Singapore podiatrist explains why care is needed for lower limbs

SINGAPORE - When Ms Tiffany Tsao I-Fen was five years old, her mother bought her a video encyclopaedia of the human anatomy. It had animation clips explaining how red blood cells travelled in vessels and it piqued her interest in health care.

In her first year at Queensland University of Technology in Australia, she studied nutrition and dietetics, before switching to podiatry. In 2008, she attended University of Sydney for a Master of Health Science, majoring in education.

Today, she is the Head of podiatry at the department of rehabilitation medicine at National University Hospital at 29 years of age.

Podiatrists diagnose and treat a wide range of problems affecting the feet, ankles and lower legs.

Having been trained in vascular podiatry, Ms Tsao can provide maggot debridement therapy and ultrasonic assisted debridement therapy, among others. The former involves letting maggots eat dead tissue and promote wound recovery, while the latter does the same using sound waves to generate mild heat on the wound and increase blood circulation to it.

Ms Tsao's 35-year-old husband is an operation manager in medical technology firm Medtronic Singapore. They have a 21/2-year-old daughter.

I specialise in vascular surgery wound management because...

I enjoy working with and learning from vascular surgeons.

With an increase in the prevalence of cardiovascular disease and diabetes mellitus here, many patients may have poor blood circulation in the arteries of their lower limbs, which can cause poor wound healing. This can lead to amputation and sepsis, a severe blood infection that can cause organ failure and death.

The foot is fascinating because...

It is an amazing and complex structure consisting of 26 bones, 33 joints and more than 100 muscles.

Our feet provide the foundation that holds a person's weight and endure pressure and gravity 365 days a year.

Think of how often people service their cars. If they applied the same principle to their feet, we would all have happy feet.

My job is to look after a person's lower limbs, from the waist down, and not just the feet.

One little known fact about vascular podiatric management is...

We have a foot sink in the hospital in which we wash a patient's feet before treatment or after a dressing is removed.

We understand that treating chronic leg wounds can be messy and patients may have difficulty maintaining proper personal hygiene. A nurse will assist with foot bathing when necessary.

A typical day for me starts...

At 8am, usually with a meeting. Our team of four podiatrists works with different departments in the hospital - foot and ankle, endocrinology, orthopaedics surgery, rehabilitation medicine, vascular surgery and dermatology.

We cover the entire hospital and I also see patients at the podiatry clinic at the National University Hospital Heart Centre, Singapore.

My day involves attending to cases in the wards and going around to help with clinics, patient care and on-the-job training of podiatrists.

Three times a week, I attend ward rounds with the vascular and orthopaedics teams.

Patients are my priority, and each procedure I do takes up to an hour or more. I also work on statistics, audits and research projects.

I aim for work-life balance and try my best to finish work on time so that I can continue with my second shift at home as a mother. I read storybooks to my daughter or take her to the swimming pool.

I have come across all types of cases...

That involve all types of wounds in the lower limbs - surgical wounds, arterial wounds, venous wounds and traumatic wounds.

An arterial wound is caused by poor blood flow because of small, narrow or damaged arteries, while a venous wound occurs when the valves in the veins do not work properly.

A traumatic wound results from an injury. There is no typical case. Any patient with foot problems can be referred to a podiatrist. Some patients have flat feet, others complain of heel pain and still others may have Achilles tendonitis, an overuse injury of the Achilles tendon, the band of tissue which connects calf muscles at the back of the lower leg to the heel bone.

Our average patient load is about 1,000 a month.

I love patients who...

Maintain a positive mindset and are willing to work with us to fight disease and achieve optimal wound healing. Most of them are willing to take our advice and believe in our treatment plans.

People who get my goat are...

Patients or family members who are rude, violent and not understanding towards health-care professionals.

Those who make unreasonable demands and think that getting treatment is like ordering set meals are not appreciated.

Things that put a smile on my face are..

Seeing patients recover and their wounds heal fully. I have treated patients who almost had to have their legs amputated because of poor wound healing. Wound healing requires an extraordinary amount of tender loving care.

It breaks my heart when...

Patients do not receive support - financially or during caregiving - from their families and they have to manage their conditions alone in the hospital.

I would not trade places for the world because...

This job allows me to do research, handle managerial tasks and have contact with patients. I also enjoy working with other health-care professionals who all have the same aim of working for better outcomes.

My best tip...

Do lots of leg stretches or simple yoga every day to balance the foot muscles.

We need balance between flexors (muscles that bend a joint) and extensors (muscles that straighten a joint) on each part of the body to keep healthy and flexible.

Wear protective and sensible shoes to accommodate daily activities and elevate your legs after a long day's work to prevent oedema (fluid retention) in the feet.

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