Hi Howard,
I was wondering if you would comment and am pleased you did.
In my previous emails regarding ankle manipulation, I did not ask anyone
to stop performing the intervention. I was only pointing out that your
trial does not prove ankle manipulation's effectiveness. More research
is needed. I would still recommend people read Hylton's letter in
regards to your paper as it helps illustrate this. We cannot "embrace"
ankle manipulation fully until more research is completed.
I also cannot recommend clinicians stop performing ankle manipulation as
there is no quality evidence against it's effectiveness. The same goes
for plantar fascial surgery. While there are still favourable
non-randomised trials supporting these interventions, people may
continue to use them.
On the other hand, ESWT has high quality research against it.
Recommendations can be made to discontinue the ESWT techniques used in
the RCTs described earlier.
Hope I've made myself a little clearer.
If I may, I would like to re-word your sentence to say:
> What is clear, however, is that each clinician must apply "whatever
evidence is available to them and" a reasonable dose
> of common sense when those who we treat depend on our skills in making
> walking a pain free experience for them.
Kind regards,
Joel.
>
>
> In a message dated 10/13/2004 2:27:09 AM Eastern Daylight Time,
> [log in to unmask] writes:
>
> >A lack of evidence from RCT's vindicating (or otherwise) surgical
> intervention cannot be used as an arguement in favour of surgery.
>
> If this were the case, clinicians would have to stop using every
> intervention that does not have an RCT behind it. Not sure many on the
> mailbase would agree with this?
>
>
>
> Joel,
>
> If I understand your position here and from prior discussions, its
> acceptable for surgery to release the plantar fascia to be performed
without RCT and
> despite the known, serious complications, but you will not "embrace"
> manipulation of the ankle, a process with no reported complications,
until more
> research is performed. The logic of this conpletely escapes me.
>
> What is clear, however, is that each clinician must apply a
reasonable dose
> of common sense when those who we treat depend on our skills in making
> walking a pain free experience for them.
>
> Howard
>
>
> Howard Dananberg, DPM
> 21 Eastman Avenue
> Bedford, New Hampshire 03110
> 603-625-5772
> fax 603-625-9889
> [log in to unmask]
>
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