A List of Medications Podiatrists Can Prescribe

Podiatrists in the United States can prescribe a broad range of medications, from antibiotics and antifungals to local anesthetics, corticosteroid injections, anti-inflammatory drugs, and in most states, controlled substances including certain opioids. The exact list depends on state law, but the scope is far wider than many patients expect. Understanding what your podiatrist can and cannot write a prescription for saves time, avoids unnecessary referrals, and helps you get treatment for foot and ankle problems faster.

Local Anesthetics

Local anesthetics are among the most commonly used medications in podiatric practice. Before performing procedures like ingrown toenail removal, wart excision, or foot surgery, podiatrists routinely administer injectable numbing agents directly to the affected area. The two workhorses are lidocaine and bupivacaine. Lidocaine acts quickly, typically numbing the area within minutes. Bupivacaine takes longer to kick in but provides a much longer duration of pain relief, which is useful for managing discomfort after a procedure ends.

In foot and ankle surgery, a common approach is to use a mixture of lidocaine and bupivacaine for the initial block, aiming to get both rapid onset and extended relief. A survey of foot and ankle surgeons found that a bupivacaine-lidocaine mix performed near the surgical site was the most commonly reported combination for local blocks.¹ However, research into the pharmacology of these combinations has raised some interesting wrinkles. When bupivacaine is injected into tissue that already has residual lidocaine from an earlier block, the extended duration of bupivacaine is significantly shortened. Bupivacaine given alone as the initial block provides the longest-lasting pain relief compared to mixtures or sequential injections.² This is the kind of detail your podiatrist navigates behind the scenes when choosing what to inject and when.

Antibiotics

Foot infections are one of the most common reasons podiatrists reach for the prescription pad. Infected ingrown toenails, puncture wounds, cellulitis, and diabetic foot ulcers all frequently require antibiotic treatment. The specific drug depends on the type of infection, its severity, and what bacteria are likely involved.

For routine soft-tissue infections, podiatrists commonly prescribe oral antibiotics. An Australian survey of podiatrists with prescribing endorsement found that the most frequently prescribed antibiotics were cephalexin, flucloxacillin, and amoxicillin with clavulanic acid.³ These are broad-spectrum agents that cover the staphylococcal and streptococcal bacteria responsible for most skin and soft-tissue infections of the foot.

Diabetic foot ulcers present a more complex challenge because they often harbor a mix of bacterial species. Treatment may involve broader antibiotic coverage. Among the options used for infected diabetic foot ulcers, ceftriaxone, clindamycin, metronidazole, amoxicillin-clavulanate, and linezolid are all recognized choices, each offering coverage against different bacterial profiles while carrying a relatively low risk of kidney damage compared to some alternatives.⁴ Whether your podiatrist prescribes these directly or coordinates with an infectious disease specialist depends on the severity of the infection and the practice setting.

Antifungal Medications

Fungal toenail infections are one of the bread-and-butter conditions podiatrists treat, and antifungal prescribing is a core part of the job. Treatment ranges from topical solutions you paint onto the nail to oral medications that work from the inside out.

In the United States, the FDA-approved options for toenail fungus include oral terbinafine, itraconazole, and griseofulvin, as well as topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution.⁵ Your podiatrist can prescribe any of these depending on how severe the infection is, how many nails are affected, and your overall health. Oral terbinafine is often the first choice for moderate-to-severe cases because it tends to be the most effective, but it requires monitoring of liver function. Topical agents work best for mild infections or when oral medication is not a good fit due to drug interactions or liver concerns.

