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Toenail Surgery

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Toenail surgeries are procedures that we often carry out in our clinic as a solution to toenails that have become ingrown, involuted, disfigured, thickened or are affecting a patient’s quality of life, comfort, their risk of injury, or other negative effects.

 

The two main procedures we carry out are the:

  • Partial Nail Avulsion (PNA), for ingrown toenails
  • Total Nail Avulsion (TNA), for a variety of conditions

 

Both of these procedures may be carried out with or without a chemical matrixectomy. The descriptions of each of these procedures are below.

 

 

Partial Nail Avulsion (PNA): Treating ingrown toenails

 

Ingrown toenails can be extremely painful, difficult to manage and pose a significant risk for infection, leaving our patients wanting a professional, and often permanent, solution to this frustrating problem.

A PNA procedure achieves this excellently, and is one of the most common procedures carried out in our clinic. It removes the small part of the toenail edge that is growing downwards/inwards, piercing the skin and causing your painful symptoms. We see fantastic results from this procedure and great satisfaction with it, especially as many patients struggle with recurring ingrown toenails for years before having the procedure.

Don’t worry – the procedure won’t leave your nail looking unsightly or abnormal. Instead, you’ll just have a very straight nail edge that is only slightly narrower than normal. This may be best described as “oh, I see that now that you’ve pointed it out but otherwise I’d never have been able to tell”.

The PNA procedure can be done with or without a step called a chemical matrixectomy, as described below, to destroy the nail growing cells present at the base of the nail. You’ll be able to discuss the best option for you with your podiatrist, but the primary difference is that the offending nail edge won’t grow back when we perform a chemical matrixectomy as part of your procedure, and it most likely will grow back without one. Without a chemical matrixectomy, it is difficult to predict whether the nail will regrow with a straight nail edge that will fix the problem, or if it will continue to become ingrown and cause you pain.

We’ll go through everything including your expected outcome in the consultation to see if a PNA is the best option for you. If the nail has become severely deformed or if removing side sections would achieve an unsatisfactory result, you may choose to have a Total Nail Avulsion (TNA).

 

The benefits of a PNA include:

  • The procedure is done simply in-clinic
  • The total appointment time typically doesn’t exceed 60 minutes (with the procedure time typically around 20 minutes)
  • The procedure is performed under local anaesthetic so is pain-free
  • You do not need to take any additional time off work/school following the procedure and can go home immediately
  • You do not need any special boots or braces while the toe heals
  • The procedure causes very little post-procedure discomfort, however, painkillers can be taken should discomfort arise
  • We dress your toe, provide you with a take-home dressing pack and re-dressing instructions
  • We monitor your progress to ensure it is healing well

 

The Procedure

This procedure is for the partial removal of the nail or an offending piece of nail.

  • We first inject the toe with a common local anaesthetic using the thinnest needle possible for your comfort
  • When the area is numb, we will perform the procedure in which a very small piece of nail along the edge that is growing into the skin is cut away and is pulled out
  • If you already have an infection, it will be surgically drained and any overgrown tissue is cut away
  • Where a chemical matrixectomy is part of the procedure, we apply the chemical (phenol) to the exposed nail base, before flushing it away and neutralising the area
  • We dress the toe with a number of dressing materials for optimal healing

Recovery time is anywhere from two weeks to two months barring any complications such as infection. We provide you with all the dressings, topical antibacterial solutions and ointments, the post-op shoe and aftercare instructions, all tailored individually to your needs.

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Total Nail Avulsion (TNA): For ingrown toenails & other nail disorders

 

 

Unlike a PNA which only removes a small part of the nail, the entire toenail is removed in the TNA procedure. This may be indicated in cases of ingrown toenails where both sides recurrently ingrow and there is a large curvature at the sides of the nail. In these cases, instead of removing two larger sides of the offending nail, a patient will opt to simply have the entire nail removed.

 

Aside from ingrowing or involuting (high degree of curvature) nails, this procedure is also used as a solution for disfigured, thickened, infected and damaged toenails where the nail itself is causing ongoing pain or great discomfort, especially when wearing shoes and performing daily activities.

 

Again, this procedure may be performed with or without a chemical matrixectomy. When performed with a chemical matrixectomy, the nail will not regrow and you will no longer suffer from the problems your toenail was causing. When performed without, the nail will regrow from scratch, a process that takes approximately 12 months.

 

This may produce a new, healthy nail that does not cause the previous problems you were experiencing. For example, where nail thickness was causing ongoing pain and discomfort and was very difficult to reduce, the new nail may grow to a normal thickness and no longer cause the original problems.

 

Because the growth of your new nail is determined by your body’s nail growing cells and not anything we can control, the nail may also grow back to continue to cause the same original problems. For example, where both sides of the nail were previously ingrowing, the nail may grow back in the same shape and the nail edges will continue to re-grow. If the base of your nail has been exposed to injury or trauma, this may also have damaged the nail growing cells and resulted in the abnormal production of nail, resulting in a disfigured nail shape. In these cases, the nail will likely also grow back in a similar original (problematic) shape.

 

Your consultation with your podiatrist will cover all of these factors and the likely outcome of your procedure, both with or without the chemical matrixectomy. Once you have all of the information, you will be best informed on which procedure will be the best option for you.

 

The benefits of a TNA include:

  • The procedure is done simply in-clinic
  • The total appointment time typically doesn’t exceed 60 minutes (with the procedure time typically around 20 minutes)
  • The procedure is performed under local anaesthetic so is pain-free
  • You do not need to take any additional time off work/school following the procedure and can go home immediately
  • You do not need any special boots or braces while the toe heals
  • The procedure causes little post-procedure discomfort, however painkillers can be taken should discomfort arise
  • We dress your toe, provide you with a take-home dressing pack and re-dressing instructions
  • We monitor your progress to ensure it is healing well

 

The Procedure

 

This procedure is very similar to the PNA, but instead removes the entire nail.

  • We first inject the toe with a common local anaesthetic using the thinnest needle possible for your comfort
  • When the area is numb, we will perform the procedure in which the nail will be detached and pulled out
  • If you already have an infection, it will be surgically drained and any overgrown tissue is cut away
  • Where a chemical matrixectomy is part of the procedure, we apply the chemical (phenol) to the exposed nail base (where the nail growing cells are located), before flushing it away and neutralising the area
  • We dress the toe with a number of dressing materials for optimal healing

Recovery time is anywhere from two weeks to two months barring any complications such as infection. We provide you with all the dressings, topical antibacterial solutions and ointments, the post-op shoe and aftercare instructions, all tailored individually to your needs.