A partial nail avulsion (PNA) provides a professional, safe and effective solution to the problem of frustrating and painful ingrown toenails. This is one of the most common procedures carried out in our clinic.
The procedure 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 have 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
- 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.
It is important to note that while the procedure, when completed with a chemical matrixectomy, does destroy the nail growing cells, there is always a chance that over time, these cells will heal and regenerate. Unfortunately, this is completely out of our control, as it depends completely on your body’s reparative response. We estimate permanent success in 4 out of 5 patients that we treat at Perform Podiatry. The way we distinguish cell regeneration vs. an ineffective procedure is the time between when symptoms develop. If your procedure was unable to completely remove the ingrown toenail, you should notice pain in the toe within the first few months after the procedure, indicating that the original nail was not completely removed. If this is the case, you must notify us immediately and come in for us to fix the problem. If your symptoms arise 12+ months after the procedure, this is a clear indication that the either your body has regenerated the nail-growing cells, or that re-injury has occurred through other methods in your control, such as continuing to wear tight, restrictive footwear that pushes the skin on your toe into the nail.