The podiatry department at the Royal Free Hospital diagnoses and treats acute foot pathology causing ulceration due to diabetes, peripheral vascular disease, and peripheral neuropathy.
The service is part of the acute foot multidisciplinary team, working with vascular surgery and diabetology consultant-led teams. Treatment is only available for people with acute foot disease.
Routine care of nails (nail cutting), ingrown nail care, general foot care (corns and calluses) and biomechanics (insoles) are not available. We do not provide a domiciliary (home visiting) service.
We cover three main areas within the department:
- outpatient podiatry
- ward podiatry (for inpatients)
- ‘hot’ clinic (emergency podiatry)
The podiatry clinic forms the core of the outpatient multidisciplinary foot team.
High-risk patients who have developed foot ulceration or have active Charcot arthropathy are reviewed at the clinic. This also includes patients who have been discharged from the hospital with ulcerations or post-amputation wounds.
The podiatrists specialise in advanced wound therapies. This includes sharp debridement (tissue removal) and advanced dressings techniques.
The outpatient clinic also runs a weekly multidisciplinary clinic, combining the expertise of podiatrists, vascular surgeons, and infectious diseases doctors with a focus on patient-centred care.
The clinic is on the 1st floor at the Royal Free Hospital and runs on an appointment-only basis every weekday from 8.30am to 4.30pm.
Patients who have been referred from GPs, community podiatry, consultants and nurses are seen at the clinic. Patients cannot self-refer into this service.
Podiatrists provide inpatient cover across the whole of the Royal Free Hospital.
They review high-risk patients who have active foot ulceration or have acute Charcot neuro-arthropathy.
The team are the first port of call for all foot wounds (including heel pressure wounds). They can assess, treat and appropriately signpost to a number of other hospital-based services including:
- vascular surgery/vascular studies
- diabetes services
- infectious diseases/microbiology
- surgical appliances
The team operate on Monday to Friday from 8.30am to 4.30pm. This includes the diabetic foot ward round, which takes place every Monday and Thursday.
The podiatry department runs a five-day-a-week emergency diabetic foot service to help patients seek appropriate treatment for high-risk foot conditions that would otherwise require attendance at the emergency department (A&E).
These include new ulceration, infection, acute Charcot arthropathy, necrosis, burns and gangrene.
The service runs Monday to Friday, from 8.30am to 4.30pm.
Referrals will come from a variety of sources such as emergency department walk-ins, GPs, community podiatry and district nursing referrals.
The team will aim to review each patient within 24 hours or the next working day of the referral being received.
Referrals are accepted from any health professional on the wards and must be emailed to the department prior to a patient being reviewed.
Routine care of toenails, ingrown nail care, general foot care, and biomechanics are not available.
Hot clinic referrals
If a patient is systemically well, please try to refer direct to the podiatrist to arrange an appointment instead of sending the patient to the emergency department.
The podiatrist treating you will perform a full medical history, and in most cases a full neurological and vascular assessment will be completed. Any foot wound or foot pathology will be assessed.
The podiatrist will explain the procedure and agree a treatment plan prior to any treatment being carried out. The first appointment usually takes approximately an hour.
Treatment can include sharp debridement (removing non-viable tissue with a scalpel) and possible wound or tissue samples to establish the microbiology of the wound. Appropriate dressings will be applied, and often this will mean the foot is bandaged to the ankle. If needed, offloading (support) devices will be fitted.
We may request further investigations. These may include blood tests or imaging (X-rays, MRIs, or vascular studies), which you may need to attend on the day. Most patients should prepare to be in hospital for up to half a day.
If needed, members of the multidisciplinary team will be asked to review patients. This includes vascular surgeons and infectious diseases doctors.
The following websites have support and information you may find useful:
Royal College of Podiatry
Amputee support group
An amputee support group is available for all patients who have had a major amputation. This takes place on the first Friday of every month.
The group provides new and established amputees with the opportunity to come together and share their personal experiences of life after an amputation, to share learning with each other of what they have found to be helpful. Family and carers are also welcome to attend.