Ingrowing toe nails can be very painful and can become infected. They rarely resolve without treatment. Sometimes these problems can be resolved with conservative treatment through regular Podiatry appointments. However, in some circumstances nail surgery may be needed.

 

A true ingrowing toenail is one where a sharp corner or spicule of nail has pierced the skin like a splinter. Creating a painful open wound, this is also a risk for infection.

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However, toenails can become painful for other reasons which can also cause us to consider surgery.

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Causes of painful toenails can include:

• thickened, deformed toenails putting pressure on the skin under and around the nail

• very curved (involuted) nails causing the side to press painfully on the skin around the nail

• trauma to the toe

• hard skin or corns developing under the nail plate or down the sides of the nail

• Incorrectly fitting shoes can also cause discomfort around the nail unit 

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Nail surgery is not always necessary for painful toenails. We may need to provide assistance with nail cutting to keep you pain free or we may be able to advise you how to cut your own toenails safely. Sometimes footwear advice is indicated.

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What is nail surgery?

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Nail surgery is a minor procedure performed by your podiatrist. It is indicated when conservative measures have failed to adequately manage an ingrowing toenail or deformed nail which is causing pain or discomfort. We can also consider removal of nails which have fungal infection, particularly if the patient is not suitable for standard treatments or if other treatments have failed.

 

Nail surgery involves removing a portion of a toenail e.g. a side which is digging in and ingrowing, or a whole toenail. We more commonly perform partial nail avulsions which is where a portion of the offending nail is removed. Less commonly a total nail avulsion, removal of the whole nail, is necessary.

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How does it work?

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Nail surgery involves removing the offending portion of nail which is causing the issue, and the application of a chemical called phenol to destroy the nail root and prevent that bit of nail from re-growing.

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What are the benefits?

 

Ingrowing toenail surgery with phenolisation of the nail root is approximately 96% successful. 

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The benefits include:

• resolution of pain

• healing of the wound caused by the nail digging in

• reduced risk of infection

• easier to manage nails

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Does it hurt?

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Nail surgery is performed under local anaesthesia so the procedure itself is painless. You may of course experience some discomfort from the injection of the anaesthesia in your toe, a little like a sharp scratch for a few seconds. 

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After a few minutes the toe goes numb, you will not feel any pain but will be aware of your toe being moved around during the procedure.

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The anaesthesia gradually wears off and the feeling will return to your toe in around 2 to 4 hours. After this the toe may feel a little sore. Your podiatrist will discuss analgesia with you during your appointment.

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How many appointments will I need?

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You will first be required to attend an assessment appointment to see if nail surgery is appropriate for you. If suitable, the nail surgery appointment can then be arranged and performed at a convenient time for you.

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After nail surgery you will be required to attend a few post operative appointments to change dressings, ensure the surgical site is healing as it should, and for advice on how to manage the wound until it heals.

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The surgery should not need to be repeated. However if you are unlucky enough to be one of the very few people whose nail regrows, the procedure can be repeated.

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Contraindications

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There are a few medical conditions and medications that may mean this procedure cannot be performed. Your podiatrist will thoroughly assess your foot health, medical history and medication before determining if the surgery can go ahead.

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We are unable to perform nail surgery if you are pregnant or breastfeeding, have problems with your circulation or if you have peripheral neuropathy (damage to the nerves causing lack of sensation in the feet).

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For patients that are not suitable for this particular procedure we may be able to refer you to a podiatric surgeon for an alternative toenail surgery.

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Before the procedure

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The podiatrist will need to check if there have been any changes since your assessment. Please inform the podiatrist if you think you may be pregnant, if you are breastfeeding, if your medical history has changed or you have changed medications.

 

Your circulation will be checked, and your podiatrist will perform a few tests to check the sensation in your feet is normal. Please remove all nail varnish from toenails before attending the clinic – this enables us to better assess your circulation and reduces the risk of post operative infections.

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Your podiatrist will make sure you are suitable for nail surgery and will fully explain the treatment prior to its use. Your podiatrist will discuss all the possible side effects and complications at your consultation before proceeding with the treatment. You will be required to give written consent before the procedure can proceed.

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What will happen during the procedure?

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• You will be awake during the procedure.

• The toe is thoroughly cleaned

• A local anaesthetic is injected (near the base of the offending toe) to stop you feeling pain in the toe.

• Once the toe is numb a tourniquet is applied to the toe to reduce any bleeding.

• The offending portion of nail is then removed with sterile instruments.

• Phenol is applied to the root of the nail 

• The surgical site is thoroughly cleansed and the tourniquet removed

• A sterile dressing is applied. This normally includes specialised dressings to reduce any post operative bleeding

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After the procedure

 

You will be given advice about how to look after your foot and a follow-up appointment, will be booked before you leave.

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You will be able to walk normally after the procedure although your toe will feel a little strange for a while! 

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You will not be able to drive as a numb toe makes your insurance invalid and is very unsafe. You will need someone to collect you afterwards and drive you home.

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You will normally be able to return to work and your regular day to day activities the next day. We do advise that you avoid any sports (including swimming) or strenuous activity until your surgical site has completely healed. Any trauma to the area will delay healing and put you at risk of an infection.

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