Over-the-counter antifungal creams and sprays, such as topical terbinafine and clotrimazole, are also commonly recommended by podiatrists for athlete’s foot and superficial skin fungal infections. In Australia, topical terbinafine was among the most frequently recommended over-the-counter medications by podiatrists.³

Anti-Inflammatory Drugs and Simple Pain Relievers

Nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen are a staple of podiatric care. Conditions such as plantar fasciitis, tendinitis, bursitis, and arthritis of the foot and ankle frequently call for them. In a survey of UK healthcare professionals managing plantar heel pain, about 83% reported advising patients on NSAIDs and about 81% on simple analgesics like paracetamol (acetaminophen in the US).⁶

A randomized trial specifically looking at NSAIDs for plantar fasciitis found evidence that they can increase pain relief and decrease disability when combined with conservative measures like stretching and orthotics.⁷ Your podiatrist may recommend an over-the-counter NSAID or write a prescription for a higher dose or a prescription-strength version, depending on the situation. For patients who cannot take NSAIDs due to stomach problems, kidney disease, or blood-thinner use, acetaminophen or alternative approaches are typically substituted.

Corticosteroid Injections

Injectable corticosteroids are one of the most powerful tools in a podiatrist’s toolkit for managing inflammation and pain. These are not the same as anabolic steroids. They are anti-inflammatory medications injected directly into a painful area to calm swelling and provide relief. Two of the most common uses are for plantar fasciitis and Morton’s neuroma.

For plantar fasciitis, corticosteroid injections have been shown to provide significant short-term improvement, particularly during the first month. Combining the injection with a stretching program and ultrasound guidance to place the needle accurately helps maximize benefit and reduce the risk of complications like fat pad atrophy or plantar fascia rupture.⁸

For Morton’s neuroma, a painful thickening of nerve tissue between the toes, corticosteroid injections can also help, but the relief tends to be temporary. A systematic review found that pain scores improved significantly in the weeks to months after injection, but about 30% of patients eventually required surgery because the pain returned.⁹ The injection’s effectiveness also depends on the size of the neuroma. Research suggests that the benefit is more significant and longer-lasting for neuromas smaller than 5 mm.¹⁰ Your podiatrist can use ultrasound to measure the neuroma and help set realistic expectations about how long the injection might last.

Postoperative Pain Medications, Including Opioids

After foot or ankle surgery, pain management is a significant part of recovery. Podiatric surgeons follow a stepwise approach: non-opioid medications first, with opioids reserved for pain that does not respond to milder options. A consensus study among Australian podiatric surgeons recommended non-opioid oral analgesics for mild postoperative pain, while both non-opioid and opioid products were considered appropriate for moderate and severe pain. Oral opioids were specifically reserved for breakthrough pain across all severity levels.¹¹

In the United States, the most commonly prescribed opioid after elective foot and ankle surgery is hydrocodone combined with acetaminophen, and most podiatric surgeons prescribe opioids for less than two weeks following a procedure.¹² About two-thirds of podiatric surgeons also use regional anesthesia blocks to reduce the need for systemic pain medication after surgery. Whether a podiatrist can prescribe controlled substances like opioids depends on state law and whether they hold a DEA registration, but in most US states, podiatrists have this authority for conditions within their scope of practice.

Medications for Nerve Pain

Diabetic peripheral neuropathy, the burning, tingling, and shooting pain that affects the feet of many people with diabetes, is a condition podiatrists frequently encounter and manage. The pharmacological approach to this type of nerve pain is quite different from treating acute injury or inflammation, because the pain originates from damaged nerves rather than tissue damage.

First-line medications for painful diabetic neuropathy include tricyclic antidepressants, the antidepressant duloxetine, and the anticonvulsants pregabalin and gabapentin.¹³ These drugs were not originally developed for pain, but they work by dampening the abnormal nerve signaling that produces neuropathic symptoms. Other options with evidence of benefit include certain opioids, membrane stabilizers, the antioxidant alpha-lipoic acid, and topical capsaicin cream.

Duloxetine and gabapentin are the two agents most commonly compared head-to-head. A meta-analysis pooling several trials found a slight edge for duloxetine in reducing pain scores, though the difference did not quite reach statistical significance across the pooled data.¹⁴ A separate head-to-head trial found that duloxetine at 60 mg daily was more effective than gabapentin at 300 mg daily, though gabapentin was better tolerated in terms of side effects.¹⁵ In practice, the choice between these medications comes down to the individual patient’s other health conditions, what side effects they can tolerate, and what other drugs they are already taking.

