Nail surgeries are performed to fix a number of nail pathologies including ingrown toenails and fungal nails. We are able to perform either a partial nail avulsion (PNA), where the problematic section of nail is removed, or a total nail avulsion (TNA), where the entire nail is removed. They are a common procedure conducted at our clinic and allows for better long term outcomes, rather than having the nail cut every few weeks.
Here is a brief step by step summary of a nail surgery.
- The toe is anaesthetised (numbed) using a local anaesthetic called xylocaine. The needle is inserted into the top of the toe at 2 locations. This generally causes some discomfort, but once this section of the procedure is done, the rest is a breeze!
- Once the toe is numb, we swab the toe with betadine and apply a tourniquet. This temporarily reduces the blood flow to the toe so that we can perform the procedure easily.
- We then remove the section of nail required using a variety of tools.
- A chemical called phenol is applied where the nail has been removed to prevent it from growing back.
- The tourniquet is then removed and the toe is dressed appropriately.
Following your nail surgery, we will see the day after to change the dressings and then show you how to manage the dressings at home.
Some common questions that we are asked at the clinic in relation to nail surgeries include:
What Can I Expect To Feel Or Not Feel During The Procedure?
Local anaesthetic is designed to reduce sensation in order for a procedure to be performed safely. It is important to note that you may still be able to feel a pushing or pulling sensation during the procedure. This is completely normal, as the local anaesthetic works specifically on the pain receptors. Those who have had dental work or even a caesarean will understand this feeling. It is important that you are able to distinguish between feeling ‘something’ and feeling pain. If you are in pain at any stage during the procedure after the local anaesthetic has been administered, let your podiatrist know right away. They will then be able to inject more local anaesthetic into the toe.
How Much Local Anaesthetic Will Be Injected Into My Toe?
This will be different for each patient as every toe is different. Before we inject any local anaesthetic, we will firstly ask for your weight. This allows us to calculate what your maximum safe dosage of local anaesthetic is. It is not often that we will reach this maximum dosage, but it is necessary to calculate to ensure maximum safety. Generally, we will inject between 2-4ml into one toe.
How Much Nail Will Be Removed?
This too will depend on the person. Some patients will only need a small amount of nail taken, others may need the whole nail. It really depends on the extent of the problem.
Why Do You Apply Phenol Where The Nail Has Been Removed?
Phenol is applied to where the nail is removed to prevent regrowth of the nail. A large percentage of the nail surgeries that we perform are a solution to ongoing ingrown toenails or nail problems. This means that the pain will subside and you will not require regular ongoing appointments to manage the nail.
What Should I Bring With Me To My Nail Surgery Appointment?
Bring a bottle of water with you and make sure that you wear open toed shoes such as sandals, as you will leave with quite a large bandage on the toe. A lot of patients who are nervous about their nail surgery will bring an electronic device with them, such as an iPad or tablet to keep themselves occupied during the procedure.
What Should I Expect After The Procedure?
You may experience some pain once the local anaesthetic wears off, usually 1-2 hours after the procedure. This can be managed by keeping the foot elevated and taking pain medication such as panadol. The day after your procedure, you will return to the clinic for a redressing appointment which allows us to examine and clean the toe. We will also teach you how to dress the site properly every 2nd day at home. After this, you will return to the clinic weekly to check on the healing. It generally takes 4-8 weeks for the site to be completely healed, which is dependent on a number of factors including underlying medical conditions and the amount of nail that was removed. It is important that the site is monitored closely and dressed properly to reduce the risk of infection.