Glen A. Whittaker

Introduction: Corticosteroid injections are commonly used to manage foot and ankle conditions; however, there is limited evidence guiding corticosteroid selection, dosing, imaging guidance and injection techniques. This study aimed to describe current corticosteroid injection practices among Australian podiatrists and podiatric surgeons. Methods: A descriptive cross‐sectional survey was distributed via REDCap to Australian podiatrists and podiatric surgeons endorsed to prescribe scheduled medicines. The questions were developed using an iterative process and focused on demographic and professional characteristics, administrative factors and injection practices for plantar fascia, intermetatarsal and intra‐articular injections. The survey was conducted between January 2025 and April 2026 and reported according to the Consensus‐Based Checklist for Reporting of Survey Studies (CROSS). Descriptive statistics were used to summarise injection practices for plantar fascia, intermetatarsal and intra‐articular injections. Results: Forty‐five people participated in the study, and 33 completed the survey in full. Participants had a mean of 17.1 years in practice and 9.6 years administering corticosteroid injections. Most participants were endorsed podiatrists (64%), with the remainder being podiatric surgeons (33%). Participants reported administering a mean maximum of three corticosteroid injections per patient annually and recommending a mean interval of 3 months between injections. Betamethasone 5.7 mg/mL was the most common corticosteroid across all injection sites and was frequently combined with ropivacaine or bupivacaine. Ultrasound guidance was used by 50% of participants for plantar fascia injections, 39% for intermetatarsal injections and 46% for intra‐articular injections. Symptom relief was perceived to last between 3 and 6 months, whereas adverse effects were recalled to be infrequent and most commonly included steroid flare and post‐injection pain. Conclusion: Australian podiatrists and podiatric surgeons reported consistency in some corticosteroid injection practices and variability in others. These findings provide an initial descriptive benchmark of corticosteroid injection practice in Australian podiatry and may inform future clinical guidelines and research.

People with rheumatological conditions often experience debilitating foot-related symptoms requiring expert multidisciplinary care. However, in Australia there is a glaring gap in the provision of universally accessible, publicly-funded podiatry services. This study aims to assess the feasibility of a randomised trial evaluating a publicly-funded podiatry service for people with foot-specific symptoms related to rheumatological conditions. A pragmatic, participant-blind, parallel-group, randomised feasibility trial will compare effectiveness of a podiatry service with usual care. Consumer interviews will inform the design of the feasibility trial. Thirty adults with a rheumatological condition and foot specific symptoms will be recruited from an outpatient rheumatology clinic and randomised to receive access to a podiatry service or a control group who will receive usual care. Outcome measures will be obtained at baseline, week 6 and week 12. Feasibility will be evaluated using a framework that includes 10 important domains of uncertainty in pragmatic feasibility trials. Secondary outcomes (such as Goal Attainment Scaling) will also be collected and effect sizes of between group differences calculated to signal efficacy. The study will explore the feasibility of conducting a fully powered randomised trial of the effectiveness of a podiatry service for people with a rheumatological condition and foot-specific symptoms. In addition, the trial will determine the feasibility of Goal Attainment Scaling as a primary outcome measure for this population. Trial registration. The trial is registered with the Australian and New Zealand Clinical Trial Registry (ANZCTRN12625001000493 on the 9th of September 2025).

Background: Foot and ankle muscle strengthening exercises are common interventions for many musculoskeletal conditions that are associated with pain and limited function in the lower limb. The scientific literature has a multitude of strengthening exercises recommended, and they have been criticized for not adhering to best practice and for being poorly reported. The aims of this scoping review were to (i) describe what foot and ankle strengthening exercises have been recommended in the scientific literature, (ii) compare the prescription of these exercises to best practice recommendations, and (iii) assess the completeness of the reporting of these exercises and exercise programs.Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A systematic search of peer‐review journal articles was conducted on 23 February 2023. Study designs that were included were experimental, quasi‐experimental, feasibility, pilot studies, and observational. For each study included in the review, study design and participant details such as age, sex, and conditions treated were noted. To describe the foot and ankle strengthening exercises, each exercise was noted, which included its name, the number of sets and repetitions recommended, the load type and its magnitude, and whether there were any progression strategies. Exercises were grouped according to primary movement and a general exercise descriptor. To compare to best practice, each program's prescription parameters of frequency, intensity, and time were compared to the American College of Sports Medicine's (ACSM) guidelines. To assess completeness of reporting, each study was assessed with the Consensus on Exercise Reporting Template (CERT).Results: The search yielded 1511 documents, and 87 were included after full‐text screening. Of the included studies, most were randomized controlled trials, and the most common participants were healthy adults (mean age range: 18–83 years). Across all studies, a total of 300 foot and ankle exercises were prescribed. The most common strengthening exercise category involved ankle plantar flexion (25% of 300 exercises), followed by plantar foot intrinsics (16%). The most common prescription of strengthening exercises included 3 sets (37%) of 10 repetitions (38%) performed 3 times per week (34%), often without a prescribed load (66%). Prescribed sets per muscle group met ACSM recommendations for novice lifters in 93% of studies. In contrast, load intensity (for increasing muscle strength) was prescribed at the recommended dose of 60% of 1 repetition maximum or greater in only 2% of exercises. The median score for completeness of reporting according to the CERT checklist was 31% of all items.Conclusions: This scoping review found that the studies predominantly included ankle plantar flexion and plantar foot intrinsic muscle strengthening exercises, typically prescribed at 3 sets of 10 repetitions, 3 times per week. When compared to best practice recommendations, load intensity in exercise prescription is commonly less than recommended or is not reported. In addition, the review highlights deficiencies in the reporting of exercise programs. We propose using established best‐practice exercise prescription guidelines like those from the ACSM and the adoption of CERT for reporting exercises in the scientific literature.

