Nail Surgery

Why might I need to have Nail Surgery?

One very common condition that affects young and old is an ingrowing toenail. The infection and pain is something that is hard to ignore. Having excellent skills in assessment and treatment of this condition makes podiatry very exciting and has huge benefits in day to day life. Nail surgery is a minor operation which is routinely carried out to treat painful toenail conditions such as involuted and ingrowing toenails. The procedure involves removal of either all of, or part of the painful toenail. The nail bed is then destroyed to prevent unwanted painful regrowth. The procedure is carried out under a local anaesthetic so patients do not feel any pain during the surgery.

What will happen on the day of my surgery?

• On arrival you should book in with the Receptionist. You will be called through to the treatment room and be asked to remove both your shoes and socks.
• The Podiatrist will re-check your health and medication you are taking and confirm with you which toenail(s) will be operated on. It is very important that you inform the Podiatrist if there has been any changes to your health or medication as these may have an effect on the anaesthetic or your post-operative healing.
• You will have the opportunity to ask any questions. The Podiatrist will then ask you to sign your consent form. By doing so, you are confirming that you understand the proposed treatment including any potential risks/complications.
• The Podiatrist will then administer the anaesthetic to the base of the affected toe(s). After approximately 5 –10 minutes, the Podiatrist will check that your toe(s) has gone numb. It is important to realise that the local anaesthetic will get rid of the sensation of pain/sharpness only.
• You should still expect to feel pressure, touch, movement and temperature. The Podiatrist will not proceed until the toe is completely numb.
• The toe(s) is then applied with an antiseptic solution and a tight rubber ring is also applied.
• It is normal to feel pressure during surgery.
• Once surgery has finished the nail bed is destroyed using a chemical (phenol) which should prevent the nail from regrowing.
• The tight rubber ring is then removed and an antiseptic dressing is applied. This dressing should be left in place until your follow up appointment or when the Podiatrist has advised you to do so.
• You will be expected to remain in the treatment room for 5 –10 minutes following your surgery to check for any post-operative bleeding.
• You will be given post-operative advice following your surgery as well as a follow up appointment.

 What are the advantages of having nail surgery?

• Less discomfort
• No episodes of infection
• Easier shoe choice
• Easier walking

Whilst it cannot be guaranteed that you will never have another problem with the toe or be completely pain free, it is highly likely that your toe will be much improved.

I have heard it is a very painful operation

Advances in techniques, local anaesthetics and pain killers now mean that patients have a high level of success with much less pain. Generally speaking, there is very little discomfort the night of the operation or during the healing period, depending on the tightness of the shoes worn. It is rare that the level of pain is not controlled by normal pain medication (e.g. Paracetamol or Ibuprofen if you can take them).

What are the complications?

Every effort is made to minimise the risk of complications and these are rare. However, some specific complications may occur, such as:

• This can occur during recovery although the operation is often performed due to an infected ingrown toenail, thus this is less likely once the nail has been removed
• Prolonged weeping
• Re-growth of the nail. This occurs in approximately 2-4% of patients. The re-growth is often less troublesome than the original problem but the procedure can be repeated if necessary.
• A reaction to phenol (phenol flare) can occur but this is rare and will be dealt with if necessary (less than 1%)
• Chronic regional pain syndrome is a very rare complication (less than 0.1%) that can occur following any surgery of the extremities, resulting in severe pain to the area. Specific medical treatment / referral is often necessary to resolve the problem. However, precise diagnosis is difficult and a small number of affected patients are left with disabling long term pain.

Although all these complications are possible they are infrequent. Please be sure to discuss any areas of concern with the podiatrist as well as specific complications related to the procedure you may undergo.

How long will it take me to recover?

First day

• You should not drive following the operation. We advise you to arrange a lift or get a taxi after the operation.
• We generally advise you to rest the first night and take pain killers as necessary

First week

• The application of the phenol to destroy the nail bed causes a chemical burn, which takes time to heal. However, this can be helped by keeping the operation site draining. You will need to bathe your toe/s in warm salt water for 10-15 minutes twice daily from the day after the operation.
• It is advisable to keep the toe covered with a sterile dressing to keep it clean.
• You should be able to get about fairly well but may need to take care with your shoe choice and avoid excessive activity.
• You will be seen one week following the operation

Between 2-6 weeks after surgery

• You will need to keep dressing the toe as above until the toe stops weeping. On average, this occurs between 2-6 weeks following the operation.
• You should be relatively active during this period.
• You will be seen at 5-6 weeks following the operation.

Please note, if a complication arises, recovery may be delayed.