If a patient has an ingrowing toenail or fungal infection one option for treatment is to remove part or all of the nail under local anaesthetic.
This is performed when your podiatrist has diagnosed a deformity of one or more toenails. The most common deformities/causes are:
1. ingrowing toenail
2. excessively curved nail (involution)
3. excessively wide nails
4. thickened nails due to fungal infection or trauma
5. incorrect cutting of the nails
An ingrown nail will predispose the skin around the nail to swell and press onto the nail causing pain. This could lead to infection which must be treated immediately.
These are problems that are of particular concern to diabetic patients and other at risk patients.
If an infection is present, antibiotics from your Podiatrist or GP may be necessary, however they will not cure the problem alone. The cause (the nail digging into the skin) must be addressed or the infection and pain will return or persist after the course of antibiotics have ceased.
There are conservative treatments which can help to prevent pain or infection, although this will not cure the problem. If the problem recurs regularly or if the condition is acute (comes about very quickly), then surgery is recommended.
Usually only the troublesome sides of the nail are removed. If you have one or both sides of the nail removed, this is termed a partial nail avulsion or PNA. This approach involves a chemical called phenol being applied to the nail matrix (where the nail grows from), which kills the cells of the matrix. This means that the offending sides do not grow again, leaving a slightly thinner looking nail in the middle. It is very often not noticeable that surgery has been performed.
If the entire nail is damaged, thickened or infected with fungus, it is sometimes required to remove the entire nail. This is termed a total nail avulsion or TNA. The skin under the nail (nail bed) will harden once exposed to the air and after 6-8 weeks, a tougher skin will develop where the nail used to be. Many ladies paint this skin and the surgery again goes virtually unnoticed.
The surgery will usually last only 15-20 minutes, but you will usually be in the surgery for around an hour to allow sufficient time for the anaesthetic to work and for preparation.
Generally speaking, there is very little discomfort the night of the operation or during the healing period. Any pain is usually easily controlled by paracetamol or ibuprofen (do not use aspirin or products that contain aspirin, as this could encourage bleeding ).
It is advisable that you rest with your foot/feet elevated for a few hours after the operation. You should be able to return to work the following day, dependant of course on the type of work you do. Elevation of the foot and reduced pressure on the toe is essential as much as possible to aid healing.
The footwear that you wear post-surgery needs to be spacious enough to accommodate the dressing and not cause pressure, which may cause discomfort.
You will require an appointment the following day for a check-up. Here, you will be instructed how to change the dressing yourself on a daily basis. From then, appointments will be scheduled on a fortnightly basis for dressing changes and to monitor the healing process. You must keep the dressings dry.
If there are any worries or complications, you may telephone us and we will either advise you over the telephone or online video consultation or give you an appointment to return as soon as possible.
This involves two injections at the base of the toe, not at the site of the inflammation and pain. A mild discomfort is felt, but this will pass quickly as the toe numbs. No treatment will begin until the patient is totally pain free. It is important to note that local anaesthesia does not block all sensation, so the feelings of pressure will still be present. Only pain sensations are blocked.
People heal at different rates, but expect at least 2-3 weeks for the nailbed to heal. Your doctor will let you know when you can get back to your normal physical activity.