What is nail surgery?

This is a minor operation to remove the partial nail avulsion or sometimes all (total nail avulsion) of an ingrowing or thickened nail. A partial nail avulsion will leave you with a narrower nail whereas a total nail avulsion leaves no nail, just an indentation where the nail used to be.

This is done by removing the tissue where the nail grows from (nail matrix) either surgically (Zadek’s and Winograd procedures are common techniques) or by using a chemical (phenol).

Why would it be performed?

Nail surgery is performed because the nail is either ingrowing or deformed and hasn’t responded to non-surgical treatment. The aim of the surgery is usually to prevent the area of nail that is removed from growing back.

What does it involve?

The toe is injected with local anaesthetic to prevent any pain during the surgery. A tourniquet (tight rubber band) is then applied around the toe which stays in place during the operation to prevent bleeding during the procedure.  
The nail and the area where the nail grows from (nail matrix) is then removed. This involves a small cut being made in the skin at the base of the nail. The area is then stitched and a bulky dressing is applied.

If the chemical technique is used then there is no surgical incision, but a chemical called phenol is rubbed over nail matrix area to prevent regrowth.

How long will I be in hospital?

After the operation your toe will be swollen and you should rest with your foot raised to help the swelling go down. You will be in hospital for some of the day and will be able to go home later that day without the need for an overnight stay.

Will I have to go to sleep (have a general anaesthetic)?

The operation is usually performed while you are awake and the toe is numbed (local anaesthetic). The toe will remain numb for a few hours after the operation. If you experience any pain after the anaesthetic has worn off you can use the pain killer you would take for a headache, such as Paracetamol.

In some cases, it may be preferable to be asleep (general anaesthetic) during the procedure. This will be discussed with your surgeon.

What will happen afterwards?

You will be able to walk straight away after the operation. If crutches are advised, these will be provided. You will need to wear open-toe shoes such as flip-flops or a post-operative shoe. You should rest with your foot elevated when possible for a few days after the operation to manage the swelling.

10-14 days after the operation you will attend a nurse led clinic where your dressing will be changed and stitches (if you have had a surgical incision) removed.

How soon can I go back to work?

If your foot is comfortable, you have a sedentary job and you can wear an open toe shoe, you can go back to work the next day. If you have had stitches or you are in a manual job with a lot of dirt or dust around and a lot of pressure on your foot you may need to take longer off work.

How soon can I drive?

Once you are able to wear a normal, closed in shoe, you can drive. It is best to try the pedals while the car is stationary and to do short distances before longer ones. If you cannot safely make an emergency stop your insurance company will not cover you in the event of an accident.

How soon can I play sport?

When the toe has fully healed you can gradually start to increase your activity levels. It is advisable to avoid any sports such as football where there is direct impact on the toe for 3 months.

Risks

• The main problem is trying to avoid pressure over the toe in order to allow the area to heal.
• Sometimes wounds are slow to heal. This usually just requires extra dressing changes and keeping a close eye on the toe to make sure the wounds do not become infected.
• Minor infections in the wounds can occur and normally settle with a short course of antibiotics.
• Sometimes the nail regrows. If this area of nail becomes a problem, further/repeat surgery may be indicated.
• Damage of the small nerves around the area can occur which may leave permanent numbness.
• There are general risks with any operation that include blood clots, anaesthetic complications and tourniquet complications. Generalised pain and swelling can occur.

What can I do to help my recovery?

Most patients find simple measures can make a big difference to the outcome of surgery.  The evidence from studies and our experience supports this:

• Take simple vitamin C & D tablets needed for good healing.
• Stop smoking as smoking is linked to poor wound healing and increased complications.

Further information

www.bofas.org.uk
www.cop.org.uk