Hot, swollen, red is urgent
A warm swollen foot in a neuropathic patient is treated as infection or Charcot neuroarthropathy until excluded, with immediate routing and offloading advice rather than a routine appointment.
Specialty · Podiatry
The diabetic foot checked before it becomes an amputation.
Diabetic foot surveillance with image review, wound follow-up, orthotic and nail surgery pathways, and an infection threshold that treats a hot swollen foot as the emergency it is.
- < 60s
- Hot swollen foot to urgent routing
- 84%
- Surveillance contacts completed
- 2.2x
- Wound reviews without a clinic slot
In the product
Podiatry — surveillance contact
UrgentOutbound 11:20 · Vincent O. · 63 · T2DM · neuropathy · high risk · 6-week interval
Primum
Any change in either foot since we last spoke — colour, swelling, anything on your socks?
Caller
The right one's been a bit puffy. It's warm too but it doesn't hurt, so I left it.
Primum
I'm glad you mentioned it. Can you take a photo of both feet side by side, and one of the sole of the right?
Images received 11:26 · right foot erythematous, swollen, midfoot · no visible ulcer
Warm swollen neuropathic foot, no ulcer → Charcot vs infection, urgent
Primum
You need to be seen today. Until then keep weight off that foot completely — use crutches if you have them. The foot protection team is expecting you.
Foot assessment
- Risk band
- High · neuropathy, prior ulcer
- Right foot
- Warm, swollen, midfoot
- Pain
- Absent — neuropathic
- Ulcer
- None visible
- Differential
- Charcot vs infection
- Routed
- Foot protection, today
Offloading advised · images in chart · service notified 11:29
Overview
A diabetic foot ulcer is a clock, and nobody hears it ticking.
- Surveillance interval set by risk stratification, and actually kept.
- Images collected and assessed alongside symptoms, not appearance alone.
- Infection and Charcot presentations routed urgently, same contact.
Neuropathy means the warning system is gone. The patient does not feel the ulcer forming, does not feel it getting deeper, and often does not mention it because it does not hurt. By the time it is seen in clinic the question is no longer whether it will heal but what will be preserved.
Primum makes surveillance contact on the interval the patient's risk stratification demands, asks the questions that find an ulcer somebody has not noticed, collects images, and escalates immediately on infection or on the red hot swollen foot that might be Charcot. Around it the specialty's routine work — orthotics, nail surgery preparation, general wound follow-up — is handled without clinic time.
Capabilities
Four jobs, one of them time-critical
Foot care is unglamorous and the consequences of missing it are not.
Surveillance that finds things
Risk-stratified contact asking about colour change, discharge on socks, new lesions and footwear problems, with images collected including the sole and between the toes.
Wound progress tracked
Size, depth, exudate, odour and surrounding skin captured with each image, so the trajectory is visible between appointments and deterioration is caught early.
Orthotics and nail surgery
Fitting, adjustment and review scheduling, plus nail surgery preparation, anticoagulation checks, aftercare instructions and dressing follow-up.
How it works
Risk band to reviewed foot
The interval comes from the patient's risk, and the escalation comes from the findings.
- Arrives
- Decided
- Done
- Returned
01
Risk stratified
Neuropathy, vascular status, deformity, prior ulceration and prior amputation read from the record to set the surveillance interval.
Risk banding
02
Surveillance contact
Structured questions plus images of the sole, heel and interdigital spaces, with guidance on how to take them or who can help.
Image-led
03
Findings assessed
Images and symptoms evaluated together against infection, ischaemia and Charcot criteria, and verified before anything is recorded.
Criteria applied
04
Routed or scheduled
Urgent routing to the foot protection service, or the next surveillance contact booked and the record updated with the images attached.
Service routing
01
Risk stratified
Neuropathy, vascular status, deformity, prior ulceration and prior amputation read from the record to set the surveillance interval.
Risk banding
02
Surveillance contact
Structured questions plus images of the sole, heel and interdigital spaces, with guidance on how to take them or who can help.
Image-led
03
Findings assessed
Images and symptoms evaluated together against infection, ischaemia and Charcot criteria, and verified before anything is recorded.
Criteria applied
04
Routed or scheduled
Urgent routing to the foot protection service, or the next surveillance contact booked and the record updated with the images attached.
Service routing
Benefits
Earlier contact changes what is preserved
Nowhere in medicine does timing matter more relative to the effort involved.
Ulcers are found, not reported
Patients with neuropathy do not present with pain. Asking the right questions on schedule is the only reliable way these are found early.
Urgent presentations skip the queue
A hot swollen foot routed the same day rather than into a routine list is the intervention that changes the outcome.
Clinics keep their capacity
Stable reviews and orthotic follow-up handled remotely, so appointments go to feet that need hands on them.
In practice
Four foot contacts
Two of them the patient did not consider worth mentioning.
Swollen warm foot, no pain
Urgent, same dayNeuropathic patient, no trauma recalled. Charcot and infection both possible, so offloading advice is given and the foot protection service sees them that day.
Marks on the sock
Ulcer foundMentioned in passing on a surveillance call. Images reveal a grade 2 ulcer under the first metatarsal head that the patient had not felt.
Nail surgery next week
PreparedAnticoagulation checked, aftercare explained, dressing supplies confirmed and the follow-up dressing appointment booked.
Orthotic rubbing
AdjustedNew device causing a pressure point. Reviewed by image, adjustment appointment booked and interim advice given to prevent breakdown.
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Start with the high-risk register
Give us the patients whose surveillance interval has already slipped. We will contact all of them, collect images, and tell you what is on those feet right now.