INGROWN TOENAILS – Partial Nail Avulsion
Many nail problems can be improved by good chiropody and careful self-treatment. Nails that are very curved, hard, thickened and inflamed around the edges may require professional assistance.
When cutting toenails, do not try to shape them like a fingernail. This is likely to cause ongoing discomfort.
There is no evidence that cutting a “V” in the tip of the toenail relieves the pain of an ingrowing toenail.
Discolouration, crumbling or thickening of the nail may be signs of a fungal infection. Fungal nail infections usually need to be proven by laboratory investigations. Your GP can arrange this. Sometimes a fungal infection can be mimicked by other conditions, such as psoriasis.
The area around the ingrown toenail becomes painful, swollen, discoloured (reddened) and infected, giving rise to a discharge. Amongst the causative factors are;
- Poor nail cutting,
- Using un-sterile instruments,
- Tight footwear,
- Picking the nail or an abnormal walking pattern, usually pronation or flattening of the foot.
Wherever possible, the nail will be treated without surgery.
If surgery is required, then the commonest method is a partial nail wedge resection with phenolisation.
The toe is cleaned and given a local anaesthetic. The nail section is loosened from nail bed and cut with a special instrument. A small section of nail is removed from the affected side(s).
A saturated solution of phenol (carbolic acid) is applied to the nail matrix, which is the area at the base of the nail section that has just been removed. Phenol is applied for up to three minutes and then flushed away. A tourniquet is applied to the toe for the whole of this operation.
The toe will be dressed to protect and keep it clean.
This dressing is changed after three or four days and the patient usually continues these dressings themselves. Healing is normally complete in two to three weeks, but can take much longer. The whole process should be pain free.
Healing following Partial Nail Avulsion (PNA) takes about 3-6 weeks or longer.
The toenail however will take about 6 months to 1 year to look completely normal again. This is because complete growth of the toenail from the base to the top of the toenail has to happen. Eventually the toenail will look the same as before the procedure but much narrower which means it will no longer dig in and cause pain and infection.
- Delayed healing
Total Nail Ablation
In a few cases, the nail may be so badly distorted or damaged that it requires complete removal (avulsion). This is essentially similar to the partial nail wedge resection, but may take longer to heal.
Occasionally, a small piece of bone or spur can grow beneath the nail plate. This is called an exostosis and it may be caused by;
- Chronic, but intermittent pressure from footwear or
- A bone defect.
This can be removed in a simple operation and may be combined with corrective nail surgery.
Nail conditions that can be treated include:
- Painful, infected in-growing toe nails – where the nail has pierced the skin causing discomfort, which may be infected and inflamed.
- Involuted nails – where the nail is abruptly curved causing discomfort.
- Thickened nails
- Nails that are severely affected by a fungal infection.
- ‘Rams Horn’ type nails.
- Nail Surgery is an area of practice in Podiatry that deals with the removal of painful nail conditions, under a local anaesthetic.
- This is a relatively painless procedure with excellent results for resolution and healing.
How much will it cost?
The procedure will cost £200 for one side and £225 for two sides of one toe. If two toes are done at the same time the cost would be £300. However it is not recommended to have both toes done at the same time unless you are sure that you can rest adequately to allow the healing process to progress.
This cost includes the pre-assessment, actual procedure and up to 3 dressing changes.
For an appointment, please ring 01672 564642 (Surgery), 01672 564685 (Home Visits) or 07970 482882