One of the core skills and expertise that podiatrists possess is in the management of ingrowing toenails.
While these can be managed conservatively with regular nail care to maintain the smooth edges of the nail and remove any debris which causes pressure, often this needs to be performed regularly, can be uncomfortable for the patient and there is a risk of the nail ingrowing and infecting the surrounding skin.
One of the definitive ways of managing these types of problems is to use a minor surgical procedure. This allows for part of, or all of the nail to be removed and a chemical applied to the nail bed to prevent regrowth.
What is an ingrowing nail?
An ingrowing nail is a nail that has a sharp edge, which pierces the skin to the side of the nail. This allows bacteria to enter the wound and leads to infection.
What is nail surgery?
Nail surgery is a minor procedure performed under local anaesthetic, to remove part of or all of the nail plate. A chemical is then applied to the nail bed to prevent the nail regrowing.
The procedure is performed using a sterile technique. This involves the use of sterile gloves and drapes to reduce the risk of an infection after the surgery.
How is the surgery performed?
Prior to the any surgical intervention the podiatrist will have performed a full medical history and physical examination. This allows for an individual treatment plan to be discussed. The podiatrist will discuss non-surgical and surgical management options with the risks and benefits of each.
If surgery is decided upon written consent is obtained from the patient before booking the appointment.
On the day of the surgery the podiatrist will use a local anaesthetic injection to numb the toe. The injection is placed on both sides of the toe in order to numb the four nerves that supply sensation to the area.
This can be uncomfortable and often a sharp scratch is felt, followed by stinging as the anaesthetic is injected into the toe. This part of the procedure is the most uncomfortable but does not last too long.
Whilst you will have a numb toe and you will not feel pain, you may still feel movement and temperature changes. This is normal.
There are two types of local anaesthetic, which we use at Walk. The first takes approximately 15 minutes to work fully, but can last up to four hours. The second takes approximately 5 minutes to work but only last up to a maximum of an hour and a half. Your podiatrist will discuss the most appropriate anaesthetic for you.
Once the toe is numb, the podiatrist cleans the area with an alcohol disinfectant to remove as much of the local bacteria as possible. Then sterile drapes are placed around the foot.
A ring tourniquet is placed over the toe to squeeze any blood from the area to make sure the podiatrist has a clear field of vision when performing the procedure. It also makes the chemical more effective. The time the tourniquet is placed on the toe is noted.
Then the agreed portion of the nail is removed, the nail bed cleaned and dried and a chemical called phenol is applied to the nail bed for a maximum of three minutes.
Once the phenol has been applied, the area is once again cleaned and dried. The tourniquet is removed and the time of removal noted. The return of blood to the toe is also noted and a sterile dressing is applied to protect the toe.
After the surgery
The main thing to do after the surgery is relax and put your feet up at home. If you do get an discomfort as the anaesthetic wears off, take the normal medication your would take for a headache (for example, paracetamol). It is best to avoid ibuprofen as this can encourage bleeding.
Your podiatrist will have arranged a follow up appointment for the first redressing and will then discuss the full process of aftercare.
Things you need to know
Overall, nail surgery is a good way of managing long terms problems with thickened or excessively curved nails, and the short terms problems associated with ingrowing toenails or infection.
Podiatrists are skilled in the use of local anaesthetic and minor surgery and are probably the best placed healthcare professionals to undertake nail surgery.
If you have any questions, wish to find out more or would like to book an appointment, then please call 01562 51 561 61 or 077 666 888 29. You can also contact us via email – email@example.com.
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