Topical Medications and Wound Care Agents

Beyond pills and injections, podiatrists prescribe and apply a variety of topical medications. These include prescription-strength antifungal creams and solutions, topical antibiotics for minor wounds, silver-containing dressings for infected ulcers, and specialized wound care products for chronic diabetic foot ulcers. Wound care in the diabetic foot involves choosing materials based on the type and severity of the ulcer, and podiatrists play a central role in making those decisions alongside systemic antibiotic therapy and surgical debridement when needed.¹⁶

Topical capsaicin cream deserves a separate mention. Derived from chili peppers, it works by depleting a chemical messenger involved in pain signaling. It is sometimes recommended for neuropathic foot pain in patients who prefer to avoid systemic medications or who need something additional on top of an oral regimen. It stings on first application but that sensation usually fades with regular use over a few weeks.

Medications for Circulation Problems

Peripheral artery disease, the narrowing of blood vessels that supply the legs and feet, often overlaps with other foot conditions podiatrists manage. Cilostazol is a medication that improves blood flow and is sometimes used for people who experience leg pain while walking due to poor circulation. It requires dose adjustment in patients with kidney disease; guidelines suggest starting with a lower dose and monitoring tolerance before increasing.¹⁷ Whether your podiatrist prescribes this directly or coordinates the prescription with your primary care physician or vascular specialist depends on the practice setting and state regulations.

How Prescribing Authority Varies

One of the biggest sources of confusion for patients is that a podiatrist’s prescribing authority is not the same everywhere. In the United States, prescribing rights are set at the state level. Most states allow podiatrists with a Doctor of Podiatric Medicine (DPM) degree to prescribe a wide range of medications, including controlled substances, as long as the condition falls within their scope of practice (the foot, ankle, and related structures). Some states place restrictions on specific drug classes or require additional certifications for controlled substances.

Internationally, the picture is even more varied. In the UK, podiatrists have established prescribing rights and pharmacological management is considered a key component of podiatric care.¹⁸ In Australia, podiatrists can gain endorsement to prescribe scheduled medicines, and the most common indications driving those prescriptions are nail surgery, foot infections, postoperative pain, and fungal infections.³ In other countries, such as South Africa, podiatrists currently lack prescribing authority entirely, which creates reliance on referrals and limits access to timely treatment. The trend globally has been toward expanding podiatric prescribing rights, driven in part by advances in podiatric education and training since the 1980s.¹⁹

What Podiatrists Typically Do Not Prescribe

Knowing the boundaries is just as useful as knowing the list. Podiatrists generally do not prescribe medications for conditions unrelated to the lower extremity. If you have high blood pressure, diabetes management beyond foot complications, or a systemic infection that goes beyond the foot and ankle, those prescriptions come from your primary care physician or a relevant specialist. Podiatrists also do not typically prescribe psychiatric medications, cardiac drugs, or chemotherapy agents, even if a foot condition is related to those health areas.

There are also gray zones. A podiatrist managing a diabetic foot ulcer might prescribe antibiotics for the wound infection but coordinate with an endocrinologist or internist for adjusting diabetes medications. A podiatrist treating gout-related foot pain might discuss medications like allopurinol or colchicine with the patient but defer the actual prescription to rheumatology or primary care, since gout is a systemic metabolic condition. In primary care settings where gout comes up, podiatrists have been observed participating in consultations about gout treatment, but the prescribing itself often falls to the physician.²⁰

Practical Tips for Patients

If you are seeing a podiatrist for the first time and expect to need medication, a few things will make the visit smoother. Bring a current list of all your medications, including over-the-counter supplements and herbal products. Drug interactions matter, and your podiatrist needs the full picture before adding anything new, especially antibiotics or pain medications. If you have kidney disease, liver problems, or a history of stomach ulcers, mention those upfront because they affect which drugs are safe for you.

