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Opioids, for example methadone, sometimes work and techniques like nerve block with local anaesthetic or transcutaneous electrical nerve stimulation or the topical use of capsaicin as a counter-irritant may help.
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Bupivacaine can also be used with adrenaline.
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The clear advantages of supplementary prescribing for a consultant podiatrist working in the community now are that a referral system has been set up with the GPs of vulnerable patients in a local area; the patients receive timely and appropriate access to urgent treatment; there is improved compliance for many patients; management of serious foot ulcers follows published protocols; drug monitoring for adverse effects and drugdrug interactions is the responsibility of the prescribing podiatrist; and the patients are likely to need fewer episodes of care.
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