Nail surgery

The aim of nail surgery is to permanently remove all or part of the problem nail. The benefits of this are to reduce pain and the risk of infection which can be caused by ingrowing nails.

The procedure

What does nail surgery involve?

• The surgery will take around 30-60 minutes, depending on your procedure. Please arrive on time.
• Whilst you will remain awake throughout the procedure, you will have the option of sitting or lying back, whichever is most comfortable for you.
• A local anaesthetic will be used to numb/anaesthetise the toe. This is injected on each side at the base of the toe.
• After the anaesthetic is given, the toe is tested prior to the procedure to ensure no pain can be felt. You will feel pressure and movement.
• To prevent re-growth, a chemical is applied once the nail, or part of the nail, has been removed. The aim is for the nail, or part of the nail not to re-grow, although some nails will re-grow.

You will be able to walk after the procedure but please do not drive for 24 hours after, as this may invalidate your insurance.

Important

If, when you receive your surgery date, your circumstances have changed since your assessment (change in medical history, medication, holidays booked, pregnancy etc), then you must inform us as soon as possible prior to your appointment.

What are the problems / risks with nail surgery?

As with any procedure, there are always risks to consider.

Pain
• Pain and numbness can occur at the injection site. In most cases this will resolve within 12 months.
• Pain can be due to the open wound or an infection.

Infection
• If local infection is suspected contact your local Podiatry Department or GP as antibiotics may be required.
• Bone infection; this will require antibiotics from your doctor, X-rays and blood tests.
• Sepsis is a potentially life threatening condition caused by your body’s response to an infection. Symptoms can include difficulty breathing or fast breathing, blotchy skin, confusion, feeling unwell, uncontrolled shivering, no urine output for 24 hours. If you are experiencing some of these symptoms please phone 111/999 or go to A&E.

Delayed healing; Infection, activity, footwear and occupation can all delay healing.
• Partial nail removal; healing time average 4-8 weeks
• Total nail removal; healing time average 8-12 weeks

Adverse reaction to anaesthetic; this can include anaphylaxis (severe life threatening allergic reaction), seizures or fainting.

Phenol Flare; this can make your toe look as though it is infected, but there is actually no infection present. Please contact the Podiatry Service if you are concerned.

Regrowth of nail; If this is a problem, the procedure can be repeated.
Extremely rare complications could include deep vein thrombosis (DVT), amputation and loss of life.

On the day of the procedure

What do I need to do to prepare for surgery?

• Eat as normal beforehand. Avoid alcohol.
• Take any medication as normal, unless advised otherwise.
• Arrange transport and a chaperone/friend/relative to accompany you if required.
• Remove all toe nail varnish. If this is not removed, we may not be able to operate.
• If you are prescribed inhalers or sprays we advise you to bring them to your appointment.
• Make sure you have footwear that is broad and deep, or with open toes, to allow room for the dressings.
• On rare occasions, such as a change in certain medical circumstances, or if the advice above is not followed, we may not be able to operate on the day.
• Please feel free to bring mobile phones, books etc. for distraction during the procedure.
• Please note: no audio / visual recording of the procedure is permitted.

After the procedure

What can I expect afterwards?

• The toe may remain numb for up to 2-4 hours after the procedure.
• If you experience any discomfort take your normal painkillers. Avoid aspirin.
• Go home and sit with your foot/feet up for the rest of the day.
• Follow the dressing advice given by the Podiatrist (refer to re-dressing leaflet).
• It may be necessary to arrange a follow up dressing appointment within one week after the date of the procedure.

How do I look after my toe afterwards?

• You will be expected to change your own dressings on a daily basis. If this is difficult, you will need to arrange for a family member or friend to help.
• Healing can take between 4-12 weeks depending on your medical history and the procedure you have had.
• You must follow the advice given by your Podiatrist to ensure any complications are kept to a minimum.
• You will not be able to swim or do strenuous activity until the toe has healed. Your Podiatrist will be able to give you more advice in relation to specific activities.

Who should I contact if I have any concerns?

If you have any further questions or concerns that are not covered within this information leaflet please don’t hesitate to get in touch. You can either discuss them with the Podiatrist on the day of your appointment or contact
the Podiatry Service.

If you are feeling generally unwell / have a fever, phone 111/999 for urgent medical advice.

If you have any problems or worries please contact the Podiatry service during normal clinic hours, during out of hours please contact your local primary care service via your GP.