Craig Payne

University lecturer, runner, researcher, skeptic, woo basher, clinician

Mar 30, 2017
Published on:
1 min read

Like anyone else who writes about medical or health topics when reporting and commenting on science, I always get responses with anecdotes about what was written with it either does or does not apply to them. Anecdotes and testimonials always turn up in the comments sections. While they may be important to the individual, anecdotes are of no value when trying to move forward the science and the understanding of a topic and they are simply not that helpful.

For example, on one of my previous posts (that I am too lazy to look up), I had one comment from a runner that his Hoka One One running shoes caused his plantar fasciitis. The very next post was from a runner who swore that his Hoka One One cured his plantar fasciitis! Surely that is enough “evidence” of how useless anecdotes or testimonials are. What should a clinician do when treating a runner with plantar fasciitis in the context of those two anecdotes? Should they use Hoka running shoes to treat plantar fasciitis or should they advise all their runner patients with plantar fasciitis to avoid the Hoka running shoes?

Having said that, unfortunately anecdotes can be powerful convincers as we have a tendency to empathize with an individual personal story and can relate it to themselves. These accounts are subjective and prone to so many forms of error such as wishful thinking, self-deception, confirmation biases and post hoc reasoning (1). I have previously blogged in more detail on that and how ineffective treatments can work (natural history, placebo, self-delusion etc). Because of that, there is no scientific value to anecdotes and they are certainly not any form of evidence that stacks up to scrutiny.

In the medical literature a type of anecdote is the case report, typically this involves the reporting of an unusual or rare condition. What brought this up for me today was this case report in which a runner with plantar fasciitis got better after taking up barefoot running.

Reduction in Plantar Heel Pain and a Return to Sport After a Barefoot Running Intervention in a Female Triathlete With Plantar Fasciitis
Peter Francis, Cassie Oddy Mark Johnson
International Journal of Athletic Therapy and Training
Patient characteristics:
In a 27 year-old female triathlete, magnetic resonance imaging revealed mild thickening and oedema at the calcaneal insertion of the plantar fascia in keeping with a degree of plantar fasciitis.
After 6 weeks of conservative treatment failed to elicit a return to sport, the patient engaged in 6 sessions of barefoot running (15 – 30 minutes) on a soft grass surface, without further conservative treatment.
Comparative outcome:
After two sessions of barefoot running the patient was pain free before, during and after running. This outcome was maintained at the 6 week follow-up period.
This is the first case report to use barefoot running as a treatment strategy for chronic heel pain. Barefoot running has the potential to reduce the load on the plantar fascia and warrants further investigation using a case series.

Where does one start (after the facepalms and eye rolling has finished)? There are any number of reasons that the plantar fasciitis could have got better and it could have easily had nothing to do with the barefoot running. It could easily have been the natural history. It could have easily been the treatment that was done before the “two sessions” of barefoot running. It could have been … etc.

As for this “Barefoot running has the potential to reduce the load on the plantar fascia” – barefoot running does not reduce the load on the plantar fascia.

I and many others could easily publish case reports (anecdotes) in which barefoot running increased the symptoms of plantar fasciitis! See how useless these case reports and anecdotes are. They add no value to the literature.

You could also head over to any of the patient support groups for those with plantar fasciitis in places like Facebook and suggest barefoot running as a treatment for plantar fasciitis and you will get ridiculed. I have previously posted about minimalism as an intervention for plantar fasciitis and the fan boys responded in the comments with their anecdotes that I was wrong!

This also reminded me of another case report (anecdote) about plantar fasciitis clearly up after starting a gluten-free diet. Based on the above, surely it is obvious why no one is taking it seriously. At least the authors in this case were honest enough to subtitle the paper: “Relationship or just coincidence?

Anecdotes can be legitimate, I use them a lot in my lectures and courses to support claims and illustrate the point, but it is always based on other evidence. The purpose here is the anecdote or story is that it is the anchor that I use to hang the evidence on. This facilitates learning and long-term memory in students.

I like this comment on the anecdote: “The problem with anecdotal evidence comes from the capacity humans have to let their personal needs, prior expectations, attitudes, prejudices, and biases unwittingly influence the outcome of their evaluations.” Source.

As always, I go where the evidence takes me until convinced otherwise …. and anecdotes are not evidence and barefoot running is not a panacea for plantar fasciitis.

Francis, P., Oddy, C., & Johnson, M. (2017). Reduction in Plantar Heel Pain and a Return to Sport After a Barefoot Running Intervention in a Female Triathlete With Plantar Fasciitis International Journal of Athletic Therapy and Training, 1-17 DOI: 10.1123/ijatt.2016-0072