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Is Ingrown Toenail surgery as scary as it sounds?

The word "surgery" strikes fear into the heart of most people.

However, post- surgery it is quite unusual to have people comment, "oh, that really wasn't all that bad after all." This is the common consensus for most of our patients who undergo nail procedures here at Foot Body Sole.

You might be thinking, there is no way that a needle is going into your toe. Trust me, thats what we have all thought at one point, even us Podiatrists.

However, when an ingrown nail is so painful that it stops you running, walking, playing with your children/grandchildren or even wearing your favourite shoes, the minor duration of discomfort suddenly appears very justifiable.

Why Do Nails Hurt?

1. Genetics: genetically people can have nails that are very rounded, or very flat. These nail types can both cause trouble by causing increased pressure on the skin surrounding the sides of the nail, the "nail sulci." The increased pressure on the skin often causes pain.

2. Trauma: Often, a knock, incorrect clipping or infection around the nail can induce pain in the nail sulci.

3. Nail pathology: Nails can become thickened or fungal (or both!) which can increase pressure on the nail bed, sulci and may deform the nail leading to pain.

4. Previous foot surgical procedures: previous surgery to the feet may cause a change in biomechanics or digital congruence which may give rise to ingrown nails.

5. Shoes: Incorrect fitting footwear such as too tight in the toes may lead to squashing of the toes together where the increased pressure may lead to nail sulci pain or an ingrown nail.

6. Medications: some medications may change the structure, strength and shape of the nails and occasionally this change of shape may disrupt the surrounding skin and give rise to discomfort.

Why Do We Do Nail Surgery?
  1. Pain or discomfort in the toe, stemming from multiple causes where the nail causes pain in the nearby skin.

  2. Reduce infection from an ingrown nail

  3. On rare occasions, nail surgery may be used to help clear a nail infection.

What Does Surgery Entail?

Before surgery is considered, a thorough assessment of foot and toe posture is undertaken, alongside medical, social, nail and footwear histories. The painful or concerning nail sides are considered, and often non- invasive treatments are implemented as primary treatments.

Prior to the procedure, education about risks, benefits, healing times and thorough at- home nail care directions post surgery is delivered. Consent forms are signed and safe dosage of anaesthetic are calculated for the patient.

The procedure requires administration of a local anaesthetic. A local anaesthetic is where, through injection, nerves of choice may be numbed. For a toe procedure, we place injections around the base of the big toe so only the big toe becomes completely numb.

You may have had a similar anaesthetic at the dentist!

Please tell me what actually happens!

- A sterile field is set up prior to the procedure starting.

- When the toe(s) is/are completely numb, the procedure can begin. - We apply a torniquet to the toe and use betadine for cleanliness. All of our instruments are sterile, we use sterile gloves and correct PPE.

- The nail portion is separated from the nail bed and clipped, then removed.

- Afterwards, a drug called Phenol is applied to the nail base ("matrix") to stop the small edge of nail re- growing.

- Often, no blood is sighted during the procedure as we do not cut the skin, rather only clip the nail.

- Dressings are applied after the torniquet is removed and the patient is able to easily walk out of the room and head off home.

The patient is provided information on toe care, and dressings are provided for use when necessary.

We review surgery patients in 2-3 days post the procedure, then 1 week later, and a month after that, where individualised instructions are given at each appointment.

What About Pain, Can I Go To Work/School?

The anaesthetic usually wears off in around 4-6 hours after it is delivered. This occurs gradually. Often, no pain relief is needed however 1 or 2 tablets of paracetamol may be taken to aid sleep, however this will be discussed on an individual basis prior to the procedure.

The majority of patients are able to walk with little to no pain as soon as the anaesthetic wears off.

Depending on work and school, most patients are able to attend work as normal, however many choose to take a few days at home between the procedure and the first re- dressing appointment.

The healing process is extremely individual and is determined by age, presence of prior infection, work/school demands, and adherence to advice regarding redressing and foot hygiene post- surgery. No one is the same, and we do all assessments and give all advice on an individual basis.

Should I Get My Ingrown Nail Taken Out Surgically?

This is a common question we are asked as Podiatrists. The answer really is that it is up to you.

Tip: I am a Podiatrist and I have had this procedure completed.

The questions I asked myself were:

  1. How much is this really bothering me?

  2. Is the extent of my bothersome toe causing activity change or concern about infection?

  3. Does my walking and do my shoe choices change when it is painful?

  4. Is it better to get the procedure done once and for all, or am I happy to get regular Podiatry care to keep my nail comfortable?

  5. Do I have any medical reasons why this procedure may be a risk? (Diabetes, neuropathy, balance challenges etc...)

If you have any questions about your painful nails, surgery or conservative options, please do not hesitate to contact us here at Foot Body Sole and we will be more than happy to guide you through a journey to more comfortable toes, with whatever treatment that may be

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