The College's position 

Injectable hyaluronic acid-based fillers, such as Curacorn®, are being used by some clinicians to manage atrophy of the fat pad over bony prominences in the foot. 

The Royal College of Podiatry acknowledges the growing interest in these interventions and that some of the initial evidence suggested that there may be benefits for carefully selected patients. 

However, the College believes that considerable questions remain around regulation, prescribing, governance and the current evidence base.  

Until these issues are addressed consistently, clinicians are urged to use caution and prioritise established evidence-based approaches to care. 

Why is the College concerned? 

The position statement identifies several areas where patient safety and professional standards must be carefully considered. 

Regulatory compliance 

Clinicians must be clear about the regulatory status of any products they use. 

The College stresses that all treatments and practices must comply with UK medical device regulations and medicines legislation. Injectable dermal fillers with hyaluronic acid are a Class III medical device and are governed medically by strict regulation. Use of these devices as a cosmetic product are not recognised within scope of practice of Podiatry or the HCPC standards. 

The use of unverified or off-license products presents unacceptable risks to patient safety. 

Prescribing governance 

The position statement also highlights the importance of prescribing governance. 

Independent prescribers must work within their legal and professional scope of practice.  

Prescribing prescription-only medicines remotely requires a valid clinical management plan and patient consent. 

The College states that prescribing for patients outside an established care relationship is not allowed. 

It also notes that informal or ad hoc prescribing arrangements, including reliance on external networks for emergency prescribing, do not meet the standards expected under appropriate clinical governance. 

Members without independent prescribing annotation should not be managing prescription-only medicines beyond those permitted under their POM-A and POM-S exemptions. To do so could lead to investigations around fitness to practice or legal action. 

Managing complications 

The College stresses that clinicians undertaking these procedures must possess advanced clinical knowledge and skills from post registration education, including the ability to recognise and manage potentially serious complications. 

One of the biggest risks is vascular occlusion, a time-critical emergency that requires rapid intervention to prevent irreversible tissue damage. 

Clinicians need to be independent prescribers and have access to, and competence in the use of, appropriate reversal agents such as hyaluronidase before undertaking treatment. 

The position statement notes that understanding the supply, administration and dosing requirements of Hyaluronidase is essential.  

POM-A and POM-S annotation alone does not provide authority to obtain or supply hyaluronidase. 

What does the evidence say? 

The College accepts that some published studies report encouraging short-term outcomes. 

However, the current evidence base remains limited and there is insufficient high-quality data to fully understand the long-term safety and effectiveness of these interventions. 

There is also limited evidence regarding rare but potentially serious complications, therefore we are unable to provide patients with safe information about the risks of having the treatment. 

The College therefore supports further research in this area while pointing out that innovation must be underpinned by strong evidence and the appropriate governance. 

What does this mean for practice? 

The Royal College of Podiatry does not currently consider injectable hydrogels in the foot to be a part of routine podiatric practice.  

The College's position is that any adoption of these procedures should be restricted to appropriately qualified clinicians with independent prescribing annotation who are working at an advanced level within solid clinical governance frameworks. Those without an independent prescribing annotation should not be engaging in this treatment. 

Clinicians should ensure that patients are fully informed about the potential risks, benefits and uncertainties associated with the treatment. 

Remember your insurance covers you for your scope of practice. 

Why this matters to members 

As interest in injectable hydrogels grows, members may come across questions from patients, colleagues or commercial providers about these treatments. 

The College's position statement provides clarity on the standards expected around prescribing, regulation, governance and patient safety. 

It also confirms the importance of ensuring that new interventions are supported by appropriate evidence, professional competence and regulatory compliance before becoming part of wider clinical practice. 

Links and references 

Royal College of Podiatry: Medicines legislation guidance. 

Royal College of Podiatry: Clinical position statement on the use of injectable hyaluronic hydrogel dermal fillers in the foot