Purpose Patients with high-risk foot pathology frequently require coordinated vascular and multidisciplinary care coordination, yet traditional models often result in fragmented care and delayed decision-making. We evaluated an integrated vascular–high risk foot clinic model at Royal North Shore Hospital, designed to improve efficiency, streamline care, and optimise surgical triage. Methodology A 13-week prospective service redesign trial was undertaken within a tertiary High Risk Foot Service. Vascular registrar-led consultations were undertaken with podiatric clinicians supported by ambulatory care nursing staff in accordance with defined referral and de-escalation pathways for chronic limb-threatening ischaemia (CLTI), post-revascularisation surveillance, osteomyelitis, and complex ulcerations. Pre- and post-implementation clinic metrics were compared, including overbooking frequency, overtime occurrence, discharge rates, waitlist burden, multidisciplinary engagement and admission avoidance. Results Following implementation, vascular clinic overbooking reduced substantially (92% to 7%), while clinic overtime was eliminated (92% to 0%). Waitlist burden decreased from 217 to 99 patients. Patients required fewer clinic encounters (2.7 to 1.3 clinics per patient) and fewer appointments overall (8.27 to 2.6 appointments). Thirty-three percent of patients were discharged or de-escalated to local services or podiatric-led care. Multidisciplinary input was streamlined, with frequent same-day involvement from Endocrinology, Hospital-in-the-Home, Orthotics and Infectious Diseases. Fifty-six potential admissions were avoided, representing substantial healthcare cost avoidance. Conclusion An integrated vascular–high risk foot clinic improved access, reduced duplication, enhanced multidisciplinary efficiency and supported timely limb salvage decision-making. This model demonstrates a scalable framework for tertiary vascular services managing complex diabetic foot and CLTI presentations.