Nail Surgery

Common causes of ingrown nails

Ingrown nails (onychocryptosis) is a common condition that can affect people of all ages.

Causes include:

Ill-fitting footwear, socks or tights

Picking

Incorrect toenail cutting

The shape of the nail – some are very curved (involuted) or have wide nail plates.

Some sports

Ingrown nails are toenails that have grown into the side of end of the skin on the toe.  This can cause pain, swelling, redness, and may feel hot.  There may be yellow or white pus, or blood.  There may also be some overgrown skin called hypergranulation tissue.  Sometimes an ingrown nail will resolve on its own, but other times it will require surgery, especially if it happens more than once.

Nail surgery is a minor procedure that involves removing either part of, or all of the nail.  This can be done either permanently (with the use of phenol) or temporarily (without phenol).  Phenol is a type of acid that stops the nail regrowing and cauterises the wound, which stops the bleeding.  This technique does not require any stitches.  Phenol also has pain killing properties (analgesic), which makes post operative discomfort minimal.

Partial nail avulsion

A partial nail avulsion is the removal of a small strip along the affected side of the nail, (either one or both sides).

Total nail avulsion

In some cases, it is necessary to remove the whole nail.  This is called a total nail avulsion.

Pre surgery advice

·       Do not drive to/from your surgery.  The DVLA advise against driving after having anaesthesia.  Please make alternative arrangements.

·       Wear open toed shoes.  This is to accommodate a large dressing and to avoid excess pressure on the wound.

·       Continue to take any medications as normal, unless otherwise stated by your podiatrist.

·       Bathe before you come to your appointment.  The wound must be kept clean and dry until you have had your first redressing appointment (usually 24 to 48 hours following your procedure).

·       Make sure you have eaten before attending the clinic.

·       Let the podiatrist know if you have had, or are due to have, any local anaesthetic in the 24 hours before or after your appointment.

·       Remove any nail polish.

Risks

As with all minor surgical procedures, there are some risks to be aware of.

1.      Adverse reaction to local anaesthetic.

2.      Adverse reaction to phenol.

3.      Infection following the procedure.

4.      Regrowth of nail (approximately 4% for PNA, 6% for TNA).

5.      Delayed healing

FAQs

What are the risks involved?

As with all minor surgical procedures, there are some risks to be aware of.

1.      Adverse reaction to local anaesthetic.

2.      Adverse reaction to phenol.

3.      Infection following the procedure.

4.      Regrowth of nail (approximately 4% for PNA, 6% for TNA).

5.      Delayed healing

How long will the procedure take?

The appointment will take approximately an hour.  This is mostly due to the pre op assessment and waiting for the local anaesthetic to take effect.  The surgical procedure takes about 15 minutes.

How long will it take to heal?

                Everybody is different, and will heal at different rates.  Healing times also differ depending on the procedure you have had, and whether or not phenol was used.  On average a PNA takes between 4 and 6 weeks to heal.  TNA will take a bit longer to heal.

Will I need to take time off work/school?

It is better to go home and rest for the remainder of the day following the procedure, with your feet up.  You will have a large dressing until at least your first follow up appointment, which you may find hard to fit in your usual shoes.  The day after your procedure you can go about gentle activities, such as going to work or school, as long as you that does not involve anything very athletic.

Can I go swimming following nail surgery? 

You can go swimming as soon as the wound has closed over and there is no weeping.  If you want to go swimming earlier than that, you can, but will need to be even more vigilant about cleaning the wound.

Can I do my usual sports following nail surgery?

It is advisable to rest your foot following nail surgery.  The day after your nail surgery you can resume gentle activities.  When it’s comfortable enough, and the wound has closed over, you can resume your usual sports.

What are the signs of infection to look out for?

It is normal for there to be some redness, swelling and bruising following your surgery, around the nail and where the tourniquet was applied.  Signs of infection to look out for are:

Redness

Hot to touch

Painful

Swollen

Pus (exudate)

General feeling of being unwell, a temperature or feeling shivery.  This could be a sign of systemic infection and you should see your podiatrist immediately.  It is important that you contact your podiatrist immediately if you think you have an infection so it can be treated and prevented from getting worse.

Step by step PNA

1.      Pre-op assessment, which includes questions about your medical history such as any allergies or medical conditions you may have, and any medications you are taking.  You will also be weighed in order to calculate the correct amount of anaesthetic needed, and your blood pressure will be taken.  This is to ensure that you are fit and healthy enough to have the procedure.

2.      The affected toe will be cleaned with a skin disinfectant.

3.       The anaesthetic will be injected into the toe.  There will be 2 injections.  This can be uncomfortable, and you may feel some pressure in your toe.

4.      There will be a short wait while the toe goes numb.  Sometimes, more anaesthetic is needed, however, this is painless since the toe is already partially numb.  Once the anaesthetic has taken effect, it is normal to feel pressure or pushing and pulling, but you should feel no sharp pain.

5.      Once the toe is numb, a band (tourniquet) will be applied to stop the blood flowing to your toe.

6.      The nail will be loosened underneath and down the affected side (or the whole nail in the case of a TNA).

7.      The problematic portion will be cut and removed (or the whole nail in the case of a TNA)

8.      A chemical called phenol will be applied to the wound site.  This stops the nail growing back and cauterises the wound.

9.      The tourniquet will be removed.

10.  The toe will be dressed with antimicrobial and sterile dressings to keep the wound clean and dry.