Background: The visual analogue scale (VAS) and the Foot Health Status Questionnaire (FHSQ) are patient‐reported outcome measures that are frequently used to evaluate the management of plantar heel pain. This study aimed to re‐calculate (i.e. revise) the minimal important differences (MIDs) of the VAS and the FHSQ when used for plantar heel pain to enhance the validity and precision of previous estimates.Methods: This study used an anchor‐based method to calculate MIDs and incorporated best‐practice analyses to ensure credibility of the estimates. Data from 369 participants previously recruited from the community into four randomised controlled trials that evaluated interventions for plantar heel pain were used. VAS and FHSQ data from these participants at baseline and follow‐up were pooled to calculate the MIDs (95% confidence intervals). A 15‐point global rating of change Likert scale was used at follow‐up as the transition scale, which was anchored to baseline. For the VAS, MIDs for two distinct types of pain were calculated: average pain and first‐step pain. For the FHSQ, MIDs for two domains were calculated: foot pain and foot function.Results: The revised MIDs for the 100 mm VAS were −8.5 mm (95% CI: −12.2 to −4.7) for average pain and −19.2 mm (95% CI: −24.7 to −13.8) for first‐step pain, which represent improvements in pain. The MIDs for the FHSQ were 12.4 points (95% CI: 6.9 to 18.0) for foot pain and 6.4 points (95% CI: 0.9 to 11.9) for foot function, which represent improvements in foot health status.Conclusions: The revised MIDs from this study for the VAS and the FHSQ when used for plantar heel pain have enhanced validity and precision compared to previous estimates. This is important for clinicians and researchers as it provides a better understanding of how much improvement is required by an individual before an important change is experienced. The revised MIDs will also assist researchers with prospective sample size calculations, so future clinical trials are appropriately powered from a statistical standpoint.

Rheumatological conditions are complex and impact many facets of daily life. Management of people with rheumatological conditions can be optimised through multidisciplinary care. However, the current access to nursing and allied health professionals in Australia is unknown. A cross-sectional study of nursing and allied health professionals in Australian public rheumatology departments for adult and paediatric services was conducted. The heads of Australian public rheumatology departments were invited to report the health professionals working within their departments, referral pathways, and barriers to greater multidisciplinary care. A total of 27/39 (69.2%) of the hospitals responded. The most common health professionals within departments were nurses (n = 23; 85.2%) and physiotherapists (n = 10; 37.0%), followed by pharmacists (n = 5; 18.5%), psychologists (n = 4; 14.8%), and occupational therapists (n = 4; 14.8%). No podiatrists were employed within departments. Referral pathways were most common for physiotherapy (n = 20; 74.1%), followed by occupational therapy (n = 15; 55.5%), podiatry (n = 13; 48.1%), and psychology (n = 6; 22%). The mean full-time equivalent of nursing and allied health professionals per 100,000 population in Australia was 0.29. Funding was identified as the most common barrier. In Australia, publicly funded multidisciplinary care from nurses and allied health professionals in rheumatology departments is approximately 1.5 days per week on average. This level of multidisciplinary care is unlikely to meet the needs of rheumatology patients. Research is needed to determine the minimum staffing requirements of nursing and allied health professionals to provide optimal care.

