Nail Surgery

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?

These include removing part or all of the nail to:

• relieve pain

• prevent the problem recurring (happening again).

How should I prepare for my operation?

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:

• have something to eat before your appointment so you do not feel faint

• bring any inhalers for asthma or medication for angina with you to your appointment

• bring roomy footwear to wear when you go home after your operation. Open-toed sandals or slippers are the best to allow room for the dressings

• rest after your operation

• be able to go back to work or school the day after your operation. If you think this may be a problem, you should discuss this with your podiatrist

• remove any nail varnish and acrylic nails from your fingers and toes and any toe rings.

What does the operation involve?

Your operation will be carried out under local anaesthetic. Injections are given into the base of your toe to numb the toe and toenail area. You will be awake during the operation but will not be able to see your operation or feel any pain.

The operation takes about 45 minutes and then you will be able to go home.

During your operation, a tourniquet (tight elastic band) 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 the wound is covered with a dressing.

What happens after your surgery?

• The effects of the local anaesthetic should wear off after approximately 2 to 3 hours. You may wish to take something for pain that you would normally take for a headache e.g. paracetamol

• Keep your foot raised as much as possible in the first 24 hours, this will help reduce the risk of swelling and bleeding

• Do not take part in any exercise until your toe is healed

• If blood comes through your dressing put the spare dressing you were given at your nail surgery appointment over the top of the dressing already on your toe. Do not take off the dressing put on after your surgery

• Keep the dressing on, clean and dry until you return for your redressing appointment. This is normally between 3 to 7 days after nail surgery. The podiatrist will check your wound and give you further advice about caring for your toe yourself.

How do I redress my toe?

You should:

• redress your toe at least every 2 days or if your dressing gets wet or dirty

• buy some non-adherent, sterile dressings (dressings that do not stick to the wound) and some tape from the chemist to redress your toe

• bathe or shower as normal leaving the dressing on your toe in place. Remove the dressing afterwards and allow your wound to air dry. When your wound is dry put on a non-adherent dressing, the shiny side of the dressing goes towards your wound. Keep the dressing in place with a small amount of tape

• you can bathe your foot in a clean bowl of warm (not hot) salty water for two minutes. Allow your wound to air dry. When your wound is dry put on a non-adherent dressing, the shiny side of the dressing goes towards your wound. Keep the dressing in place with a small amount of tape

• your wound will be weepy. This is normal after nail surgery. There may also be some blistering or redness at the base or sides of your toe where the nail has been removed. This is normal and is a reaction to the chemical that has been applied

• be aware that your toe may take approximately 6 to 8 weeks to heal but may take as long as 12 weeks

• speak to your podiatrist for further advice if you do not feel you will manage to redress your toe at home yourself

• be aware if you have not contacted the department with any problems or concerns, you will be discharged from the service after 12 weeks.

If you:

• notice that your toe becomes very red, painful and swollen this may mean you have an infection. You should contact the Podiatry Department, your GP or the GP Out of Hours Service immediately (see contact numbers at the end of this leaflet)

• have any problems or concerns with redressing your toe or your wound you should contact the Podiatry Department for advice (see contact numbers at the end of this leaflet).

What are the risks and possible complications?

This type of operation is very successful; however, there are risks you need to consider before you agree to the operation.

These can include:

• some or all of your removed nail growing back. This can happen to less than 10 patients in every 100¹.  Regrowth of your toenail may cause problems. If this happens the operation can be done 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 happens 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 you follow the advice given to you after your nail surgery to avoid developing an infection. However, as you will have an open wound for some weeks there is a small risk an infection can occur. Signs of infection can include heat, swelling and pain.  If this happens you should contact your GP immediately for antibiotics. It is normal to have discharge from your toe; this does not mean you have an infection

• delayed healing. Due to the use of phenol to destroy the nail bed, healing will be slow. Healing can take between 6-12 weeks. Although you will be told how long your wound should take to heal, delays in healing can occur

• problems with local anaesthetic. A reaction to the local anaesthetic used to numb your toe is rare and can happen to less than 1 patient in every 10,000¹

• 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 go home after your operation, rest and raise your foot. You will be given extra dressings to put on if the blood comes through the bandage. You must not take the first dressing off

• 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 supplied with your tablets.

What other treatments are available?

Other treatments 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.

Contact numbers

If you need advice or have any problems, please contact the Podiatry Department.

North Tees and Hartlepool NHS Foundation Trust

Podiatry Department
Specialist Services Administration Team
Ward 2, Floor 1
University Hospital Hartlepool
Holdforth Road
Hartlepool
TS24 9AH
Central booking office: 01429 522471
Monday – Friday, 8.30am – 4.30pm

Further information is available from:

The Society of Chiropodist and Podiatrist
1 Fellmonger’s Path
Tower Bridge Road
London
SE1 3LY
telephone: 020 7234 8620
fax: 0845 450 3721
or via the website at www.feetforlife.org

NHS Choices
telephone: 111 (when it is less urgent than 999)
Calls to this number are free from landlines and mobile phones
or via the website at www.nhs.uk

Reference

1. Bostanci, S., Ekmekci P. and Gurgey, E. (2001) Chemical matricectony with phenol for the treatment of ingrowning toenail: A review of the literature and follow-up of 172 treated patients. Acta Derm Venereol, 81: pages 181 – 183.

Comments, concerns, compliments or complaints

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