What happens at the assessment appointment?
It is usual for you to be assessed first, and an appointment made for surgery at a later date. During the assessment the podiatrist will explain the procedure and answer any questions you may have. They will carry out a careful examination of your toe(s) and will also assess your general health to ensure you are suitable for surgery.
If you are taking any medication, please inform the podiatrist. You will need to sign a consent form for the surgical procedure to go ahead; however, you can withdraw your consent at any time.
Please inform the podiatrist if –
- There is a possibility you may be pregnant
- You are taking Warfarin or anti-coagulants
- You have a blood disorder such as sickle cell anaemia or haemophilia
- You have a needle or blood phobia
What will happen when I have nail surgery?
You will be fully awake during the procedure, but it is recommended you do not watch in case it makes you feel uncomfortable. A local anaesthetic is injected in the toe to stop you feeling any pain. A tight rubber band, called a tourniquet, is put around the toe to reduce bleeding. The nail, or piece of nail, is then removed.
A chemical called phenol is applied to the nail bed to stop the nail from growing back (however, in rare cases re-growth can occur). The tourniquet is removed and an antiseptic dressing is applied, along with another special dressing that will help stop any post-operative bleeding.
These dressings are then covered with sterile gauze which helps pad and protect the wound. You will be asked to return in a few days for the wound to be inspected and re-dressed. After that you’ll be given advice about how to look after your toe and to continue any re-dressings yourself.
What does it feel like to have nail surgery?
There is some discomfort when injecting the anaesthetic, but this only lasts a couple of minutes. Once the toe has been anaesthetised (numbed), you will be able to move the toe but will not feel any pain.
The local anaesthetic usually wears off in 2-4 hours, so it is important to exercise caution during this period and avoid any unnecessary activity.
What would my toe look like afterwards?
The result of your surgery will depend on your particular toenail problem and the exact procedure used. In the days following surgery it is usual for there to be a temporary discharge from the wound, and bruising around the injection sites. Below shows a before and after appearance.
Phenol may cause some inflammation at the base of the nail and the area can be a little red and tender for a few weeks. These should all settle in time. If you have a total nail avulsion with phenolisation your toe, after healing, will have skin covering where the nail once was.
If you’ve had just a small section of nail removed then the result will be a narrower nail plate as the fold(s) of skin at the side(s) closes up.
Will nail surgery affect work or school?
If you have an active job, you may need to take a few days off work to rest the affected toe(s). We recommend that you wear open toe shoes until the first redressing appointment.
Please be aware that these may not comply with any Health & Safety requirements at your place of employment so it may be wise to ask for time off or request a temporary change in role.
For children we recommend they do not return to school until after the follow-up appointment when the toe is re-dressed (typically after about 3 days). If necessary the surgery can be arranged to avoid clashes with other commitments, for example, exam time or holidays.
Is there an alternative to nail surgery?
There may be instances when the patient’s general health indicates that surgery is not recommended. In these cases careful, regular nail cutting from a podiatrist may help, and they may apply padding to the inner edges of the nails to provide relief.
Sometimes, just wearing footwear with adequate toe space may be sufficient in keeping the problem manageable. Your podiatrist will advise you of the options open to you.
Rarely, a local anaesthetic cannot be used for a particular patient, in which case a referral can be arranged for the procedure to be carried out under general anaesthetic in a hospital setting.
What are the risks of not having the procedure?
If the nail has caused a previous bacterial infection then it is likely to recur even with repeated courses of antibiotics. As a result, there is a chance you will suffer from repeated episodes of pain and discomfort.
What are the possible complications/risks in having surgery?
Like all medical procedures there are risks in undergoing nail surgery. These are rare, but can include:
- Bruising from the injection or tourniquet
- An allergic reaction to the local anaesthetic
- Pain (this will often subside within a few days)
- Periostitis – inflammation/infection of the outer covering of the bone
- Nail re-growth – it may also grow back deformed
- Persistent wound drainage
- Persistent numbness
- Long healing time of between 6-12 weeks
- Cosmetic changes – skin will eventually cover the removed nail.
- Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs.
Where is nail surgery carried out?
The podiatrist will need to check to see if there have been any changes since the original assessment, such as the possibility that you may be pregnant. If this is so, the procedure should not go ahead as the anaesthetic used may affect the unborn baby, particularly in the first trimester.