Identifying and Managing Sepsis in Podiatry

Laura M. Cascella, MA, CPHRM

In the regular course of patient care and treatment, podiatrists will encounter wounds on patients’ feet, ankles, and legs (e.g., ingrown toenails, lesions, cuts, blisters, and ulcers). Some wounds may heal on their own or with minimal treatment, but other wounds might progress and cause serious complications, including sepsis.

Sepsis is a serious and debilitating condition that may prove fatal if it’s not identified and treated quickly. Yet, knowledge about the condition, early recognition, and management are a persistent challenge in healthcare because of fluctuating definitions and identification criteria, nonspecific symptoms and progression, and lack of definitive testing.¹

These barriers present a significant challenge because early identification and immediate treatment of sepsis are necessary to prevent long-term morbidity and mortality. A treatment delay of just 6 hours worsens the prognosis, and the risk of mortality increases 7.6 percent each hour that antimicrobial treatment is delayed.²

Because most cases of sepsis develop outside the hospital setting,³ outpatient healthcare providers — as well as those who treat patients in long-term care and skilled nursing facilities — should be vigilant in understanding and recognizing potential warning signs of the condition. Podiatrists are in a unique position to help support early recognition and prompt treatment of sepsis for patients who have infections because of foot, ankle, or leg wounds.

The following strategies can help podiatrists and podiatry staff members better understand, prepare for, identify, and manage sepsis:

• Include a sepsis protocol as part of your practice’s infection prevention and control program. The protocol should include guidance on recognition, diagnosis, treatment, and monitoring.
• Be alert to common infections associated with sepsis, such as skin/soft tissue infections, bone infections, etc.
• Be cautious when treating patient populations that are at increased risk for sepsis, such as older adults, infants and young children, people who have chronic conditions (e.g., diabetes or cancer), people who are immunocompromised, people who have recently been severely ill or hospitalized, people who are pregnant or postpartum, or people who have recently had surgery.
• Review the common signs and symptoms associated with sepsis (e.g., fever, chills, and tachycardia) as well as potential atypical presentations (e.g., altered mental state).
• Make sure that patients who have wounds or who have recently had surgery are aware of the risk of sepsis. Provide them with clear, easy-to-understand information that explains what sepsis is, the potential signs and symptoms, and how to act quickly. When possible, also engage patients’ family members and caregivers in sepsis recognition and action.
• Educate patients about the importance of taking antibiotics exactly as prescribed and only when indicated to prevent issues related to antibiotic resistance.
• Use an early warning tool or scoring system to evaluate patients who have infections or suspected infections and identify which patients might be at risk for sepsis. Although these tools have limitations, they still can provide a useful framework for screening.
• Develop a process to follow if screening criteria for sepsis are met. The process should delineate what steps to take, including assessing for the source of infection, ordering tests and cultures, communicating with all members of the healthcare team, and escalating care to another provider or sending the patient to the hospital.
• Ensure that all providers and clinical care staff in the podiatry practice receive education about sepsis and are knowledgeable about the organization’s sepsis protocol and processes.⁴

Sepsis is a medical emergency that requires quick recognition and immediate action. Delays in diagnosis and treatment can lead to catastrophic consequences for patients. To learn more about sepsis and how to identify and manage it, see the Podiatry Institute’s Update on Sepsis Diagnosis and Management and MedPro’s Risk Resources: Sepsis.

Endnotes

¹ MacDonald, A. (2019, December 4). Detecting sepsis early. Technology Networks. Retrieved from www.technologynetworks.com/diagnostics/blog/detecting-sepsis-early-327999; Handzel, S. (2016, December 14). Early sepsis recognition in outpatient settings: Challenges and progress. Oncology Nursing News. Retrieved from www.oncnursingnews.com/view/early-sepsis-recognition-in-outpatient-settings-challenges-and-progress

² Virkstis, K. (2023, March 24 [last updated]). The 3 keys to a best-in-class sepsis prevention strategy. Advisory Board. Retrieved from www.advisory.com/daily-briefing/2018/04/18/sepsis-prevention

³ Ibid.

⁴ Health Service Executive. (2022, October 3 [last reviewed]). Sepsis causes. Retrieved from www2.hse.ie/conditions/sepsis/causes/; Centers for Disease Control and Prevention. (2025, January 31). Risk factors for sepsis. Retrieved from www.cdc.gov/sepsis/risk-factors/index.html; World Health Organization. (2024, May 3). Sepsis. Retrieved from www.who.int/news-room/fact-sheets/detail/sepsis; Neviere, R. (2023, June 13 [last updated]). Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. UpToDate. Retrieved from www.uptodate.com; Alexander, K. (2018). Update on sepsis diagnosis and management. In The Proceedings of the Annual Meeting of the Podiatry Institute: 2018 Update. The Podiatry Institute. Retrieved from www.podiatryinstitute.com/pdfs/Update_2018/Chapter_12.pdf; Patient Safety Movement. (2023). Early detection and treatment of sepsis. Retrieved from https://psmf.org/aebp-publications/early-detection-and-treatment-of-sepsis/

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