INGROWN TOENAIL & NAIL SURGERY

Ingrowing toenails are a painful condition in which the nail edge penetrates the nail fold.

There are two main causes. In-growth may be caused by a splinter of nail penetrating the nail sulcus.

This is more likely to occur if the nail plate is thin and broad, and is often accompanied by secondary infection and hyper granulation (excess tissue growth).

TREATMENT OPTIONS

The treatment of an ingrown toenail with antibiotics resolves the immediate problem of infection, but only temporarily as the infection will soon reoccur unless the penetrating section of nail is removed from the surrounding tissue. The removal of the entire nail plate is recommended when the curvature of the nail is too great; excessively thick and/or infected with fungus. We apply phenol (acid) to the nail growth cells for approximately three minutes to prevent against nail re-growth. This application has been shown to cause less post-operative pain and bleeding, however, it is important to note that phenol is a caustic that damages wound tissues thus giving rise to prolonged wound healing and increased risk of post-operative infection, which we monitor closely. We continue to use phenol in the clinic as the high levels of patient satisfaction and very low re-growth rate greatly outweigh any disadvantages.

AVULSION (REMOVAL) USING 40% UREA

Where patients are not suitable for other forms of nail surgery, the area is occluded with adhesive tape and a finger cut from a surgical glove and a solution of 40% urea applied to nail plate dissolving the bond between the nail bed and nail plate. We advise that patients change this dressing and reapply urea once/twice weekly with the necrotic nail being cut back at regular visits until symptomatic relief is obtained. 

NAIL SURGERY PROCEDURE EXPLAINED

A partial (one side or two sides) or entire removal of nail plate is carried out in a sterile environment using sterile (autoclaved) instruments and dressings. Following local anesthesia, a digital block & pre-surgical scrub to the foot, a tourniquet is applied to stem blood flow and recorded in the patient's notes. We identify the portion of the nail plate to be removed and separate the eponychium (nail bed) from the nail plate and matrix. In partial removals only, we then split the nail vertically with a sharp chisel blade and gain a firm hold of the nail plate using forceps, gently rotating towards the centre of the toe and pulling forward. Petroleum jelly is applied to the surrounding skin at the base of the toe to protect against unnecessary burns. We then rub liquified phenol (acid) to the germinal matrix for a minimum of 3 minutes and flush/irrigate the acid with chlorohexidine 0.5% and saline solution to neutralise. The tourniquet is then removed restoring arterial blood flow and an alginate sterile dressing is applied.

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FAQ

How long does it take to recover from toenail removal?

Healing time varies, but on average it takes four to six weeks to heal one side or two sides of the nail that had been removed at the same time. However, due to a larger surface area of the wound, It takes on average 10 to 12 weeks if the whole nail is removed and phenolised. During this time you will be able to walk and carry on your life as normal although you should avoid sporting activities or dancing to limit the risk of unnecessary trauma. Following nail surgery, we will schedule all your post-operative wound management appointments. 

How painful is toenail removal?

Does it hurt? Ingrown toenails are a common cause of pain, disability and absence of work and nail surgery is now the most common surgical procedure carried out in the clinic. Some people report that the injection of local anaesthetic prior to surgery mildly uncomfortable but this pain is short-lived. You may have pain after surgery once the anaesthetic wears off. The application of phenol has an analgesic effect and because of this, some people report no pain after surgery. 

Can I drive after ingrown toenail surgery?

No, not until the anaesthetic has completely worn off and your sensation has returned to normal. It is also not recommended that you drive any significant distance for the first couple of days after surgery.

How much pain should I expect after surgery?

This depends on individual patients, but the surgical site may feel uncomfortable for a couple of days. The application of phenol has an analgesic effect and often people report little to no pain after surgery. 

How long after toenail removal can I wear shoes?

You should wear loose-fitting shoes or trainers with a round, deep toe box for the first 2 weeks after the procedure. Please avoid wearing high-heeled or tight-fitting shoes in the future. You should avoid running, jumping, or strenuous activity for 2 weeks after the surgery.

Cost?

- One side of ingrown toenail removed permanently: €160

- Two sides of ingrown toenail removed permanently: €250

 - Total toenail removed permanently: €250

* Prices include surgery dressing packs and all post operative wound management appointments for the 3-4 weeks it takes on average to heal.

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