Ingrown Toenail Surgery

Ingrown toenail surgery aims to remove the portion of the nail causing chronic ingrown toenails permanently.

What is an ingrown toenail?

An ingrown toenail is a condition where the corner or edge of the nail grows into the flesh. It most often affects the big toe. It is generally a very painful condition however can still be serious for those who don’t experience pain due to nerve damage (such as those with diabetic neuropathy).

Ingrown toenail treatment options

Ingrown toenail treatment typically involves the podiatrist removing the piece of the nail that has grown into the flesh. The care approach generally fits into 2 categories:

• Conservative care options for ingrown toenails (non-surgical) are where the strategy of the podiatrist is to settle down the pain, inflammation and infection caused by the ingrown toenail.
• Chronic ingrown toenails may require ingrown toenail surgery as a permanent way to stop the ingrown toenail coming back.

Ingrown toenail surgery

Ingrown toenail surgery aims to remove the portion of the nail causing chronic ingrown toenails permanently. A partial nail avulsion is our main ingrown toenail surgery. It is a very effective procedure resulting in permanent removal of the ingrown toenail more than 95% of the time. A chemical is used to destroy the nail producing cells resulting in a narrower nail that is no longer prone to ingrown toenails. You can read more about our ingrown toenail surgery below.

What can I expect on the day of my ingrown toenail surgery?

Arrive a bit early and get comfortable

Please arrive 15 minutes before your appointment to fill in some paperwork while the clinical room is being finalised (cleaned and set up). Once the paperwork has been completed, we will explain the procedure and make sure you wish to go ahead. 

We allow plenty of time for the appointment and make sure you are comfortable and not feeling rushed. The appointment is typically 1.5 hours but the procedure itself only takes about 30 minutes. Most people look at their phones, listen to music or read a magazine through the procedure itself. It’s up to you. The extra time we allow is for room set up and pack up, paperwork, to answer questions, for the anaesthetic to be effective and afterwards to explain the post-operative instructions.

The procedure itself

We begin by numbing your toe. This is likely the worst part of the whole procedure. You feel a stinging sensation for about 25 seconds when we give a local anaesthetic injection either side of the toe. Best to get the worst over first right? Done! The toe tingles and then goes numb after a few minutes. After that you can relax and start reading your magazine or streaming the Fresh Prince of Bel Air or whatever it is you like to do.

While you are listening to your favourite tune (and the anaesthetic kicks in) we do a surgical handwash, glove up and finalise the set up of our sterilised instruments on the trolley and dressings required. 

The next step is testing the numbness of your toe to make sure we are ready to continue with the surgery. Your toe is washed and covered with betadine and a tourniquet is rolled around your toe to restrict blood flow to the toe we are working on.

And now we get to remove the bit of nail that has been causing you all this trouble! We remove a sliver of nail right to the nail base under the skin fold. A chemical called phenol is used to destroy the nail producing cells in this location. This chemical application further minimises the risk of the ingrown nail returning. The phenol is left in for a few minutes and then flushed/neutralised.

The tourniquet is removed and the toe is dressed with a thick sterile dressing. As it can be fairly large we recommend bringing a pair of sandals or thongs to wear out of the appointment. Closed in shoes can be a bit tight after the toe has been dressed.

What happens next? 

Care of the toe after the nail surgery

After the ingrown toenail removal surgery is completed we spend a bit of time explaining how to look after your toe until it heals. We want to do this to make sure you are comfortable and minimise the risk of complications. 

We recommend that you rest your feet for two days, elevating your foot where possible. The dressing is to be kept dry until the review appointment – generally 24-48 hours later. The sensation in your toe will gradually return over approximately 2-3 hours. There is usually very little pain after this time. However, the toe may sting or throb slightly for 12-24 hours. Paracetamol can be taken as directed by the manufacturer. 

Review appointments/Dressing changes

Three review appointments with the podiatrist are typically needed after the ingrown toenail surgery. The first review appointment is usually 24-48 hours after the surgery. After a few days, the thick dressing can be replaced with a thin breathable dressing and you can spend more time on your feet and usually go back to work if it is not too strenuous or dirty. 

The toe and nail is checked by the podiatrist on another two or more occasions over 2-3 weeks for cleansing and re-dressing. It usually takes about 3-4 weeks for the toe to heal sufficiently to remove the dressing permanently.

Conclusion

Ingrown toenail surgery (Partial Nail Avulsion) is a very effective procedure for ingrown toenails. Ideally, the surgery is done while the nail is not infected as this means the anesthetic is more effective and the toe will heal faster.

Most people are so happy with the long lasting relief provided by surgery they wonder why they put it off for so long.