Can podiatrists prescribe medication in Australia?

Traditionally medical practitioners (doctors) were the only profession that prescribed medication. Over the past few years this has changed in many countries, and a range of health professionals are permitted to prescribe.

In Australia, there are several professions that can prescribe medication, including medical practitioners, nurse practitioners, dentists, optometrists and also endorsed podiatrists. So who are endorsed podiatrists?

Endorsed podiatrists

Endorsed podiatrists are podiatrists who have undertaken further postgraduate training to be 'endorsed' to prescribe medication. The training process involves undergraduate pharmacology, postgraduate case based learning, and finally, a one year period of supervised practice. There are several benefits of endorsed podiatrists to the health system, but there are also several benefits for patients, which include:

1. Continuity of care - having one health professional manage a condition can be beneficial

2. Save time - you wont need to be referred to a GP for medication

3. Save money - you wont spend extra money seeing your GP

Your GP is the central healthcare provider for you, so even though you might be prescribed medication by another health professional, your GP will be informed about your condition and if any medication has been used to manage this condition.

What medication can endorsed podiatrists prescribe?

Podiatrists can prescribe a limited list of medicines. These include:

• antibiotics for infection

• corticosteroids for topical use (such as dermatitis), and for injection (e.g. cortisone) related to certain musculoskeletal conditions.

• analgesics to manage pain

• long-acting local anaesthetics

• antihistamines

• miscellaneous medicines for conditions such as gout, fungal toenails, procedural anxiety

Fitzpod podiatrist Dr Glen Whittaker is an Endorsed Podiatrist and can manage conditions that may require prescription medication, such as injection therapy using corticosteroids. Learn more here.

Is dry-needling for me?

Dry-needling is a treatment modality that our podiatrists use at Fitzroy Foot and Ankle Clinic.

Dry-needling is not the same as acupuncture. Acupuncture is a method used in and adopted from Traditional Chinese Medicine that focuses on the meridian system within the body.

Dry-needling uses a western model of medicine to release trigger points (tight bands) in muscle, but using the same acupuncture needles. The “dry” in dry-needling suggests there are no injectable substances being passed through the needle into the body. Dry-needling is not usually painful but it can be uncomfortable for some people.

Let’s discuss the idea of trigger-point therapy and try to understand its relationship to dry needling. A trigger-point is a hyperirritable spot, usually within a taut band of skeletal muscle. The spot can be painful on compression and may give rise to referred pain and tenderness. A 'twitch' response may be elicited when the needle contacts a trigger point, may cause slight discomfort and an unusual sensation.

What can dry needling help with?

As podiatrists, a dry-needling treatment in our clinic is localised to the lower limb and foot. Dry needling can provide excellent relief for tight calf muscles, tibialis posterior pathology, achilles tendon pathology, plantar fasciitis, peroneal pain or dysfunction, specific muscular pain in the forefoot region.

Is dry needling for everyone?

There are some situation where dry-needling may not be appropriate, but for most people, dry-needling can be an valuable part of a treatment plan. It is suitable for patients who are open to the treatment modality, and age, gender, body composition, and history of dry needling are not barriers. Patients with a severe phobia of needles would likely struggle to relax during the treatment, and so for that reason, might like to consider other treatments.

Are there any side effects?

Following treatment, the tissue that has been needled, may feel a little tender to touch. There may also be a sensation of muscle stiffness during movement. Light stretching as demonstrated by your podiatrist and increasing your intake of water are two ways to reduce symptoms post-needling. Side effects from dry-needling subside within 6-24 hours of treatment.

If you think this treatment option may benefit you, make a time to chat with one of our podiatrists. Click here to make an appointment.

Nail salons. Keeping podiatrists busy

A lot of people visit nail salons, which is fine. However, a growing number of the people who visit nail salons are leaving with ingrown toenails, fungal infections, or more serious foot conditions.

There is no requirement for people who work in nail salons to hold a qualification, use sterile instruments, or adhere to quality and safety standards.

Podiatrists are university trained practitioners with skills and expertise to prevent, diagnose and treat conditions of the foot and lower limb. Podiatrists are foot health experts and are the safest and best qualified professionals to deliver care to patients with foot problems. Registered podiatrists are also required adhere to registration standards including strict infection control guidelines.

I hear you say, "but it's cheaper than a podiatrist so I'm going to keep going." This is fair enough, so here are a few tips to reduce your chance of running into trouble.

1. Don't let the salon attendants use a scalpel to remove callus. It takes many years of training to learn to use a scalpel appropriately, and many people who visits nail salons leave with large wounds from improper scalpel use.

2. To reduce your risk of a fungal or bacterial infection, take your own set of instruments.

3. Discourage nail attendants from digging around down the sides of your nail. We see a lot of ingrown nails due to this.

4. Remember nail salon attendants are not health professionals and you should not reply on their advice regarding foot conditions.

What on earth is shockwave and why will it help my plantar fasciitis?

The word 'shockwave' sounds more like a '90s music festival than a medical treatment, but it can be an effective method to reduce pain for certain conditions.

How does it work?