Background: People with plantar heel pain (PHP) have reduced foot and ankle muscle function, strength and size, which is frequently treated by muscle strengthening exercises. However, there has been little investigation of what exercises are used and there is no sound evidence base to guide practice. This study aimed to develop a consensus‐driven progressive muscle strengthening program for PHP. Methods: Thirty‐eight experts were invited to participate in the study over three rounds. Round 1 was an open‐ended questionnaire that provided the core characteristics of progressive strengthening programs designed for three different adult patient types with PHP (younger athletic, overweight middle‐aged, older), which were presented as vignettes. In Round 2, experts indicated their agreement to the proposed exercises and training variables. In Round 3, experts were presented with amendments to the exercises based on responses from Round 2 and indicated their agreement to those changes. Consensus was achieved when > 70% of experts agreed. Results: Two experts were ineligible and 12 declined, leaving 24 (67%) who participated in Round 1. Eighteen (75%) completed all three rounds. From Round 1, progressive strengthening programs were developed for the three vignettes, which included 10 different exercises and three training variables (sets / repetitions, weight, and frequency). In Round 2, 68% (n = 17) of exercises and 96% (n = 72) of training variables reached consensus. In Round 3, only exercise changes were presented and 100% of exercises reached consensus.Conclusions: This study provides three progressive strengthening programs agreed to by experts that can be used in future clinical trials to determine the effectiveness of muscle strengthening for PHP. In addition, clinicians could use the programs as part of a rehabilitation strategy with the caveat that they may change as more research is conducted.

COVID-19 is likely the worst public health crisis in Australia since the 1919 Spanish Flu [1]. Effective management of the COVID-19 pandemic and future pandemics in Australia requires significant and sustained population-wide behaviour change. There is evidence that mass media interventions delivering public health information can influence behaviours such as treatment-seeking, behavioural intentions, knowledge, and […]

Background: Medical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar heel pain.Methods: This systematic review and meta‐analysis conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to 12th February 2021. Peer‐reviewed articles of cross‐sectional observational studies written in English that compared medical imaging findings in adult participants with plantar heel pain to control participants without plantar heel pain were included. Study quality and risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross‐sectional studies. Sensitivity analyses were conducted where appropriate to account for studies that used unblinded assessors.Results: Forty‐two studies (2928 participants) were identified and included in analyses. Only 21% of studies were rated ‘good’ on quality assessment. Imaging features associated with plantar heel pain included a thickened plantar fascia (on ultrasound and MRI), abnormalities of the plantar fascia (on ultrasound and MRI), abnormalities of adjacent tissue such as a thickened loaded plantar heel fat pad (on ultrasound), and a plantar calcaneal spur (on x‐ray). In addition, there is some evidence from more than one study that there is increased hyperaemia within the fascia (on power Doppler ultrasound) and abnormalities of bone in the calcaneus (increased uptake on technetium‐99 m bone scan and bone marrow oedema on MRI).Conclusions: People with plantar heel pain are more likely to have a thickened plantar fascia, abnormal plantar fascia tissue, a thicker loaded plantar heel fat pad, and a plantar calcaneal spur. In addition, there is some evidence of hyperaemia within the plantar fascia and abnormalities of the calcaneus. Whilst these medical imaging features may aid with diagnosis, additional high‐quality studies investigating medical imaging findings for some of these imaging features would be worthwhile to improve the precision of these findings and determine their clinical relevance.

Background: Studies have described general practitioner (GP) management of plantar heel pain from some countries; however, there is limited information from Australian general practice.Objectives: To describe patient and GP characteristics, and management actions for plantar heel pain in Australian general practice.Design: Secondary analysis of data from the Bettering the Evaluation and Care of Health (BEACH) dataset.Methods: Data were summarised using descriptive analysis and robust 95% confidence intervals (CIs) were calculated around point estimates. Multivariate logistic regression identified predictors of plantar heel pain management.Results: From 1,568,100 encounters between April 2000 and March 2016, plantar heel pain was managed at 3007 encounters. GPs manage plantar heel pain approximately once every 500 encounters, which extrapolates to 271,100 encounters in 2015–2016. Patient factors independently associated with plantar heel pain encounters included female sex (OR 1.27, 95% CI 1.17–1.34 cf. males), being aged 45–64 (OR 3.44, 95% CI 2.94–4.01 cf. aged 75+) and patients from a non‐English speaking background (OR 1.22, 95% CI 1.07–1.39). Plantar heel pain was frequently managed using medication (45.1 per 100), with non‐steroidal anti‐inflammatory drugs the most common (22.8 per 100). GPs also commonly provided counselling/advice/education (32.4 per 100), and referrals for diagnostic imaging (19.1 per 100) and to podiatrists (12.0 per 100).Conclusions: Plantar heel pain is a frequently managed foot condition in Australian general practice. GPs use medication, counselling and education, diagnostic imaging and referral to podiatrists for management. Further research is required to understand the drivers of these management actions and whether they are effective.