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I've mentioned this before, but it is a recurring issue.
Patient presents to me with no symptoms other than concern for her 'bunions'. They are stage I/II and pose no real cause for any drastic intervention eg. surgery.
Patient then comes back and reports she now has symptoms of pain in both feet. She associates this with her visits to a 'Doctor' who 'cracks' her feet.
The same old tricks seem to be in play:
* X-rays to suggest her subluxation and degrees of alignment need urgent adjustment.
* A program set at 3xweekly consults at X amount of $
* Attend for 6 months, fees total more than $1800
* She is offered orthotics - but already had them.
Has anyone else come across this type of 'manipulation?'
I'm sure it has it's place and DOES improve patient's well being...
Tim we have arrived at a time where EBM is being looked to more and more to establish treatment efficacy for coverage determinations by Medicare & insurers. EBM is not sacrosanct but it can be useful in developing practice guidelines for the professions which must be weighed against clinical experience.
The Council on Chiropractic Guidelines and Practice Parameters is one such guideline for the chiropractic profession. A literature synthesis was published in 2008 by the CCGPP pertinent to the lower extremity to aid in developing standards of acceptable practices of extremity manipulation. Refer to the table on page 3, treatment of Hallux Limitus/Rigidus was rated a C and Hallux Abductovalgus was rated an I (inconclusive).
That said if a patient is experiencing new complaints or increased pain in the Hallux due to manipulation the question of appropriateness and efficacy must be addressed. Failure to refer this patient is a whole other topic.
Best regards,
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"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright
The HAV as I mentioned was only mild...and asymptomatic.
Also, her pain post treatment was beyond the HAV anatomical area...but her feet started with pain.
As I also mentioned, I understand and support these manipulation techniques, but have assessed certain cases based on my clinical evaluation to be concerning and unethical. These are numerous, systematic and more tuned in on profit rather than patient well being.
Tin let's not forget that while you're assailing the chiropractic profession for the errors of a couple of bad apples, that particular DC is aligned with an MD and several DPM's in promoting the idea that orthotics are useless, weaken feet etc.
__________________
"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright
Pod Rip off?? FOOT chiro
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