Excellent question. No one knows for sure but there are a number of leading theories. Shockwave is not actually a shockwave but is an acoustic wave (sound). This acoustic wave can help tissue growth and increase blood flow, which can be important for chronic conditions. It can also reduce pain by changing neurotransmitters that are responsible for sending signals to the brain.

Is it safe?

Yes shockwave is a very safe treatment for most people. If you are pregnant, have a blood clotting disorder, a metal implant, or for children, shockwave is not a treatment option.

What does it feel like?

For this treatment a wave or pulse will be delivered approximately 2000 times. You will feel a slight 'hit' on the part that is being treated. I find that people often report different sensations. Some people think it feels amazing, like a massage. Other people report some discomfort that feels like an electric shock.

What conditions can shockwave be used to treat?

Shockwave is excellent for tendon and fascia conditions. In the foot and ankle, these will include Achillies tendonitis and plantar fasciitis. There is good evidence that supports the use of shockwave to treat these conditions.

More information

The podiatrists at Fitzroy Foot and Ankle Clinic have been using shockwave for several years and have treated hundreds of patients. It is a very effective treatment for plantar fasciitis and Achilles tendonitis, as part of an overall treatment plan.

Make an appointment with one of our podiatrists if you would like to chat about shockwave, or follow this link to our page to find out more about shockwave.

Is toe-walking in children something to worry about?

Concern for a child toe-walking is a common reason that parents consult a podiatrist or other health professional. Children who toe-walk usually fall into one of four broad categories:

1. Neurological conditions such as cerebral palsy;

2. Autism spectrum disorder;

3. Clubfoot;

4. Idiopathic (meaning no definable cause) toe-walking.

The first three categories are usually picked up in early childhood, however toe-walking may be one of the first clues for autism spectrum disorder. Children with autism spectrum disorder may prefer to walk on their toes as they receive less feedback when only a small part of their foot (i.e. their forefoot) is touching the ground. Children are placed in the final category, idiopathic toe-walking, once the first three categories have been excluded.

Idiopathic toe-walking

This is the most common cause of toe walking, with idiopathic meaning that there is no definable cause. Often, children will walk on their toes out of habit or a preference to walk this way. After toe-walking for a long time, children may experience shortening of the calf muscles, and it is also important to consider the social or emotional impact of toe-walking on the child.

Treatment usually focuses on encouraging the child to walk on their heels through games, certain footwear, plus stretches to lengthen the calf muscles. Often the toe walking will reduce with age, however in some cases more invasive interventions are required including botox injections, casting or bracing, or surgery.

If you are concerned about a child that is toe-walking, The Podiatrists at Fitzroy Foot and Ankle Clinic are experienced in assessing and managing this condition.

What is plantar fasciitis . . .

Plantar fasciitis is a pathology that affects the plantar fascia. Your plantar fascia is a structure, similar to a ligament, that attaches on the bottom the the heel and connects under the forefoot. Commonly, people will experience pain where the plantar fascia inserts onto the bottom of the heel bone, which is the called the calcaneus. The plantar fascia is primarily responsible for assisting propulsion when walking and running.

People with plantar fasciitis will report symptoms such as sharp or stabbing pain, especially when standing after a period of rest. This pain may return at the end of the day, but may feel more achey and dull rather than sharp with the first steps after standing. This is a common presentation of plantar fasciitis, however people may have plantar fasciitis but experience different symptoms. When exercising, plantar fasciitis tends to warm up and then feel less painful. If you have a pain that is constantly increasing with activity, it might be a different pathology.

Plantar fasciitis is a common condition in the community, with a prevalence of approximately 10%. It tends to be most prevalent in people aged 40-60 and in athletes. It may occur in one foot or both feet at the same time. The main factors associated with plantar fasciitis include high BMI, increased time spent standing and a restricted ankle joint range of motion.

Often people will have a bony growth on the bottom of the calcaneus that is commonly referred to as 'heel spurs'. People with heel spurs are 8 times more likely to experience plantar fasciitis (McMillan 2009), however not all people with heel spurs will have pain.

Finally, plantar fasciitis is referred to as a 'self-limiting' condition, which means that it will go away eventually. However, in the time that it is painful it can have a significant effect on quality of life (Irving 2008), and can increase depression, anxiety and stress symptoms (Cotchett 2016). Therefore, it is important to effectively reduce pain to prevent these reductions in quality of life.

References

McMillan, A. M., Landorf, K. B., Barrett, J. T., Menz, H. B., & Bird, A. R. (2009). Diagnostic imaging for chronic plantar heel pain: A systematic review and meta-analysis. Journal of Foot and Ankle Research, 2(32). Journal Article. http://doi.org/http://dx.doi.org/10.1186/1757-1146-2-32

Irving, D. B., Cook, J. L., Young, M. A., & Menz, H. B. (2008). Impact of chronic plantar heel pain on health-related quality of life. Journal of the American Podiatric Medical Association, 98(4), 283–289. Journal Article. http://doi.org/http://dx.doi.org/10.7547/0980283

Cotchett, M., Munteanu, S. E., & Landorf, K. B. (2016). Depression, anxiety, and stress in people with and without plantar heel pain. Foot & Ankle International, 37(8), 816–21. http://doi.org/10.1177/1071100716646630