What is nail surgery for ingrown toenails?
Nail surgery is a minor operation carried out under local anaesthetic by Podiatrists, most often to deal with ingrown toenails, although it may also be suggested to treat other nail conditions such as thick or fungal infected nails. Some GPs and surgeons may also offer this type of treatment. Generally, nail surgery is carried out when someone is experiencing problems with one or multiple toenails that can’t be dealt with by simply cutting the nail. It offers a permanent solution and freedom from pain and infection.
What is an ingrown toenail and why does it keep coming back?
A toenail becomes ingrown when the nail at the edge penetrates the skin, often causing pain and sometimes infection. A number of different factors can contribute to an ingrowing toenail. Cutting the nail incorrectly can lead to irritation or a hidden spike of nail which can trigger inflammation, swelling and sometimes pain. Wearing shoes that are too small in the toe box area can cause repeated pressure around the toes and encourage the nail to push against the skin. This most commonly happens with youngsters as their feet grow so quickly! Sometimes it is simply the natural nail shape which can change as we age, becoming more curved (we call this involuted). Much of the time, the structure of the nail we have is inherited and it’s not uncommon to hear that parents have also had toenail problems.
If you’ve had an ingrowing toenail for a relatively short period of time, your Podiatrist may suggest simply cutting the corner of the nail to relieve the problem in the short term. Depending on the extent of the problem, this may alleviate the pain and infection (if present) for a good length of time. This may be all that’s needed, however, for some people the problem tends to reoccur due to the ongoing irritation of the skin, particularly if the nail structure is a contributing factor. Having repeated courses of antibiotics for infection is not ideal, particularly when the problem can be dealt with permanently.
What are the different types of nail surgery?
The kind of procedure that is recommended for you depends on several factors. Firstly, some people prefer to keep part of their nail for cosmetic reasons and in these cases it’s usually possible to remove either one or both sides to preserve the central portion of the nail plate (partial nail avulsion). For others, it may be more appropriate to remove the whole of the nail (total nail avulsion), particularly if it is very thick or damaged. Your Podiatrist will talk to you about the different options and what your preference is.
The surgery is carried out under a local anaesthetic which means you have injections (usually two) at the base of the toe which causes the entire toe to go numb. Once the side or whole nail is removed, an acid called phenol is applied for three minutes to destroy the root of the nail to prevent either the section or the entire nail from growing back. The toe is bandaged up after the surgery, and your Podiatrist will ask you to return to have the wound checked until it has healed. The healing time after nail surgery varies depending on the type of procedure you have, but on average, a partial nail avulsion can take between four to six weeks, and a total nail avulsion, up to ten weeks. This sounds like a very long time but is due to the chemical reaction of phenol that gradually destroys the cells that produce the new nail. It is however, the most reliable way to deal with the unwanted nail or part of nail permanently. Your Podiatrist will see you during this healing time to ensure everything is going well.
Once you have had your surgery, you’ll be advised to rest for a couple of days, but maybe more depending on your lifestyle and activity levels. Your Podiatrist will explain how to take care of your toe which will need bathing in salty water daily and keeping covered with a dressing until it is healed. Waterproof foot covers come in handy to keep your dressing dry in the shower! The wound often produces discharge for a number of weeks and the toe itself can look a little gruesome until everything is healed and the scabs have fallen off. It takes time for everything to settle down and for the toe to look it’s best again.
Does the nail grow back after nail surgery?
Usually, the surgery will be needed because of the potential for ongoing problems with the nail, so killing the root (or part of the root) makes sense, otherwise, as the nail regrows the same issue is likely to develop. Less than 5% of nails or partial nails grow back after nail surgery. Revisional surgery can be carried out if needed (free of charge if within a certain period following the initial surgery).
Is nail surgery painful?
Having a local anaesthetic injection in the toe is a little unpleasant but as you’d expect, if you remain calm and relaxed, the experience is often better than you anticipate. Looking at your phone or listening to music can help to distract you during this part of the procedure and you are welcome to bring someone with you if you think that will help. Once your toe is completely numb, the procedure gets underway and usually takes between twenty to thirty minutes. A trolley with a drape is placed over your legs, so you are unable to see what the Podiatrist is doing. Make sure you eat as normal on the day of your surgery; having any kind of medical procedure can make some people feel a little anxious and if you have zero energy reserves, you are more likely to feel lightheaded or faint. Make sure you have organised a lift home as you won’t be able to drive straight after the surgery. There is usually some discomfort following the surgery which may last just a few hours but can persist for a few days. Paracetamol is usually adequate to keep you comfortable. Wearing a shoe that avoids pressure on the toe also helps to minimise pain.
How much does nail surgery cost and is it available on the NHS?
The cost of nail surgery varies depending on the type of procedure carried out and how many toes are operated on. At Rushden Podiatry our fees range from £450 for one toe, to £600 for two or more toes. This fee includes as many of the dressing appointments as required after the procedure (usually between four and six). The only additional cost will be a supply of dressings and a waterproof cover for your foot. If you have private health insurance, please check your individual policy for details of whether nail surgery is covered.
You may qualify for nail surgery with the NHS, particularly if you have diabetes. You can self-refer to the NHS Podiatry services, so you don’t need a referral from us or your GP. Click here to go to the Royal College of Podiatry website page about ingrowing toenails and nail surgery https://rcpod.org.uk/common-foot-problems/ingrowing-toenail
If you’re struggling with a painful or infected ingrown toenail, professional treatment can bring lasting relief. Our experienced podiatrists perform safe, permanent solutions in a calm, clinical setting.
Contact us today to book your assessment. You can call us on 01933 594444 or book in online for a consultation here https://rushdenpodiatry.co.uk/booking/
We look forward to helping you stay active and pain free!
