Nail surgery helps resolve infected, damaged or ingrowing toenails. It can provide permanent pain relief and prevent recurrent infections.
WHAT IS nail surgery?
Nail surgery is carried out to provide permanent pain relief and/or preventing recurrent infections in problem toes. Occasionally, it is carried out for cosmetic reasons. Nail surgery involves remove part, or all of a problem toenail. If the whole nail is removed it is called a Total Nail Avulsion (TNA), if only part of the nail is removed, it is called a Partial Nail Avulsion (PNA).
WHO REQUIRES NAIL SURGERY?
Nail surgery may be recommended for people with infected, ingrowing toenails or damaged, distorted thick nails that are causing pain and have not responded to conservative treatment. We often see people who have medical conditions that cause recurrent issues.
WHAT HAPPENS AT OUR FIRST APPOINTMENT?
It is usual for you to be assessed first, and an appointment made for surgery later. During the initial assessment, the podiatrist will explain the procedure and answer any questions you may have.
They will carry out a careful examination of your toe(s) and will also assess your general health. They will ask questions to find out whether you are taking any medication, if you may be pregnant, have any blood disorders or phobias to ensure that you are suitable for surgery.
WHAT HAPPENS DURING NAIL SURGERY?
Nail Surgery is carried out in the clinical room of your selected clinic. Patients are fully awake during the procedure, but we usually recommend that you do not watch in case it makes you feel uncomfortable. A local anaesthetic is injected in the toe to stop you feeling any pain. You may feel a slight discomfort when injecting the anaesthetic, but this only lasts a couple of minutes. Once the toe has been anaesthetised (numbed), you will be able to move the toe but will not feel any pain.
A tight rubber band, called a tourniquet, is put around the toe to reduce bleeding. The nail, or piece of nail, is then removed. Phenol is applied to the underlying nail matrix to help stop regrowth of the nail. This procedure is known as Phenol Matricectomy and has a success rate of around 95% in preventing re-growth.
The tourniquet is removed and an antiseptic dressing is applied, along with another special dressing that will help stop any postoperative bleeding. These dressings are then covered with sterile gauze which helps pad and protect the wound. You will be asked to return in a few days for the wound to be inspected and re-dressed. After that you’ll be given advice about how to look after your toe and to continue any re-dressings yourself.
WHAT HAPPENS AFTER NAIL SURGERY?
The local anaesthetic usually wears off in 2-4 hours, so it is important to exercise caution during this period and avoid any unnecessary activity. Wear an open toe sandal or similar shoe on the day of your procedure. This will allow room for the large dressing that will be applied. Wear loose, comfortable clothing that can be rolled back to the knee.
We would advise you not to use public transport or walk home after the procedure, as this may prolong any bleeding or increase the likelihood of accidental damage to the toe while it is still numb . Please arrange for someone to take you home in a car, or make arrangements for a taxi.
Important note: Driving when your toe is anaesthetised may make you unfit to drive and/or invalidate your insurance.
What will my toe look like afterwards?
The result of your surgery depends on your particular toenail problem and the exact procedure used. In the days following surgery it is usual to have a temporary discharge from the wound, and bruising around the injection sites. Phenol may cause some inflammation at the base of the nail and the area can be a little tender for a few weeks. These should all settle in time.
If you have a total nail avulsion with phenolisation, your healed toe will have skin covering where the nail once was. If you’ve had just a small section of nail removed then the result will be a narrower nail plate as the folds of skin at the side(s) closes up.
How will the surgery affect my ability to work?
If you have an active job, you may need to take a few days off work to rest the affected toe(s). We recommend that you wear open toe shoes until the first redressing appointment.
Please be aware that these may not comply with any Health & Safety requirements at your place of employment so it may be wise to ask for time off or request a temporary change in role.
For children, we recommend they do not return to school until after the follow-up appointment when the toe is re-dressed (typically after about 3 days). If necessary the surgery can be arranged to avoid clashes with other commitments, for example, exam time or holidays.