I've talked about nail surgery in a previous post, which looks at the procedure from the perspective of the podiatrist when performing the procedure. Now the roles have been reversed, and I have been the patient, so I wanted to write about my experience as a patient and how that compares to being the practitioner.
I've had a problem with a wide big toe nail on my right foot for a while now, and this has been dealt with very well with regular treatment; however, recently this has become more difficult to treat and after a discussion with my podiatrist it was logical to remove a section of the nail under anaesthetic.
I would have had phenol applied to ensure that the nail does not regrow, but on this occasion I needed it to heal quickly and removing a small section of nail without chemical, should see complete healing within approximately 10 days.
So, two days before christmas, I had a small section removed!
I was concerned about the anaesthetic, especially as I have never had anaesthetic in the toe before. I normally describe to patients the sensation of a sharp scratch and then some stinging and burning as the anaesthetic is deposited around the nerve. I have to say that this is exactly what I felt: the sharp scratch was not too bad at all, but the anaesthetic around the nerves, especially the ones toward the bottom of the toe, could certainly be described as tender!
The injections worked first time and the toe was anaesthetised, leaving a strange sensation of swelling but without any pain. The tourniquet application proved to be a strange sensation too. You can see on the photo below the difference in colour between the toe and the rest of the foot. This is a result of the exsanguination - draining the blood from the toe - to ensure that the operating area is clear and the podiatrist can see clearly the area they are operating on.
Them a small section of nail was elevated, cut and then removed before having the area cleaned and dried. You can see in the pictures below how much nail was removed, and compare the width of the nail to how much of the nail is visible on a daily basis.
Did this hurt? Not at all. I was vaguely aware of some movement, but there was no pain at all.
Once the nail section was removed, a large bulky dressing was applied, which reminds you that you have had surgery, allows for any bleeding and also prevents you from catching the toe because you are encouraged to rest!
With procedures where phenol is not used, I educate the patients on two main points: firstly, that the toe will bleed and elevation is essential; and secondly, the toe is likely to be painful as the anaesthetic wears off, due to the absence of phenol.
While phenol is there to reduce the chance of the nail regrowing, it also has the effect of cauterising the blood vessels and the nerves, so bleeding and pain are theoretically reduced. Certainly this is the feedback I get from my patients post-operatively.
So what did I experience? Well, for me, there wasn't much bleeding. I did elevate the foot for the rest of the evening as instructed and I am sure this was an important part of this process. Also, I only had a section of nail removed and the size of the post-operative wound will be closely related to the level of bleeding.
As for pain, there was some discomfort. I was also surprised by how quickly the anaesthetic wore off and sensation began to reappear. Normally we would cite 3-4 hours for mepivicaine (the anaesthetic used in this procedure) but it was nearer 90 minutes in this case. Obviously this will be subjective, and differ between individuals.
Personally I found the toe quite sore but a does of paracetamol helped to keep this under control.
When I awoke the next morning, the soreness had almost all gone, with only a residual sensation when it was touched or while walking.
The next day, the toe was redressed. I went into the shower with the dressing on, as I normal instruct my patients, and then removed the dressing before using the shower head to provide some tap water irrigation. Once out of the shower, I used salt water to irrigate the toe and then a dry dressing was applied.
This process continued for the first few days until I was happy that any weeping or inflammation had finished, and a dry scab was forming. Then I was able to leave the dressings off.
During these first few days, there was some residual soreness, but this never changed (unless one of my children stood on the toe) and never required further pain killers.
Overall I didn't find the experience too painful and, so far, I am pleased with the results.
Would I have it done again? Absolutely, and if I am honest, I will have the whole nail removed at a later stage and phenol applied to prevent regrowth. This in my opinion, is a necessity given the width of the nail and the issues I have had previously.
The healing time is certainly a consideration hence why I had a partial removal without phenol, plus I knew that I could relax over the christmas period. I will need to look at when I have the procedure done in the future to fit in with a reasonable recovery period, given that in the early stages it will affect my ability to exercise, and for the first 24 hours, drive. My wife was very understanding when I told her that she would be doing the Christmas Eve driving!
Minor surgical procedures for problematic, ingrowing, thickened or fungal nails can be provided at Walk. If you have any questions, comments, or wish to enquire about an appointment then please get in touch.
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