We’ve had a spate of patients present with nasty ingrown toenails recently. Maybe it’s the increased nail growth over the summer or that we’re starting to squeeze into our winter boots a little more. Even a few of our footballers and runners have had some troublesome in-growns. So, I thought it would be timely to provide an understanding of what to expect if you ever have an ingrown toenail that requires removal.
The appointment scheduled is typically 1 hour (sometimes more), but the procedure itself takes no more than 30 minutes. We allow excess time to ensure you’re comfortable, wait for the local anaesthetic to fully numb your toe, and allow plenty of time after the consult to explain the post-operative instructions.
Once we’ve explained everything, we’ll set you up with an iPad which you can watch your favourite show on Netflix, or choose your favourite artist on Spotify. We’ve had patients listen to everything from Parkway Drive to Enya, and take in some episodes of Brooklyn 99 or Sons of Anarchy. Alternatively, you can bring in a book or magazine to read.
The procedure requires us to numb your toe which can take 10-15 minutes following injection. The needle is most commonly the worst part of the procedure. It requires 2 injections, one into each side of the toe and last approximately 20 seconds, with a pinch at the start followed by a weird feeling of fluid being taken up by your toe. It will gradually fade from heavy, to tingly, to fully anaesthetised. Whilst this is taking place, we set up our trolley with all the sterilised instruments and dressings needed. People often comment on how much equipment we actually use. Once we test the numbness of your toe with a sharp instrument, we are okay to commence the procedure.
We cover your toe with betadine (chlorhexadine if you’re allergic) which can feel a little cold or strange when being applied to the numb toe, and roll a tourniquet around your toe to minimise blood flow to the nail bed. The tourniquet can feel a little uncomfortable due to the compression and pressure, but is otherwise not a bother.
We are then free to remove the nail spike, and use chemical cauterisation via phenol to minimise the risk of the nail spike returning. We wrap up the toe with a range of sterile dressings which can be quite large and take up a bit of room in your shoe. For this reason, we recommend bringing a pair of sandals, thongs or open toed shoes to wear out of the appointment.
We spend some time explaining your post-operative instructions to ensure you’re comfortable and minimise the risk of complications. From there, it’s up to you to rest your feet for the remainder of the day, and keep the dressing dry until our review appointment. The local anaesthetic will gradually fade away over approximately 2-3 hours. After this time the toe may sting or throb a little for 12-24 hours. You can use paracetomol if it becomes too uncomfortable. We review the nail 2-3 times within the first 2 weeks for cleansing and re-dressing, and you can expect total healing of the nail edge to take 3-4 weeks.
The partial nail avulsion surgery is a really simple and effective procedure for ingrown toenails. Particularly if you’re having re-occurent problems, or have a nail shape that is prone to nail infection (thin, curved and flexible) the best time to do it is while the nail isn’t inflamed or infected. This allows for better analgesia and provides a better healing environment, typically meaning your recovery will be quicker.
We hope this provides some insight into the procedure and allays any fears or concerns people might have when it comes to the Partial Nail Avulsion Procedure.