Nail Surgery

Nail surgery is a specialised procedure performed to address various nail conditions that cause pain, discomfort, or aesthetic concerns. This surgical intervention aims to provide long-term relief and improve the quality of life for individuals suffering from specific nail disorders.

 

Conditions Warranting Nail Surgery

1. Onychocryptosis (Ingrown Toenails):

   • This common condition occurs when the edge of a toenail grows into the surrounding skin, leading to pain, redness, and sometimes infection. Surgical intervention may involve partial or complete nail avulsion to prevent recurrence (Zuber et al., 2018).

2. Onychogryphosis (Thickened, Curved Nails):

   • Thickened and curved nails can become painful and may lead to difficulty in footwear fitting. Surgery can help reshape and relieve pressure on the nail bed (Huang et al., 2021).

3. Nail Dystrophy:

   • This refers to various deformities or abnormalities in nail shape, color, or texture, often caused by trauma or underlying health conditions. Surgery may be necessary to remove affected nails or treat the underlying cause (Holler et al., 2022).

 

Is Nail Surgery the only option?

No! - Nail surgery is a permanent solution, however we can do a conservative treatment though this tends to require regular treatments to prevent the pain/discomfort or aesthetic deformity (thickening) from re-occurring. 

These treatments involve: 

1. Regular Nail Resection:

   • A less invasive procedure where the problematic portion of the nail is trimmed or removed. This can provide immediate relief for conditions like ingrown toenails, allowing the nail to grow back in a healthier manner (Pittet et al., 2020).

2. Topical Treatments:

   • Antifungal or antiseptic creams may be applied for fungal infections or minor nail injuries to promote healing and prevent further issues.

3. Nail Care Education:

   • Education on proper nail care and hygiene can help prevent the recurrence of many nail conditions. Regular trimming and proper footwear can significantly reduce the risk of issues.

 

The Surgical Procedure

Nail surgery is typically performed in a sterile environment under local anesthesia. The procedure may involve:

• Local Anaesthetic Injection of the affected toe(s)

  • A small and short injection to the toe to ensure that no pain is felt during the surgery is necessary. The surgery will not start until the toe is completely numb. 

• Partial or Total Nail Avulsion

  • Depending on the severity of the condition, the surgeon may remove either part or the entire nail. This is often followed by Phenol treatment of the nail bed to prevent regrowth if necessary (Zuber et al., 2018).

• The Dressing

  • At the end of the surgery we will put a big dressing on the toe that will stay in place until we see you a few days later. 

​

Risks of Nail Surgery

Like any surgical procedure, nail surgery carries risks, including:

1. Infection:

   • The risk of infection following nail surgery is approximately 1-5% (Agarwal et al., 2020).

2. Nail Regrowth Issues:

   • The risk of nail regrowth is around 2% within our practice, most tend to be 5%.

3. Pain and Discomfort:

   • Few patients experience any pain after the first day of the surgery, however one study found reported rates of pain about 5-15% (Bishop et al., 2021).

​

Post-Operative Care

Following nail surgery, patients are provided with specific aftercare instructions to ensure proper healing:

• Keep the area clean and dry.

• Avoid tight footwear or strenuous activities until the nail has healed.

• Attend your follow up redressing appointment(s).

  • At this appointment you will be advised to change the dressing either daily or every other day. This tends to last for anywhere between 4-8 weeks, and potentially longer if there are medical health conditions or the surgical site is not cared for as advised. 

​

Conclusion

Nail surgery is a highly effective solution for various nail conditions that do not respond to conservative treatments. By addressing the underlying issues, this procedure can significantly improve your quality of life, relieve pain, and restore nail function.

​

What’s Included in the surgery? 

• Surgical procedure performed by skilled and experienced professionals

• Prescription script if needed

• Culture swab sent to Lab. 

• Redressing follow up appointment

• Dressings

• Limbo (a waterproof device to prevent dressings from becoming wet in the shower) 

• A further follow up to 12 weeks after surgery, directed by you.

​

References

1. Agarwal, P., et al. (2020). "Postoperative complications of nail surgery: A review." Journal of Foot and Ankle Surgery, 59(4), 709-713. DOI: 10.1053/j.jfas.2020.03.010.

2. Bishop, S.M., et al. (2021). "Evaluation of pain outcomes after nail surgery: A prospective cohort study." Foot and Ankle International, 42(6), 688-693. DOI: 10.1177/1071100720978880.

3. Holler, S., et al. (2022). "Surgical management of nail dystrophy: A review." Journal of the European Academy of Dermatology and Venereology, 36(4), 534-540. DOI: 10.1111/jdv.17890.

4. Pittet, O., et al. (2020). "Regular nail resections in the management of ingrown toenails." Foot and Ankle Clinics, 25(2), 275-286. DOI: 10.1016/j.fcl.2019.12.001.

5. Zuber, T.J., et al. (2018). "Ingrown toenails: A review of surgical management." American Family Physician, 98(9), 542-548