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My father has problems with his knees. His doctor said that he should get an operation. However, the operation does not usually work, is very expensive, and can make things worse.

A multi-level marketer offered him an alternative: he wears orthotic shoes that are "tilted". It seems that the shoes are working.

I look around and I do not see anyone disputing that orthotics works.

However, this is a highly unusual situation. I mean if doctor says A and alternative medicine proponent says B, usually, the doctor is right. However, this seem to be an exception. Or is it?

If such simple solution like tilted shoes can cure injured knees, why is it not more common?

  • Um, forgive me if I'm being ignorant but what is MLM? – Sam I Am May 3 '12 at 2:58
  • I believe Jim is referring to Multi-Level Marketing - a euphemism for (legal) pyramid schemes. I have edited the question with that assumption. – Oddthinking May 3 '12 at 3:41
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    Not all are like that. Some may be overpriced, but a deal is a deal. Governments intervention condemning it will just make things worst. MLM teach businesses. I seriously doubt most of their claims though. MLM is like religions. Once infected, a person would want to convert others. But some companies have fair system, like Nuskin. Want to join under me? – user4951 May 3 '12 at 11:23
  • That nuskin thing is a joke by the way :) – user4951 May 3 '12 at 11:35
  • @Jim: Essentially, the question is "do they require exponential growth to be maintained in order to be profitable for the new recruits who make a commitment?" If the answer to that is yes, they are inevitably headed for failure, with the last rounds of recruits suffering. There are surely better ways to learn business. (Also, as not all religions require evangelism, it isn't hard to break your analogy between religion and MLM.) – Oddthinking May 3 '12 at 12:29
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I love the answers that surprise me. I had never doubted the effectiveness of orthotics. (To be fair, I've never needed to care.) I thought it was part of evidence-based medicine. I went to find the evidence to show this. However, the literature seems more divided than I expected.

When there is controversy about the effectiveness of a treatment, I look to the Cochrane Collaboration, who produce high-quality meta-analyses of smaller studies to draw more robust conclusions.

There was a recent such analysis done that sounds (without knowing the details of your father's medical history, nor having the skill to understand it if I did) perfect for this question:

They looked at two available studies, and warned of the biases they found.

There were no important differences in knee pain and function in people given foot orthoses as well as physiotherapy when compared with people given physiotherapy only. Results for knee pain and function did not show important differences between foot orthoses versus physiotherapy.

[...] On the basis of the available evidence we do not recommend foot orthoses for adults with pain around the knee cap.

There may be some areas where foot orthotics might have a benefit.

This review concludes that they are largely ineffective at treating pain or preventing injury, but that there is some evidence of helping with plantar fasciitis, posterior tibial stress fractures, and patellofemoral pain syndrome. Mainly, it suggests more high-quality evidence is required.

There are also unrelated situations where orthotics may assist.

The New York Times had an article discussing the controversy.

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