TOENAIL SURGERY
Thank you for choosing to have your nail surgery at The Foot Spot. Our Podiatrists have been doing this procedure for almost 30 years and are not only proficient in the procedure itself, but Podiatrists such as Dr Paul Bowles from The Foot Spot have taught this procedure at Universities and published research on this procedure.
Nail surgery involves the removal of problem or ingrown toenail(s) or complete removal of a nail - either temporarily or permanently.
Nail surgery is performed for various reasons – in your case your Podiatrist at The Foot Spot will have identified and explained to you the reason you require the surgery.
In most cases, only a portion of the nail is removed, however sometimes it is necessary to remove the entire nail. The aim of nail surgery is to prevent the re‐growth of problematic nail or the problematic part of the nail.
Why do I need this procedure?
If you suffer from painful nails that don’t respond to other treatments, or the problem is reoccurring, then perhaps nail surgery can provide the long‐term relief or solution you are looking for.
If discomfort prevents you wearing comfortable or safe shoes
If your toenail causes excessive pain or pressure
If infection recurs in the ingrown toenail
If you suffer from persistent painful lesions under your nails
How is the procedure performed?
The procedure takes approximately 45 minutes to one hour, and is performed under local anaesthetic. It is carried out at The Foot Spot clinic with sterile non-touch technique developed by Dr Paul Bowles.
A certain amount of local anaesthetic is injected carefully into both sides of the affected toe, or in the area around where the procedure is to be performed. This makes the toe numb and the procedure painless. You will feel pressure during the procedure, but no pain. A tourniquet is applied to reduce blood flow to the toe, ensuring that the procedure is performed quickly, painlessly and effectively.
Once the offending part of nail has been removed, a chemical called phenol (carboxylic acid) is applied to the area where the nail grows from (called the nail matrix) which ensures that re‐growth does not occur. The toe is then dressed and bandaged securely using sterile dressings. You are able to walk immediately after the procedure with minimal to no pain.
What is Local Anaesthetic and Phenol?
Local anaesthetic is designed to numb a specific part of the body, whilst allowing the patient to be awake but feel no associated pain with the procedure. Prior to surgery, you should inform your Podiatrist at The Foot Spot of any medications you are currently taking, along with your medical history so they can determine whether you are suitable to receive a local anaesthetic.
Phenol is a chemical liquid that is placed directly upon and around the area that is operated on. This prevents any regrowth of the nail by killing the specialised cells which cause the nail to grow. On rare occasions a reaction known as a “phenol burn” may occur. This is an inflammatory response to the application of phenol. It typically settles within a few days of the procedure and as stated, is rarely seen.
What about scarring?
This is typically a “non‐invasive” procedure, which means that there is very rarely any cutting of the skin required. As such there is usually no scarring associated with the surgery – occasionally your Podiatrist may need to make a small incision near your nail or remove some extra tissue to help in the healing process, although this rarely causes any long term complications or scarring. After healing has taken place and the skin has regrown, the nail edge should be comfortable. Please be aware that cosmetic appearance of nails after this procedure can vary. There is the minor risk of some scarring associated with the use of phenol, but this is rare.
How long does it take to heal?
In most cases, healing should take place within 2‐4 weeks of the procedure. However medical history, medications, footwear and levels of physical activity will all affect healing times. Up to 8 weeks is NOT abnormal in some cases. Regular redressing will be required to ensure effective healing.
What are the risks?
It is important to remember to inform your Podiatrist of your complete medical history, to help identify any problem areas regarding your anaesthetic or procedure choice that may need further investigation. Generally local anaesthetic is extremely safe and the chance of having any reaction to the local anaesthetic is extremely rare.
Although the procedure itself is painless, there may be some discomfort associated with the healing process. This may include post‐operative pain, bruising or a burning sensation.
Despite sterile conditions and non-touch technique during surgery, there is also the possibility of infection which may delay healing. Most infection does not however come from the procedure itself, but the way the patient cares for it afterwards. Instructions will be given to yu after your procedure to ensure you keep the wound clean and free from infection.
There is also a risk of nail regrowth occurring despite the use of phenol. This risk is small and according to literature may be as low as 1 in 100 cases. If nail does regrow, it usually does not happen for 6-12 months after the procedure and the procedure can be performed again safely if required.
Of course there are inherent risks with ANY surgical procedure. You should discuss these with your Podiatrist at The Foot Spot during your consultations, or if you have any questions email at anytime via reception@thefootspot.com.au
WHAT DO I NEED TO KNOW BEFORE I HAVE NAIL SURGERY?
What should I bring/wear?
On the day of the surgery you should wear comfortable clothes. It is also advisable to bring a pair of open‐toed sandals or loose fitting shoes to wear after the surgery. The dressed toe is often quite bulky and pressure from any type of enclosed footwear may cause some discomfort. It is also important to bring any medications that you may need during the procedure e.g. for diabetes, asthma or angina – this should be discussed with your Podiatrist prior to the day of surgery.
Can I drive my car home?
It is not advisable to drive a car or to operate heavy machinery for some time following the administration of any type of local anaesthetic. It is also not advisable to take public transport or ride in a taxi alone, or to walk long distances. The Foot Spot advises you to organize a friend or relative to pick you up from the clinic and take you home. The Foot Spot will ring/contact you within the first 24 hours post surgery to check on your well-being. You are also given an emergency contact number that you may call at ANYTIME should you have any questions or problems after your procedure.
Will the local anaesthetic make me drowsy?
