Why would I require surgical removal of a toe nail?
If I have a nail that is ingrowing into the fleshy sides of the toe causing pain, and infection.
The most common reason for ingrown nails are:-
1. Trauma to the nail, e.g. dropping a heavy object on it, overuse by running or walking,
2. Incorrect cutting technique, or even nail biting, pulling
3. Genetic inheritance
4. Fleshy skin at the side of the nail
If I have a fungal or thickened nail that has become unmanageable.
The most common reason for fungal or thickened nails are :-
1. Trauma to the nail,
2. Athletes Foot
4. Wearing occlusive and/or heavy footwear such as safety boots
The most common nail surgery we carry out is partial removal (avulsion) of an offending piece of nail.
The digit is first injected on both sides with Mepivicaine, a common local anesthetic. When the area is numb, the Podiatrist will perform an onychectomy in which the nail along the edge that is growing into the skin is cut away (ablated) and the offending piece of nail is removed after which the nail matrix is applied with a chemical or acid (usually phenol) to prevent re-growth. This leaves the majority of the nail intact, but ensures that the problem of ingrowth will only recur in 2% of cases. A similar procedure can also be done for the complete nail, or bilaterally, where the nail remains but is ablated on both sides.
We generally advise a complete month for healing although it can be a lot quicker than this, and to rest the foot as much as possible post surgery for at least one week - excess bleeding can negate the effects of the phenol, and too much friction can initiate an infection.
The procedure also demands compliance from the patient in that they return for dressings twice a week for minimum a fortnight after the surgery
The injection can be painful but the procedure is painless as the digit is numb. We advise that the patient does not drive until the following day and to take normal pain killers as necessary. You may experience slight pain and a burning sensation - this is perfectly normal and should settle within a couple of days. The first review and dressing then takes place between 3 and 5 days post surgery