Cortisone injections

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Are the podiatrists allow to adminster cortisone injections to the feet? i've tried surfing on the guildlines on APODC but it didn't give me any insights on that.

Many thanks for any replies

 

What if a friendly GP signs off on the order and a pod injects?

 

The answer is still no as it means that the Podiatrist is injecting a scheduled poison access to which he/she does not have.
Cheers
Pete the Pod

 

I cant see the difference between the above case and a nurse injecting a drug requested by a GP?

 

Miss Gangrene

It depends on which state you practice and the relevant drugs and poisons act for that state also.

For instance, WA podiatrists with a Masters degree with relevant pharmacology units, may apply to the Podiatrists Registration Board to be a prescriber, and in WA those podiatrists (mostly podiatric surgeons) may adminster by law dexamethasone by local infiltatrion etc. Drug laws are likely to be changed very soon in Victoria and Qld to allow similar or even less restrictive access to injectable corticosteroids.

Otherwise, like I have been doing for years, ring or write to the GP, request your drug and dose of choice (eg 8mg dex) and what you are going to use it for (eg heel 'spur' infiltration), and your friendly GP can supply or prescribe the drug for the patient to bring back for you to administer under his/her "direction" . Most GPs naturally accept that a podiatrist will understand the local anatomy a lot better, and consequently will hit the target tissue with more accuracy. I do this all the time with the co-operation of friendly GPs who I have a good relationship with.

Hope this helps,

LL

 

LLF is right, the only caveat is that the podiatrist should be competant in the injection of Cortisone, and as this is not currently part of most undergraduate courses, it would need to be proved in other ways if something went wrong

 

Stephen

In some respects you are right. However, musculoskeleteal injections of the foot and ankle are not really part of any medical degree syllabus in this country either... So, I would suggest that if podiatrists were interested in learing injection therapies for common inflammatory conditions of the foot and ankle, they revise their anatomy fully, perhaps attend some cadaver courses to improve needle accuracy, and practice with some straight local anaesthesia with a consenting colleague. As long as aspectic no-touch tenchique is used, its a very safe non-surgical alternative for recalcitrant inflammatory pain.

If you can do an posterior tibial nerve or better still a full ankle block; injection the larger tissues such as the origin of the plantar fascia, the subtalar joint, or a neuroma is far easier in my experience .

LL

 

I wonder whether we should carefully study the relevant Australian registration Acts and Regulations thereunder to determine the differences in relation to access and use of certain poisons by generalist podiatrists and podiatric surgeons. I still think that podiatrists in general do not have legal access to and use of injectable corticosteroids whereas podiatric surgeons do have have a limited range [eg certain anti-iflammatories, antibiotics] beyond that of the generalists. Please correct me if this statement is in error.

 

I have looked into this in some detail.

Currently only WA podiatrists who have a Masters degree approved by the WA registration board are eligilble to administer one injectable corticosteroid, dexamethasone. Predominately, this is used by podiatric surgeons in that state to assist with postoperative pain and oedema.

As mentioned earlier, drugs and poisons laws in Vic and QLD are under review to enable access to a wider formulary, so maybe in the next 6-12 months these states may also access injectable corticosteroids. I know in QLD at least, the proposal will see this limited to podiatric surgeons if it is passed.

LL

 

In Victoria, any one can administer an appropriately prescribed medicine to any one as long as that person is not in a hospital or supported accomodation facility. ie you can give your child an insulin injection, your parents their blood pressure pills etc. In supported accomodation an RN must manage the administration of medication, but on their OK someone else can administer, for a hospital inpatient it is the nurses role, though their are a number of self administraion trials occuring for inpatients in sub-acute facilities.

So what does this mean to administering Cortisone. The Victorian drug and Poisions Act does not prevent a podiatrist from administering an appropriately prescribed cortisone injection, The Podiatrists Act does not prevent it, and the Reg Board code of conduct states, as i said above.
"Podiatrists’ services should be restricted to their areas of competence."

In Victoria the law has changed to allow all appropriately qualified podiatrists (surgeons and general) the ability to prescribe restricted medicines from a list approved by the minister. The change in the law though does not come into effect until July 1 2007 to allow the board time to establish the drugs required and the process for accrediting podiatrists as prescribers, and it is expected that cortisone will be on that list

 

Are there anyone else can provide info on cortisone injections by pod on NSW?

 

By law, you cannot access this drug in NSW. Only a medical practitioner can prescribe for you to adminster, as discussed earlier, and this is a slightly grey area.

If you are a registered podiatrist in NSW you should be aware that only ?one? local anaesthetic agent is available to you to use, and nothing else.

I would make yourself familiar with your state laws....

LL

 

Thank you all for your contributions to my question.
Very much appreciated indeed.
Hope you guys have a fantastic weekend!

 

NSW Podiatrists do infact have access to multiple "synthetic cocaine substitutes" including preparations containing 0.02% or less of adrenaline - we are not as limited regarding local anaesthesia here in NSW as our northern counter parts.



But as LL suggests - it is imperative that you consult your state laws/acts and be extremely familiar with these.

 

have any of these laws changed since 2006? or are podiatrists still not allowed to administer cortisone? (or prescribe i suppose is the more appropriate question)

 

Mak, It depends on the state in which you practice, and then your qualifications. From a Victorian perspective any podiatrist can administer an appropriately prescribed cortisone injection so long as they are competent to do so. ie: if you stuff up you could be in trouble if you can't show evidence of competancy/training.

re prescribing, we are still waiting for final ministerial sign off on the list of restricted medicines that endorsed podiatrists may prescribe. This list will include some injectable cortisones.

 

Just wanting to bump this thread and see if anything has changed regarding legislation of Podiatrists injecting cortisone in Australia.

Is anyone doing it? If you don't, who do you send your patients to?

Phil

 

Phil,

S4 Endorsed podiatrists can obtain, prescribe, and inject cortisone in the states that allow this through their poisons legislation (currently Vic and NSW only), with WA and SA having more restricted local laws.

But re: injecting/administering cortisone, this is allowed if the drug has been legally obtained (usually via a GP precribing the cortisone for the patient you wish to inject). So you are administering the drug under the direction of a GP.