Nail Surgery – PIL1199 Version 3

What is nail surgery?

Toenail surgery is a minor procedure to remove all or part of a problematic toenail. Local anaesthetic is used to numb the affected toe(s).

In most cases, once the troublesome toenail (or section of nail) has been removed, a chemical called phenol is applied to the exposed nail bed.

This is done to stop the toenail (or section of nail) from growing back again preventing further problems.

What procedures are available?

• Partial nail removal is where a small piece of nail is removed from the painful side of your toenail and then treated so the piece of nail does not grow back. The rest of your toenail should grow as normal.
• Bilateral partial nail removal is where a small piece of nail is removed from both sides of your toenail and then treated so they do not grow back. The rest of your toenail should grow as normal.
• Total nail removal is where your whole nail is removed and treated so that it does not grow back. You will have no toenail after this procedure.

What are the benefits of surgery?

The benefits of removing part or all of the nail in a surgical procedure include:

• Relieving pain.
• A return to normal activities once healed.
• Preventing the problem from happening again.

How should I prepare for my operation?

On the day of your operation you should:

• Have something to eat before your appointment so you do not feel faint.
• If you use them then please bring any inhalers or medication for angina with you to your appointment. Your surgery may not go ahead without these.
• Bring roomy footwear to wear after your operation. Open-toed sandals or slippers are the best to allow room for the dressings.
• Remove any nail varnish and acrylic nails from your fingers (in case we need to monitor your oxygen levels) and toes, and remove any rings.

Anyone under the age of 16 will need to be accompanied by a parent or a legal guardian.

What does the operation involve?

Your operation will be carried out under local anaesthetic. This means that injections are given into the base of your toe (where it meets the rest of the foot). This will numb your toe and toenail area. Having a local anaesthetic means that you will be awake for the operation, but we will put screens in place so that you will not be able to see what is happening or feel any pain.

The operation usually takes about 10 to 15 minutes, and after that you will be able to go home.

During the operation a tourniquet (tight band of elastic) is put onto your toe to stop any bleeding while your toenail is removed. Part or all of your toenail is gently lifted off the nail bed and removed.

A chemical called Phenol is then applied to all or part of the nail bed to stop your toenail from growing back. The tourniquet is then removed and your toe is covered with a dressing.

Are there other treatments available?

Other treatments are available and include:

• Routine nail care to cut down and file down your toenail. However if your toenail is severely ingrown this may not be effective to treat your problem.
• Changing footwear to relieve pressure on the toenail (wide and deep footwear is best).
• Orthotic inserts (medical grade insoles) can also help relieve pressure on the affected toenail. Gel toe separators can also help with symptoms.

What are the risks and possible complications?

This type of operation is usually very successful. However there are still some risks that you need to consider before you agree to the operation:

• Some or all of your nail growing back. This can happen in less than 10 out of 100 people.¹ Regrowth of your toenail may cause the same problem that led to surgery, however the surgery can be attempted again.

• Phenol flare. This is a reaction to the chemical which is applied to your nail bed to stop the toenail growing back. It is rare, but if it does happen the skin at the base of your toe will be red, hot, and may blister. This should settle down during the healing process.

• Infection. It is important that you follow the advice given to you after your nail surgery as this can help avoid an infection in the wound. However sometimes an infection can still happen.
  Signs of infection include: Heat, Swelling and Pain.
  If this happens you should contact your GP or the Podiatry department immediately.
  It is normal for your toe to weep following surgery, and this does not mean you have an infection.

• Delayed healing. Due to the use of Phenol to stop the nail from growing back your healing will be slow. Healing can take between 6 to 12 weeks, but this could be further delayed.

• Problems with local anaesthetic. A reaction to the local anaesthetic used to numb your toe is rare. This could include an allergic reaction (1 in 10,000 patients), or seizures/fainting (less than 3 out of 100 patients).

• Nerve damage. This is usually temporary but can be permanent. Care is taken to avoid damage to the nerves in your toe during the local anaesthetic and your operation.

• Bleeding. Your toe will bleed after the operation. To reduce the risk of bleeding you should keep your foot raised as much as possible for the first 24 hours after your operation, and you should not remove the dressing until your check-up appointment.

• Post-operation pain. You may have some pain when the local anaesthetic wears off. Taking painkillers regularly can help. You should always follow the instructions provided in the leaflet with your tablets.

What happens after the surgery?

You must arrange for someone to take you home after your operation. You must not drive until the numbness in your toe has worn off, as this may invalidate your car insurance.

You should be able to go back to work or school the day after your operation if you can keep your foot raised. If you think this may be a problem, you should discuss this with your podiatrist, but do not take part in any exercise until your toe is healed.

Once you are home you should keep the dressing on, and keep it clean and dry until you return for your redressing appointment. This is normally between 3 to 7 days after nail surgery.

Before your appointment, if blood comes through your dressing you need to put the spare dressing you were given at your nail surgery appointment over the dressing that is already on your toe. Do not take the first dressing off.

If blood seeps through the second dressing you should contact the department within surgery hours, or outside of surgery hours contact 111 for advice. Contact numbers are further on in this leaflet.

What happens at the 3 to 7 day check-up?

The podiatrist will check your wound and give you further advice about caring for your toe yourself.

After my check-up what do I need to do?

After your check-up appointment you should redress your toe at least every 2 days or if your dressing gets wet or dirty.

You will be given some dressings after your surgery. If you need further dressings you can buy some non-adherent sterile dressings (dressings that do not stick to the wound) and some tape from the chemist to redress your toe. If you are unable to buy your own dressings you can ask your GP to provide some.

You can have a bath or a shower as normal leaving the dressing on your toe in place. After your bath or shower you can remove the dressing and allow the wound to air dry. When it is dry you can then put on a new dressing.

If you think your toe needs further bathing you can put your foot in a clean bowl of warm (not hot) salty water for 2 minutes without any dressings on. You should then let your toe air dry before putting a new dressing on.

Your toe can take approximately 6 to 8 weeks to heal, but may take as long as 12 weeks.

You should speak to your podiatrist for further advice if you do not feel that you will manage to redress your toe at home yourself. They will offer advice and support if needed.

After your surgery if you have any problems or concerns you can contact the Podiatry department for advice (see contact numbers). If you have not contacted the department with any problems or concerns for 12 weeks after your surgery you will be discharged.

Contact numbers

If you need any advice or have any problems please contact:

Podiatry department

Telephone: 01429 522471
Monday to Friday, 8.30am to 4.30pm.

Further information

The Royal College of Podiatry

Telephone: 020 7234 8620
Website: www.rcpod.org.uk

NHS Website

Telephone: 111
Website: www.nhs.uk

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