• jcpodiatry

Ingrown Toenails and Nail Surgery

If you are suffering from painful and ingrown toenails, nail surgery is a way of providing a longer-term solution, particularly when the problem keeps re-occurring despite cutting the affected nail.

Ingrown toenails can develop for several reasons, the most common being:

  • Curved (involuted) nails that dig into the skin at the side of the nail. These can develop for genetic reasons or as a secondary effect of health conditions (e.g., Diabetes) and medications.

  • Poor nail cutting. Cutting too far down the side of the nail or leaving rough edges which can form into a nail spike.

  • Tight footwear which compresses the toes and nails. Most commonly dress shoes or football boots.

  • Trauma to the toe. This can be one event (e.g., dropping something on the toe) or repeated trauma over a period of time (e.g., a rubbing toe during a marathon run).

The most commonly affected nail is the big toe.

How can Nail Surgery help?

During nail surgery, I typically remove the affected strip of nail and apply a chemical called phenol (a disinfectant which can penetrate the skin rapidly) to prevent regrowth. In some cases, I may remove the whole nail.

A local anaesthetic is injected into the toe to significantly reduce pain during the procedure. Prior to surgery I carry out a full assessment of your medical history and medications to ensure that you are an appropriate candidate for nail surgery.

On the day of Nail Surgery

  • Remove all traces of nail varnish

  • Do not drink any alcohol

  • Take any medication as normal unless advised otherwise by your GP

  • Bring suitable footwear that will fit over a bulky dressing (e.g., thongs)

  • Have someone drive you home or take a taxi to minimise time on your feet

After Nail Surgery

  • Take it easy for the rest of the day, with your feet up. The toe may remain numb for up to four hours.

  • If there is any discomfort (usually in the evening), paracetamol-based analgesics are the most helpful (e.g., Panadol)

  • A small amount of blood seepage through the dressing is normal, if this happens, apply an additional dressing over the bulky one

  • You can resume normal light duties the following day; however, avoid any activities that may place any undue pressure or injury on the toe. Typically, sports or strenuous exercise should be avoided until the site has healed (at least 2-3 weeks following surgery).

Toe Re-dressings

  • Remove the bulky dressing after 24-48 hours

  • Lightly bathe the toe in salt water and redress with a simple breathable adhesive dressing – (e.g., cutiplast - not band aids)

  • Otherwise, keep the toe dry as much as possible.

  • Betadine or other anti-bacterial solutions may also be applied but there is no evidence that they reduce the chance of infection or improve healing time.

  • Redress daily for the next 2-3 weeks, or until the wound is fully healed (dry with scab formation).

Risks and Cautions

Nail surgery is a quick and safe procedure that can be performed on most people. However, nail surgery is not recommended if:

  • You are pregnant or breastfeeding.

  • You have reduced blood supply to your feet (Peripheral Vascular Disease).

  • You are allergic to local anaesthetic.

  • Your toenail is severely infected – in this case seek medical advice and consider a course of anti-biotics to address the infection before undertaking nail surgery.

As with any surgical procedure, there are some potential risks involved. The risks of nail surgery can include the following:

  • Regrowth of the unwanted nail (this type of nail surgery is successful 80%-90% of the time)

  • Infection following removal of the nail

  • A reaction to the anaesthetic or phenol

  • Distortion of the remaining nail following removal

If you have any concerns or questions after the surgery, please do not hesitate to contact your Podiatrist or GP.

This information is intended as a guide and does not replace assessment and management by a trained health professional. There are multiple approaches to treating ingrown toenails and the best treatment for you will depend on your personal circumstances and the experience of the treating practitioner.

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