Why do I need nail surgery?

If you have a nail condition that cannot be resolved by routine care at the clinic – such as a deformed, involuted (curved) or ingrowing nail – we may advise that you have either part of the nail removed (a partial nail avulsion) or the whole of the nail removed (a total nail avulsion).

We then apply a chemical to the nail bed to stop the nail growing back. The aim of nail surgery is to relieve any pain and prevent infections caused by the toenail.

What happens during the procedure?

We will double check your medical details and the procedure needed to make sure this is the best option for you. On rare occasions we may decide not to operate, for example because of medical reasons.

Your toe will be numbed by giving two local anaesthetic injections into the base of the toe and a tourniquet applied. This is a band put around your toe to stop it from bleeding.

The appropriate part of the nail is removed from the nail bed. No cutting or stitching of skin is involved. A chemical called phenol, is rubbed in to stop the unwanted piece of nail growing back.

When the procedure is finished, the tourniquet will be removed and a large dressing is applied. You will be able to walk normally in open-toed shoes or sandals.

What are the risks?

This method of nail surgery is very safe and effective, however, no surgery is without risk.

It is possible that:

• the removed part of the nail will regrow
• the wound may get infected
• it may take longer than average to heal
• you may experience an allergic reaction to the local anaesthetic or the phenol
• there may be some scarring
• the local anaesthetic may take longer than usual to wear off. It is very rare that it won’t wear off at all and your toe will be permanently numb
• if we remove both sides of the nail you may temporarily lose the remaining nail
• the new nail edge can be temporarily damaged which may cause irritation. This will resolve on its own as the nail grows out. If this causes you pain please contact us to have it checked.

The chemicals we use may cause harm to an unborn child. If you are pregnant, think you might be pregnant, or are breastfeeding, please let us know so we can discuss the options at your assessment appointment.

We also advise against anyone pregnant accompanying you into the treatment room because of the possible risk from the chemical fumes.

On the day

You will be brought to the clinic area and will need to wait until you are called in. There are no set appointment times, however, you will be made aware if you are booked into a morning or an afternoon session.

The procedure only takes a few minutes but it may take a little while for your toe to go numb and there is quite a bit of paperwork.

There is a limit to how much local anaesthetic you can have in a 24-hour period. Avoid any procedures which may involve a local anaesthetic, for example at the dentist, 24 hours before and after your appointment with us.

We recommend that you eat and drink normally. It is best to avoid alcohol for 24 hours before and after surgery.

Please make sure nail varnish has been removed and bring suitable footwear to wear home as you will have a large dressing on your toe, for example an open-toed sandal or flip flop.

When you get back to your room

The anaesthetic generally wears off after a couple of hours.

You may feel some discomfort but this varies from person to person. Take a painkiller if you need to, for example paracetamol. You will have to follow the prison protocols for accessing pain relief. Do not take aspirin as this will increase bleeding, unless you take it as part of your normal medication then you can continue to do so.

We recommend resting with your foot up for the rest of the day. Keep the large dressing on your toe and keep it dry until your first redressing. If you see any blood come through the dressing, add extra gauze over the top. This will be provided for you at your surgery appointment.

If you do not feel well

There is a small possibility that you will experience an allergic reaction to the local anaesthetic. If this happens you may suffer from some or all of the following symptoms:

• rash
• paleness
• limpness
• swelling of the face or neck causing difficulty breathing, speaking or swallowing
• hoarseness or wheezing.

If you experience any of these, you must alert the staff on duty so that appropriate medical assistance can be provided. This leaflet and your surgery paperwork will provide important information for the emergency services and doctors.

Redressing

Your first redressing appointment will be made within one to three days after your surgery. This will be in clinic. You will be provided with a box of dressings when you attend your surgery. Please make sure you take this with you for your redressing appointment. Until this appointment, please leave your original dressing in place.

After your first redressing appointment you will need to change your dressing once a day. When changing your dressing you will need:

• a cup or jug
• table or cooking salt
• a clean towel
• dressings.

To change your dressing

Please speak to health care staff if you do not have access to these consumables:

• wash your hands before you begin
• fill the cup or jug with pre-boiled but cooled water (make sure it is not too hot)
• add one teaspoon of salt and stir until dissolved
• remove the old dressing
• pour the cooled-salty water over the toe and wound area
• gently pat the toe dry with a clean towel and dry the foot. Allow the wound to dry naturally
• no creams, ointments or antiseptics are needed on the wound
• cover the wound with one of the dressings provided.

You can have a shower if you wish but do not get your toe wet for too long as this will slow the healing.

It is normal for the wound to weep a light-yellow discharge and for the area where the nail was removed to be inflamed or have a slight blister.

After three to 14 days there is usually an increase in discharge, so it is likely to look worse before it gets better. This is a normal part of the healing process due to the chemical used. This is expected and does not mean your toe is infected.

Your toe may be infected if there is a significant increase in a combination of:

• redness/change in skin tone
• heat
• swelling
• pain
• change in discharge.

If this happens, please make contact with healthcare to arrange a GP appointment as you may require antibiotics.

Gradually a scab will form and the discharge will reduce. As soon as the dressings are clean when removed for two consecutive days, you can stop dressing your toe. Eventually the scab will come away and reveal toughened skin over the nail bed.

How long does it take to heal?

Everyone is different but on average it takes four to six weeks to heal if part of the nail is removed and 10 to 12 weeks if the whole nail is removed. During this time, you will be able to walk and carry on your life as normal, although you should avoid swimming and sporting activities that may injure the toe.

If you require a review, the podiatrist will have either already made this appointment and confirmed this with you on the day of the surgery, or you would need to fill out an application for a review.

When can I wear normal shoes?

After the first redressing the dressing will be much smaller and will allow you to wear ordinary shoes. Your toe will heal more quickly if there is nothing pressing on or squashing the wound area.