Focus on Allied Health: Podiatry Time is Tissue: I mportance of Urgent Foot Ulcer Referrals When it comes to foot ulcerations, every hour counts. The phrase "time is tissue" rings particularly true in podiatric care, where delayed intervention can mean the difference between healing and amputation. As clinicians, our collective vigilance and prompt action are essential in preserving limb function and improving patient outcomes. What begins as a seemingly minor break in skin integrity, in a patient who is “at-risk” (Peripheral Arterial Disease +/- Diabetes +/- Other Conditions) can rapidly progress through a predictable yet serious cascade. Within 24-48 hours, bacterial colonisation establishes itself. By day three to five, deeper tissue involvement occurs, and within a week, osteomyelitis becomes a significant risk. Each day of delay exponentially increases the likelihood of amputation, with research showing that patients experiencing treatment delays of more than 72 hours face a 40% higher amputation rate compared to those receiving immediate care. Recognising this clinical urgency, our rapid access Podiatry and High Risk Foot Service across RNSH and Ryde Hospital operates on the principle that foot ulcer patients require rapid assessment. We have streamlined our referral pathways to eliminate traditional referral processing times that can prove problematic for this patient cohort. Our triage system prioritises any patient presenting with: • Active foot ulceration, regardless of size or apparent severity • Active Lower Limb Related Infection • Neuropathic Fracture
Remember, the visual appearance of an ulcer can be deceptively benign, masking significant underlying pathology. What appears as a small surface wound may conceal extensive undermining, tracking, or bone involvement detectable only through specialist assessment and appropriate imaging.
For more information contact Saja.Qasem@health.nsw.gov.au
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