Ask whether your podiatrist can fill the prescription during the visit or whether they will send it to a pharmacy. Many podiatric offices stock local anesthetics and injectable corticosteroids on-site for immediate use, but oral medications like antibiotics and antifungals are typically sent electronically to your pharmacy. For controlled substances, expect tighter protocols: some states require the podiatrist to check a prescription drug monitoring database before writing the script, and refills may require an in-person follow-up rather than a phone call.

If your podiatrist determines that a medication falls outside their prescribing scope or that your condition requires management by another specialist, they will refer you. This is not a limitation of their competence but a reflection of how scope-of-practice laws are structured. In many cases, the podiatrist will still coordinate your care and communicate directly with the other prescriber to make sure the treatment plan is cohesive.

Medications Used in Podiatric Surgery That Patients Rarely See

Some medications podiatrists use are administered entirely in the operating room or procedure suite, and patients may never know them by name. Beyond the local anesthetics already discussed, podiatric surgeons may use hemostatic agents to control bleeding, bone void fillers loaded with antibiotics for certain orthopedic procedures, and antibiotic-loaded bone cement in cases involving diabetic foot reconstruction. Research into which antibiotics perform best in bone cement has identified gentamicin and tobramycin as strong choices for gram-negative bacteria, and moxifloxacin and ampicillin for gram-positive organisms.²¹ These are highly specialized applications, but they illustrate the range of pharmacological decisions podiatric surgeons make beyond what ends up on a prescription label you take home.

1
PubMed. Opioid Prescribing Patterns of Foot and Ankle Surgeons: Single State Review
2
PubMed. Onset and duration of anesthesia for local anesthetic combinations commonly used in forefoot surgery; surprise results with sequential blocks
3
Journal of Foot and Ankle Research. Australian podiatrists scheduled medicine prescribing practices and barriers and facilitators to endorsement: a cross-sectional survey
4
PubMed Central. Antibiotic Treatment Practices and Microbial Profile in Diabetic Foot Ulcers: A Retrospective Cohort Study
5
PubMed Central. Updated Perspectives on the Diagnosis and Management of Onychomycosis
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PubMed Central. Plantar Heel Pain Management: A Survey of UK Registered Healthcare Professionals
7
PubMed. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study
8
PubMed Central. The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies
9
PubMed Central. Corticosteroid Injection for Morton’s Interdigital Neuroma: A Systematic Review
10
PubMed. Efficacy of corticosteroid injection versus size of plantar interdigital neuroma
11
PubMed Central. Acute postoperative pain management protocols in podiatric surgery within Australia: a Delphi study
12
PubMed. Opioid prescribing habits of podiatric surgeons following elective foot and ankle surgery
13
PubMed. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management
14
PubMed Central. Comparison of the Efficacy and Safety of Duloxetine and Gabapentin in Diabetic Peripheral Neuropathic Pain: A Meta-Analysis
15
National Journal of Physiology, Pharmacy and Pharmacology. A comparative study on efficacy and safety of tablet duloxetine 60 mg and tablet gabapentin 300 mg among patients with diabetic polyneuropathy
16
PubMed Central. Choice of wound care in diabetic foot ulcer: A practical approach
17
PubMed Central. Peripheral Artery Disease and Chronic Kidney Disease: Clinical Synergy to Improve Outcomes
18
PubMed. Enhancing diabetic foot management: Advocating for independent prescribing rights for podiatrists in South Africa
19
PubMed Central. Non-medical prescribing in Australasia and the UK: the case of podiatry
20
BMC Family Practice. “It’s complicated” – talking about gout medicines in primary care consultations: a qualitative study
21
PubMed Central. Boruta algorithm-guided antibiotic selection in antibiotic-loaded bone cement for diabetic foot ulcers: microbiota and susceptibility analysis