Nail Surgery: Risks and benefits

Nail surgery is a low-risk procedure which involves removing all or part of a toe-nail, under local anaesthetic. It is only performed after a thorough review of your medical history. Certain medical conditions and medications can affect the action of anaesthetics and also your ability to heal. Therefore, you must inform the Podiatrist if you have experienced reactions to vaccinations or insect bites, such as fainting or breathlessness.

What does it involve?

You arrive on the day to the clinic and your podiatrist will confirm the procedure and go through the benefits and risks again and ask you to sign a consent form confirmation.

Please remove all nail varnish or nail gels before your operation.

Two injections, one each side of the toe, are used to make the toe feel numb. This may be uncomfortable, but once administered you will not feel pain, although you may feel a slight sense of pressure. This is generally more comfortable than a dental injection. There may be mild swelling or bruising to the area of injection however this will soon disappear.

Part or all of the toe-nail is carefully lifted from the nail bed requiring no cutting of the skin (no stitches are required). A chemical (phenol) is used to destroy the nail bed to prevent re-growth of the nail. This can, in rare cases, cause slight burning or blistering which will be very limited.

Finally, a large sterile dressing is applied to prevent dirt getting into the wound. The procedure takes approximately 15 minutes per toe and you will be at clinic for around 1 hour. As the anaesthetic takes 2-3 hours to wear off, you must not drive yourself home, but make alternative arrangements.

What are the advantages of this operation?

• Less discomfort
• Reduce episodes of infection
• Easier shoe choice
• Easier walking

Whilst it cannot be guaranteed that you will never have another problem with the toe or be completely pain free, it is highly likely that your toe will be much improved.

I have heard it is a very painful operation?

 Advances in techniques, local anaesthetics and pain killers now mean that patients have a high level of success with much less pain. There is very little discomfort the night of the operation or during the healing period. However, tight fitting footwear can cause some discomfort. It is rare that the level of pain is not controlled by normal headache tablets (e.g. Paracetamol or Nurofen).

What are the complications?

 

Every effort is made to minimise the risk of complications and these are rare. However, some specific complications may occur such as:

 

• Prolonged weeping (see recovery below)
• This can occur during recovery although the operation is often performed due to an infected ingrown toenail, thus this is less likely once the nail has been removed.
• A reaction to phenol (phenol flare) can occur but this is rare and will be dealt with if necessary (less than 1%)
• Re-growth of the nail. This occurs in approximately 5-8% of patients undergoing partial nail avulsion and 10% of those undergoing total nail avulsion. The re-growth is often less troublesome than the original problem but the procedure can be repeated if necessary.
• In rare cases a small section of nail can re-grow beneath the skin at the base of the nail (less than 0.5%). This can form a small cyst, which requires excision.
• Blood clotting (thrombosis) in the deep veins of the leg (0.5%) can occur with any operation. This condition can result in a small piece of clot dislodging (embolism) and going to the lung (pulmonary embolism). This is extremely rare with this type of operation, as you remain mobile. However, if it does occur, it is a potentially life-threatening condition.
• Chronic regional pain syndrome is a very rare complication (less than 0.1%) that can occur following any surgery of the extremities, resulting in severe pain to the area. Specific medical treatment / referral is often necessary to resolve the problem. However, precise diagnosis is difficult and a small number of affected patients are left with disabling long term pain.

Although all these complications are possible they are infrequent. Please be sure to discuss any areas of concern with your podiatrist as well as specific complications related to the procedure you may undergo.

How long will it take me to recover?

 

Usually between 3 to 12 weeks, depending on the type of procedure performed, but it generally takes about 4 weeks. You can return to work the day after the procedure, providing you wear footwear which will accommodate the dressing. We will provide a special dressing packs to make sure you have enough until the toe has healed. (these are not covered by health insurance).

First Night

• You should not drive following the operation. We advise you to arrange a lift or get a taxi after the operation.
• We generally advise you to rest the first night and take pain killers as necessary, paracetamol is fine, nothing Aspirin based.

First week

The application of the phenol to destroy the nail bed causes a chemical burn, which takes time to heal. However, this can be helped by keeping the operation site draining. You will need to bathe your toe/s in warm salt water for 15 minutes, twice daily, from the day after the operation.

• You should keep the toe(s) covered with a sterile dressing to keep it clean. You will be provided with a supply of dressings after the operation and can get more from your local pharmacy.
• You should be able to get about well but may need to take care with your shoe choice (nothing that tight around the toes) and avoid excessive activity.
• You will have a review in clinic at one week to check the wound.

Between 2-6 weeks after surgery

• You will need to keep dressing the toe(s) as above until the toe(s) stops weeping. You can stop bathing and covering the toe(s) once there has been no weeping onto the dressing for two consecutive days.
• On average, this generally occurs between 2-3 weeks following the operation unless you have had the whole toe nail removed when it can take 2-3 months to heal completely.
• You should be relatively active during this period.
• You will be seen in clinic at 6-8 weeks following the operation unless you have a problem, in which case we will see you sooner.

Please note, if a complication arises, recovery may be delayed.

There may be some discharge from the wound, this is quite normal and is expected. Post-operative infection is rare and can easily be treated with a course of antibiotics. The wound will be monitored by the Podiatrists until healing is satisfactory.

If you have any further questions or concerns about this procedure, please do not hesitate to consult any of the Podiatrists.

Pre-Op guidance notes

For patients undergoing nail surgery

DO:

1. Have something to eat before attending, especially if you are diabetic.
2. Bring any current prescribed medication with you, eg Ventolin for asthmatics.
3. Bring a pair of sandals, soft shoes or slippers, with adequate room to accommodate a bulky dressing.
4. Bring a relative or friend to take you home.
5. Avoid alcohol before treatment.
6. Wash your feet very thoroughly and put on clean hosiery/socks.

 

DO NOT:

1. Apply any foot cream or talcum powder.
2. Wear tight fitting footwear
3. Attempt any self-treatment beforehand.
4. Arrange to do anything which might traumatise your foot afterwards e.g. sports activities.

 

1. You should not arrange to have any other treatment that could involve the use of anaesthesia during the day of your nail surgery procedure