How many times has a patient come into the office and said, “What about this thing I heard of on the Internet? Would that work?” Whether it is an ingrown toenail or a severely collapsed foot or ankle, a simple search on the Internet shows thousands of pages of alternative therapies.
Do any of them work?
With the current hot topic of evidence-based medicine (EBM), there would be a smaller chance of using alternative therapies due to the absence of any research for many of the treatments. However, it seems that a lot of the time, open-mindedness would be the biggest roadblock.
Sure, I tend not to think therapies such as snake oil or Arnica ointment are going to fix a bunion. However, I have seen success with using any form of cherries for gout or Vicks VapoRub for the improvement of fungal nails.
Most times, the only way to find these successes is to try. This is where the hesitation usually begins and sometimes for good reason.
Medicolegal issues could arise if you recommend homeopathic medicine instead of traditional pharmaceuticals. I would imagine that sarcolactic acid treatment for acute Charcot would be hard to defend. It seems most situations in which DPMs attempt alternative therapies are when standard treatments fail or if the patient wants to try them.
Will alternative therapy ever shift to a first-line treatment option? Most would brush this idea off due to things as EBM and personal beliefs.
We could equate this to the approach on global warming. Some of the data claim it exists and there is some to disprove it. In such cases, if one thinks global warming does not exist, he or she may still recycle or avoid gas guzzlers for the betterment of the environment. Whether we believe in alternative therapies or not, we should be open to the idea and perhaps suggest it more often.
Granted, some of these therapies, especially those sold on the Internet, are selling false hopes just as the diet industry has done for years. However, one thing the diet industry has done is provide choices. That is what alternative therapies would do for podiatry as well.
One of the options I have provided for patients is willow bark for inflammation. I have also recommended Vicks for those who would not be great candidates for Lamisil pills. I have also used a combination of traditional and alternative medicine for gout, including the aforementioned cherries in any form along with standard anti-inflammatories. I have personally had varying degrees of success with these few treatments.
Often, patients will come in after they have already tried a homeopathic remedy. In fact, in the middle of writing this column, I saw a patient who had pain in his toe and tried acupuncture. He had six visits and felt that it did not help. However, he did get some good sleep during those sessions.
Not to discredit that specific treatment but I have also seen some homeopathic medicine that patients said cured their aliments. For instance, one patient said he used marigold therapy for verrucae and has not had a problem since.
Even if the success stories are caused by the placebo effect, if it helps them, I am alright with it. I do agree that further studies in the homeopathic arena are needed before going mainstream. Until then, we have only anecdotal experience from ourselves, other physicians and patients.
Anecdotes are what we have used for many years in the medical community. These have helped shape treatment protocols for many practices. Many of these have been validated through more current studies. These studies seem to be trending in the way of more control groups, higher participant levels and significant p-values. It would be interesting to monitor homeopathic treatments in any of these studies to compare the outcomes to more traditional results.
Even if you are not currently using alternative therapies, it may be nice to develop a list of a couple of choices for different podiatric conditions. These alternate modalities could provide other approaches to a problem that is resistant to attempted treatments and as last efforts before more invasive treatments are required.
Whatever thoughts you may have about alternative medicine, the one thing we cannot do in podiatry is automatically discredit and suppress treatments that could potentially have a role in how we practice medicine in the years to come.
Dr. Lawton is in private practice in Naples, Fla.
Dr. McCord recently retired from practice at the Centralia Medical Center in Centralia, Wash.