Pre and Post Operative Advice and Guidance
Author: Ashleigh O`Connell- Owner and Podiatrist- Herts Wellness Centre. last updated November 2017
NAIL SURGERY- PRE AND POST OPERATIVE ADVICE
In my experience there are five main factors that can lead to a painful ingrowing toe nail
1) Trauma to the nail
2) Excessively sweaty feet
3) Inappropriate nail cutting technique (mainly cutting into the corners)
4) Hereditary ( it simply just how your nails grow.
5) Thickened nails due to a fungal infection.
Conservative nail cutting can help to prevent infection or pain but this will not cure the problem. In order to permanently correct the problem and prevent further complications such as infection or osteomylitis then either a Partial nail avulsion (PNA) or a Total nail avulasion (TNA) may be a sensible option. It is recommended if the ingrowing toe nail becomes a frequently recurring problem and there are frequent episodes of infection.
Before having nail surgery you should be certain that conservative and none-surgical options have been explored and considered.
At your initial appointment and consultation a full medical history will be taken and the pros and cons of have nail surgery will be discussed, it is important that you ask as many questions as possible (even write them down before you podiatry appointment) so you are able to give complete informed consent.
How is the procedure performed?
The toe(s) are numbed with the use of a local anesthetic and the troublesome section(s) of nail is removed and a strong chemical, Phenol, is applied to prevent the nail from re-growing albeit please be aware that there is always risk of re-growth even with the use of Phenol around 3-8%. In the vast majority of patients we only need to remove a small section at one or both sides of the nail. In some instances, the whole nail needs removing (total nail avulsion).
If an ingrown toenail has been present for some time, there is often a build up of excess tissue that bleeds easily and looks red. This is known as hypergranulation tissue and is an over reaction to the irritation and / or infection. This will be removed during the operation.
What are the advantages of this operation?
- Reduction in pain
- Reduced risk of infection
- Easier shoe choice
- Easier walking
Whilst it cannot be guaranteed that you will never have another problem with the toe or be completely pain free, it is highly likely that your toe will be much improved and we typical see complete healing around the 4-6 week mark provided there are no associated complications such as Diabetes or infection present at the time of nail surgery.
is it a very painful operation?
Advances in techniques, local anesthetics (LA) and pain killers now mean that patients have much less pain. Some patients find the administration of the LA uncomfortable but once the LA is given it takes approximately 10-20 minutes for the LA to take and all you will feel is pressure. Generally speaking, there is very little discomfort the night of the operation or during the healing period, depending on the tightness of the shoes worn. It is rare that the level of pain is not controlled by normal headache tablets (e.g. Paracetamol or Ibuprofen). please be aware that the use of Aspirin is not advised due to the risk thinning the blood which can lead to post-operative bleeding.
Are there any complications?
Every effort is made to minimise the risk of complications and these are rare. However, some specific complications may occur, such as:
- Prolonged weeping
- Infection. This can occur during the recovery period, although the operation is often performed due to an infected ingrown toenail, thus this is less likely once the nail has been removed. Following your after care advice is of paramount importance and reporting any concerns ASAP is highly recommend.
- A reaction to phenol (phenol flare) can occur but this is rare and will be dealt with if necessary (less than 1%)
- Re-growth of the nail. This occurs in approximately 3-8% of patients undergoing PNA surgery and 10% of those undergoing total nail avulsion (TNA). The re-growth is often less troublesome than the original problem but the procedure can be repeated if necessary.
- In rare cases a small section of nail can re-grow beneath he skin at the base of the nail (less than 0.5%). This can form a small cyst, which requires excision.
- Blood clotting (thrombosis) in the deep veins of the leg (0.5%) can occur with any operation. This condition can result in a small piece of clot dislodging (embolism) and going to the lung (pulmonary embolism). This is extremely rare with this type of operation, as you remain mobile. However, if it does occur, it is a potentially life threatening condition.
- Chronic regional pain syndrome is a very rare complication (less than 0.1%) that can occur following any surgery of the extremities, resulting in severe pain to the area. Specific medical treatment / referral is often necessary to resolve the problem. However, precise diagnosis is difficult and a small number of affected patients are left with disabling long term pain.
Although all these complications are possible they are rare. Please be sure to discuss any areas of concern with your podiatrist as well as specific complications related to the procedure you may undergo.
How long will it take me to recover?
- You should not drive following the operation. We advise you to arrange a lift or get a taxi after the operation.
- We generally advise you to rest the first night and take pain killers as necessary ( normally 4 hours after the nail surgery procedure)
- The application of the phenol to destroy the nail bed causes a chemical burn, which takes time to heal. However, this can be helped by keeping the operation site drained. You will need to bathe your toe/s in warm salt water (7-10 teaspoons) for 10 minutes once daily from the day after the operation.
- It is advisable to keep the toe covered with a sterile dressing to keep it clean.
- You should be able to get about fairly well but may need to take care with your shoe choice and avoid excessive activity.
- You will be seen one week following the operation
Between 2-6 weeks after surgery
- You will need to keep dressing the toe as advised by your podiatrist and attend all follow up appointments until the toe stops weeping. On average, this occurs between 2-6 weeks following the operation but can be as long as 18 weeks. Generally, this is sooner rather than later.
- You should be relatively active during this period.
- You will be seen at 5-6 weeks following the operation or sooner if need be.
we perform nail surgery at both our Hertford and Bishop stortford/(stansted mountfitchet clinics)
please note that our Stansted Mountfitchet clinic there is ample onsite parking.