Outpatient services are provided in the following areas:
Patients admitted to TTSH may be referred for appropriate Podiatry services depending on their condition.
Nail and Skin care of the Feet
Painful nail and skin conditions of the feet such as callus, corn or in-grown toenail can be treated safely and professionally by a Podiatrist.
Education on how to manage these conditions to reduce recurrence will also be provided.
Such conditions should not be treated by yourself or by unqualified personnel if you have medical conditions that affect the neurological and vascular status of the foot such as diabetes. This increases the risk of developing a wound on your feet and thus the risk of infection, especially with improper aftercare.
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TTSH Podiatry can offer Nail Surgery as a treatment option for painful nail conditions if deemed suitable for the procedure. The procedure is performed under local anaesthesia. The technique used by the Podiatrists entails partial/complete removal of the offending nail with chemical treatment of the nail-growing cells to prevent re-growth. Such technique greatly lowers the recurrence rate of re-growth and symptoms. Hence, this minimally invasive procedure provides good aesthetic outcome and resolution to painful nail conditions.
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Management of Foot Wounds
Podiatrists are trained in the management of foot wounds. A podiatrist will be able to assess and identify the possible causes of the non-healing wound. Wound healing can be compromised in the presence of medical conditions such as diabetes, peripheral vascular disease, auto-immune disorders, etc.
Foot wounds are different from wounds on other parts of the body, especially if located on the sole of the foot as it implicates walking. Treatment of these wounds may include prescribing appropriate wound dressings, advice on proper wound care regime, prescribing insoles to offload the wound or footwear advice. The Podiatrist often refers patients to other relevant specialties to address underlying conditions that may be hindering wound healing. Podiatrists can also remove tissue from around the wound bed that is impairing the wound healing process. This is known as debridement.
Wounds found on the sole of the feet will require offloading devices (such as insoles) and good footwear. Proper offloading of the wound after careful assessment of the gait and the foot is thus crucial for its healing. This is in the expertise of Podiatrists who are trained in Biomechanics and Wound Care.
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Biomechanical Assessment and Intervention
Common conditions/ areas of pain that Podiatrists treat:
- Heel Pain (i.e. Plantar Fasciitis, Achilles’ Tendonitis)
- Arch Pain (i.e. Posterior Tibial Tendon Dysfunction)
- Painful Bunions
- Knee/ Hip/ Lower Back Pain related to structural misalignment of foot and lower limb.
- Flat foot or High arch foot with pain
A Podiatrist will conduct a biomechanical assessment to establish any structural or functional abnormalities in the foot and the lower limb, which can contribute to a person’s overall posture and function.
The assessment comprises of a thorough examination of the presenting condition, joint positioning, mobility, foot posture and gait. Structural and/or functional abnormalities in the foot and the lower limb can often predispose one to injuries, commonly resulting in chronic and overuse conditions.
Appropriate treatment plan can be implemented based on the assessment findings. Treatment can vary from stretching, footwear education, prefabricated or custom-made orthoses/insoles, activity modification, ultrasound therapy etc.
When necessary, further referrals through your doctor will be made.
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Diabetic Foot Screening
Diabetes can silently affect the feet by causing the loss of sensation, reduction of blood flow, structural deformities and reduced immune system. These increase the risk of developing chronic wounds and infections, leading to amputation in the lower limb.
During Diabetic Foot Screening, patients diagnosed with diabetes are screened and given advice. This will help them to prevent and reduce the risk of developing wounds and undergoing amputations.
The screening involves vascular assessment, neurological assessment, dermatological assessment, biomechanical assessment and footwear assessment. From the results of the assessment, your foot risk status can be identified.
Advice on daily foot care and checks, footwear and early wound care will be provided as these are crucial in protecting your feet from wounds and infection.
Awareness of your foot status is important to determine the care for your feet and what is required to keep your feet healthy. If you have diabetes, annual Diabetic Foot Screening along with your efforts in checking your feet daily is the way to prevent amputation.
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Chew T, Ho M (2015): Effectiveness of podiatric nail surgery for patients with onchocryptosis by Tan Tock Seng Hospital Podiatry Department: An observational study. Ann Acad Med, Oct 44 Suppl(10): S56.
Wong T, Sani F, Chew T (2015): Patient-focused offloading options help with healing of chronic plantar ulcers. Ann Acad Med, Oct 44 Suppl(10): S92.
Phua M, Cheong KY, Quirk P, Anuar K (2016): Effectiveness of orthotics in improving Foot Posture Index and reported pain scores for patients referred to a Podiatry biomechanics clinic. Ann Acad Med, Sep 45 Suppl(9): S105.
Ng CG, Cheong KY (2016): Management of chronic diabetic plantar forefoot ulcer with the modified “Mandakini” offloading device for non-compliant patients in an Asian Society: a case series report. Ann Acad Med, Sep 45 Suppl(9): S100.
Murakami T, Cheung B, Ho M, Sani F, Anuar K (2016): Development of an algorithm to aid clinical decisions for offloading of plantar forefoot ulcers and Charcot deformities. Ann Acad Med, Sep 45 Suppl(9): S99.