounds more scientific than my pie chart, which is based on people’s plantar fasciitis stories that I find on Facebook, don’t you think? We’ll see about that!

ASTRO website

The ASTRO is based on a reasonable working hypothesis for plantar fasciitis disease induction. Worked for FitOldDog, that’s for sure.

That said, as a pathologist, I can’t but wonder about the risks associated with injecting anything into the heel. These antipodean investigators did have one valuable conclusion, that “Significant pain relief did not continue beyond four weeks.” This observation is consistent with many of the reports I’ve read on Facebook, and will hopefully discourage this crazy treatment – doctors or no doctors [please note – I do have attitude bias, I’m a veterinarian]. It would appear that similar results can be achieved by injecting blood or platelets into the heel, changing one’s shoes or diet, using shoe inserts, going off your Lipitor, inserting arch supports in your shoes (which actually triggered my last case), or undertaking single leg calf raises, as demonstrated in a recent scientific study in Sweden. The latter approach is stage five of the original FitOldDog Plantar Fasciitis Treatment Method, that we published almost two years ago.

I just cannot understand why doctors, without recommending all the alternatives first, would inject people’s heels with anything, considering all the attendant risks of infection. An example of such an untoward response to a corticosteroid heel injection was ‘nicely’ demonstrated by Matt’s foot, when he contracted MRSA – if you really want to see it, go to our website, to experience the terrible damage done by this infection.

Lex 18 Asheville

Alan, owner of Lex 18, an excellent dining experience, is a wonderful story teller – I had no idea that a scene in Look Homeward Angel, by Thomas Wolfe, was inspired by his edifice. Such stories have the power to modify the mind, making for Story Bias! Photo by FitOldDog, with permission.

But what about my friend’s accusation of my data being riddled with sample bias?

A reasonable statement, as it is correct.

In fact, all experiments contain some kind of bias – the Australian study referred to above is based on the assumption that plantar fasciitis is due to inflammation of the plantar fascia. Well, it’s called plantar fasciitis, so it must be inflammation of the plantar fascia, right? Wrong, until late in the disease progression, if ever, in my opinion.

The Australian research, cited above, therefore incorporates causation assumption bias, in a similar way that all of that epicycle research done many, many years ago, was based on the assumption that the Earth lies at the center of the Universe. Assumption bias skews the thinking of researchers as they design, analyze, interpret, and report their data. This is true of everything we think and do, becoming quite a hurdle in science, which is why my favorite lesson to science students was:

Always question the obvious, as I discussed in a blog post on awareness, moons ago!

Furthermore, such assumptions about the nature of reality can cause us to fall prey to the foolish consistency hobgoblin of Thoreau (true for both little and big minds, I’m afraid).

FitOldDog enjoys the Obama Trail

Having fixed my plantar fasciitis, using a combination of the FitOldDog Method, and the ASTRO, I enjoyed a hike along the Obama trail near Asheville today, with Deb and Willbe. Photo by FitOldDog, with permission.

Let’s return to my friend’s accusation of sample bias in my Facebook datasets. Well, I admit to:

Under-coverage bias: Most of my data come from Facebook in the form of stories, many about people being unable to fix their plantar fasciitis. Clearly my data will be skewed to under-represent people who fixed their problem.

Nonresponse or Voluntary Response bias: Some people don’t want to tell their stories on Facebook, or any other media that I can access.

Misdiagnosis bias: Some of these people have surely been misdiagnosed, thus contaminating my datasets.

Inadequate reporting bias: A critical component of these datasets is a listing of the treatments tried that failed to ameliorate symptoms. Some people just say they have tried everything, which has to be excluded from my analysis, as ‘everything’ is undefined.

FitOldDog's plantar fasciitis landing page at fitolddog.com

This whole journey started way back when, in the early days of FitOldDog. Visit this site at FitOldDog.Com

FitOldDog Bias: Based on personal experience, I consider inflammation of the plantar fascia as a primary cause of this condition to be extremely unlikely. In my opinion, all treatments, of which I am aware, even nutritional modifications, have the potential to alter biomechanics in a manner that could stress normal proprioceptive function. I’ve moved away from my initial opinion that the answer lies in the loose connective tissue, known as fascia. It is probably involved, but not as a primary cause. Yes! I changed my mind, based on anecdotal data from one subject, myself.

I plan to continue with my junk science, because it is so interesting!

Best defense against sports injury is your mindI’m busy putting in another 100 cases, and improving our benefit risk equation, having addressed the divide by zero dilemma – had to think about that one, and the answer came to me during a very wet 6-mile trail run.

I’m increasingly persuaded that plantar fasciitis research should be directed towards the study of proprioceptive imbalance, at least for it’s earliest stages. Based on my understanding of disease progression, this is probably when the condition is most amenable to treatment.

At least try the ASTRO before you risk your foot; because it appears to make sense and it worked for FitOldDog. That is why I enjoyed a pretty rigorous hike today, during an easy week of Ironman training, having fixed my heel pain without the doubtful aid of risky, and in my opinion misguided, heel injections.

Finally, am I irritated by my friend calling my hard work ‘junk science?’ Not one bit! He took the time to think about it, which is a gift to any scientist, unless such a report were to block my funding.

But as I have no funding, no agro!

Happy Trails.

 

Comments

  1. rory conolly says:

    I wonder how much plantar fasciitis there was back in cave man days, before there were shoes with built-up padded heels that facilitate fast, heel-strike running – possibly faster running than we are really designed to do. Starting bare foot/forefoot running in a adult years isn’t the same thing as doing it from birth.

    • I wonder about such things, too. But I have no idea how to find out, without a time machine. Starting barefoot later in life is pretty risky, and it gave me a hard time. One guy in my dataset reported fixing it with barefoot running, just because he saw someone run by his apartment barefoot, and he thought he’d give it a try, and his plantar fasciitis went away. How’s training? -kevin

Speak Your Mind

*

WordPress spam blocked by CleanTalk.
Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.