Local anaesthetic is designed to remove the sensations of pain whilst maintaining consciousness. Therefore, local anaesthetic will not make you drowsy. Many people are familiar with local anaesthetics as Dentists often use them in routine practice.
If you have ever had a bad reaction to a local anaesthetic, it is vital that you make the Podiatrist aware of it before proceeding with the injections.
Can I eat before surgery?
Eating of your regular meals is suggested both before and after the surgery. A full stomach will have no effect on the success of the local anaesthetic. In rare circumstances the local anaesthetic can cause nausea and/or dizziness. If at any time during the procedure you feel this please let the Podiatrist know immediately.
Do I stop taking my medication?
It is recommended that you continue taking your regular medication as per your usual routine. It is important that you let the Podiatrist know which types of medications you are taking. If you are on blood thinning agents such as Aspirin, Heparin or Warfarin, please inform your Podiatrist PRIOR to the procedure, as you may need to stop taking these for a few days both before and after the procedure. DO NOT STOP ANY MEDICATION without discussions with your Podiatrist first!
Do I need time off work?
This depends on what you do for a living. If your occupation involves manual work then you may be advised to organize some time off, or to arrange for light duties. Limiting the amount of trauma to the toe is an important aspect of wound care particularly in the initial stages as it greatly affects healing rates. The first 48 hours is the most important time for rest – although it is not essential, the more rest you get in this period, the more comfortable you should feel. Also be aware that not moving at all for periods of time always predisposes you to potential health risks such as blood clots – long sustained periods of activity should be avoided, however some minimal walking should still occur.
Can I still play sport?
The playing of sports, running and long periods of walking are not recommended for the first few weeks following nail surgery. Trauma to the operated toe may delay healing and increase both the risk of infection and the chances of scarring. In addition to this, it is important to keep the toe as dry as possible following surgery, so swimming is also not recommended until such time that your Podiatrist advises you that it is OK to pursue such activities. Please discuss any sporting activities you wish to return to with your Podiatrist.
What about alcohol and smoking?
It is advised that you should cease smoking and limit alcohol consumption both prior to and after the surgery. The reason this is important is that both of these activities cause a reduction in blood flow to the feet and may therefore affect healing rates.
I’m under 18 years old, what should I do?
If you are under the age 18 years old, you will need to bring either a parent or legal guardian with you on the day to ensure consent.
Will I need to come back after the surgery?
You will need to return to the surgery several times following the procedure. The first visit will take place approximately 1 ‐ 3 days after the surgery has taken place so that the toe can be assessed and re‐dressed. The second visit usually takes place around 3-4 weeks after the initial surgery. Of course, we are happy to review you at anytime - and there are no charges for review appointments pertaining to your procedure.
WHAT HAPPENS AFTER I’VE HAD THE NAIL SURGERY?
How do I care for the toe?
Following the procedure it is important that you limit the amount of weight bearing activity so as to minimise trauma to the toe. In addition to this, it is also important to keep the toe as dry as possible for the first week or two. Both of these can affect how successfully the toe heals.
You may be required at some point to re‐dress the toe following the surgery. If necessary your Podiatrist will give you instructions at on how to redress the toe and guide you on what signs to look for which may indicate infection or delayed healing.
What happens if I feel pain or burning?
Once the local anaesthetic has worn off you may feel some pain or discomfort associated with the toe that has just had surgery. In this circumstance Paracetamol is recommended, however only take as directed. If the pain does not subside then please contact The Foot Spot or Podiatrist on the number given, your GP or local Medical Clinic. Do not take ASPIRIN or any other pain relieving medications unless you have discussed this with your Podiatrist first.
On rare occasions a reaction known as a phenol burn can occur resulting in a burning sensation in the toe. This reaction typically settles after 4 – 5 days, however you should always contact your Podiatrist immediately if this occurs.
What do I do if it bleeds?
If the toe starts to bleed quite heavily following the procedure it is important to raise the affected leg above heart level, place another bandage over the top of the existing dressing and apply compression if needed. DO NOT REMOVE THE DRESSING THAT IS ALREADY THERE!!!!!!
If bleeding continues please contact The Foot Spot or Podiatrist on the number given, your GP or local Medical Clinic immediately.
How do I have a shower?
As it is important to keep the toe as dry as possibly, particularly in the early stages, we recommend using a plastic bag and tying it around the foot to prevent the dressing becoming saturated. A bath may also be preferable.
For elderly patients it is recommended that you use a shower seat to bathe, as you must avoid slipping in the shower whilst trying to keep the toe dry.
Redressing Procedure
During the first 24 – 72 hours after surgery you will be asked to return so that the toe can be thoroughly checked. You will then be given instructions for future re‐dressings – this instruction may include you re‐dressing the toe yourself at some point. Below is the correct procedure to follow when re‐dressing your toe.
The toe will require to be dressed at least ONCE daily.
Remove the dressing and soak the toe in warm salty water or sterile saline whilst at the same time gently swabbing the wound area with sterile gauze swabs to assist with the cleaning of the wound.
Dry the foot gently with more sterile gauze swabs, and apply antiseptic such as ISOCOL or BETADINE GEL (as long as you are not allergic to iodine).
Apply the recommended dressing to the toe. Usually the dressing will be Melolin or Handipor which can then be taped securely in place. Your Podiatrist should advise you where to obtain these materials.
Who do I contact if I have any questions or concerns?
If you have any further questions regarding nail surgery or if you are concerned about a toe that has been operated on, then please contact your Podiatrist at The Foot Spot on (02) 9326 3777 or via the emergency contact number that you were issued with.
