This information aims to answer your questions and help you decide whether to have nail surgery. It explains the benefits, risks and alternatives, as well as what you can expect when you have nail surgery. If you have any further questions, please speak to your podiatrist.

What is Nail Surgery?

Nail surgery (or Nail Avulsion) is a minor operation to remove the whole nail or part of a nail where there is an ingrown toe nail.

What is an ingrown toe nail?

An ingrown toe nail is a condition where the edge of the nail grows into the skin at the side of the nail. This can cause pain, a wound and lead to infection.

Why does an ingrown toe nail happen?

  • If the nail is curved and grows into the toe
  • Incorrect nail cutting leaves a sharp and ragged nail edge that grows into the toe
  • Nail picking, tearing and injury
  • Narrow shoes push the nail growth into the toe

Will I need Nail Surgery?

Cutting the nail can help with the pain or prevent infection, but this will not necessarily treat the problem in the long run. We recommend that you have nail surgery if infection or pain is occurring often.

What are other treatments for ingrown toe nails?

Non surgical treatment to correct an ingrown toe nail includes the removal of the nail spike, and regular trimming of the corners of the nail.

What are the Benefits?

Nail surgery is successful in around 8 out of 10 cases. After healing, the area is usually pain free. The nail does not usually grow back.

What will happen at the assessment appointment?

  • We will carry out a full foot assessment and general health checks. Please bring with you a list of all of the medicines that you take, including anything that you buy over the counter, and any herbal or homeopathic medicines. Let us know if you have any allergies to any medicines
  • We will explain what is involved during the surgery and discuss the best treatment options for you
  • We will assess the amount of nail that needs to be removed and discuss this with you. This depends on the shape, thickness and deformity of the nail. This will leave you with a slightly narrower nail which no longer digs (ingrown) into the skin. Most patients will need a small part of the side of the nail taken out. Occasionally the whole nail will be taken out
  • If you have any questions we will be happy to answer them
  • We will gain your consent (your permission) and make an appointment for the operation.

Giving My Consent (Permission)

The staff caring for you will need to ask your permission to perform this treatment. You will be asked to sign a consent form that says you have agreed to the treatment and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you.

Remember, it is your decision. You can change your mind at any time, even if you have signed the consent form. Let staff know immediately if you change your mind. Your wishes will be respected at all times. If you would like to read our consent policy, please tell a member of staff.

What happens during Nail Surgery?

  • We will re-check your medical history
  • On rare occasions, we may decide not to operate e.g. for medical reasons
  • We will cleanse your foot with antiseptic and we will give you local anaesthetic. This is usually two injections on the toe
  • The anaesthetic tends to last for a couple of hours and will numb/block the pain during the operation
  • Once the toe is numb, we will place a tight rubber band over the toe to reduce bleeding during the operation
  • We will remove the nail or part of the nail by simply lifting it from the skin. We then remove or cut the nail edge using special nail clippers.
  • The nail root is then treated with a chemical called phenol to prevent re-growth of the nail
  • We remove the rubber band
  • We apply a sterile bandage to the toe.
  • The appointment takes about one hour. The anaesthetic will still have some effect for about two to three hours after the surgery

What are the risks and problems with nail surgery?

These are the things you need to know in order to make up your mind about whether to have nail surgery or not:

  • Infection is always possible after any operation. But is far less likely if you follow our advice
  • Pain: You might feel little pain or discomfort. This usually goes once the toe is healed and should be for a short period only
  • Chronic regional pain syndrome (CRPS) is a very rare painful nerve condition that can happen as a result of the operation, which can leave you with a permanent painful foot
  • A temporary change in feeling at the site of the anaesthetic injection, such as numbness, but this should be for a short period only
  • Phenol can cause a localised reaction: Phenol is the acid/chemical that we apply to destroy the cells that grow the nail. If you have a reaction it can be painful and can delay the healing time
  • Seeping of the phenol: When the sides of a nail are removed the phenol may go underneath the nail. This may result in a lifted nail edge until the nail grows out fully.
  • Re-growth: Occasionally the operation does not work and the nail grows back.
  • Allergic reaction: This is a rare, but serious allergic reaction following the injection. If this happens we will immediately treat you with an injection of adrenaline and send you to hospital
  • Bleeding after the surgery: Your toe might bleed after the surgery. It is important to rest as much as possible for 48 hours, with your feet up on a stool or chair, or in bed.
  • Nail loss: Removal of the sides of a nail may loosen the whole nail causing total and permanent nail loss.
  • Cosmetic appearance: The appearance of the nail will be different. If this is a concern, ask us what your nail is expected to look like.

Other things you need to know:

  • Average healing can take between six to eight weeks. However, some medical problems can make healing take longer
  • The toe must be kept dry until healed
  • We advise you to rest your foot as much as possible until it is healed
  • You will not be able to play sport or swim, until it has healed

What are the risks of not having nail surgery?

  • If the nail is causing a wound and a bacterial infection, then the infection is likely to come back even with repeated courses of antibiotics
  • If the nail is causing discomfort and pain this will carry on

What do I need to do to prepare for the operation?

  • Make sure you can rest after your operation. This might mean taking time off from work or school. If you need a certificate, please see your doctor
  • Get help with child care
  • Make sure you have enough food at home so you don’t need to go out to the shops for a day or two
  • You should not drive a car or travel on public transport immediately after the operation. Please arrange for someone to take you home. If you need to take a taxi, please make sure you bring enough money to pay for this
  • On the day of your appointment, have your breakfast or lunch as normal
  • Take your medication as normal (unless advised otherwise)
  • Make sure you remove all nail varnish from toe nails before attending the clinic
  • Don’t drink alcohol for the first 24 hours after the operation
  • You will need to apply a bandage to your toe(s) yourself after we change the first bandage. Sterile bandages and adhesive tape are available from your doctor or pharmacist.

Please bring:

  • Sandals that allow all your toes to stick out, or some old shoes that we can cut up, because your first bandage will be quite large and you do not want your shoes to press on wound
  • A list of any health problems you have. Inform us of any changes in your health since your assessment
  • A list of all the medicines you take, including anything that you buy yourself over the counter, and any herbal or homeopathic medicines. Please also bring the actual medicines with you, and let us know if any of them are new

Other important information before having Nail Surgery:

  • Please tell the podiatrist if you think you are pregnant
  • If you can’t keep your appointment, let us know straight away. We will remove patients from the waiting list who do not attend without telling us
  • You are very welcome to bring a friend or relative with you
  • If you are aged 16 or under, please bring your parent or guardian with you. We may not be able to treat you without their permission

Indicative Fees

  • From £200 (including 1st redressing)
  • Redressings – £18


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