Nail Surgery

Painful / Ingrowing Toe Nails?

Painful, infected, ingrowing toe nails can be amongst the most debilatatiing problems you can have with your feet, right up there next to heel pain.  You can get them on any toe, but they most commonly occur in the big toe.  As the big toe is used to maintain your balance when stood still, and takes much of the pressure when walking, when you have a problem with your big toe, you really know about it.  An ingrowing toenail can be caused by several different causes, but the two most common causes are curved (or involuted) toenails, or extra wide toenails.  Both of these cause the edge of the nail to be sticking into the soft tissue / skin at the edges of the toe.

Many people have potentially problem toenails, but a problem only occurs after a trauma such as stubbing the toe, wearing badly fitted shoes, or cutting the toenails incorrectly.  In some cases, the nail can be cut back and helped to grow out, but in many cases part or all of the nail needs to be removed to prevent the problem reoccuring.

Do I need a Doctor's Referal?

If you want to see a Podiatrist on the NHS, then you will need to see your G.P for a referal into NHS Podiatry.  However, if you want to see a podiatrist privately, then you do not need your doctors permission.  If you have an infection in your toe from an ingrowing toe nail, it is recommended you see your doctor for some anti-biotics to help with the infection, but this will not treat the underlying problem.

What Can I Expect When I See A Podiatrist?

At your initial appointment, I take down your medical details, noting any previous and current health conditions, and any medication you are on.  I'll perform some health checks on your feet, including checking the circulation and your overall foot health.

Your ingrowing toe nail will be assessed, and it may be the case where you have a nail spike sticking into the soft tissues  / side of your toe, which can be cut out, and we just monitor the progress.

In other cases, it may be more suitable to recommend nail surgery to rectify the problem.  If this is the case, then I'll describe the procedure to you in detail, talk you through the risks and benefits, and the expected outcome.  If you decide you would like to go ahead, then a date will be scheduled, and the consent forms will be completed, along with a deposit to be paid to secure the appointment.

Doppler and Monofilament
Doppler Check

Nail Surgery Sounds a Drastic Option!

It does sound very major, but most nail surgery procedures only take about 40 minutes from walking in to walking out - Yes, that's right, you walk out.

There are various options when it comes to nail surgery.  I can either remove all of the nail, or just remove a small slither at the edge of the nail, so you can keep most of your nail.  The best option will be advised to you on assessment.

What Happends During The Nail Surgery Procedure?

On the day, as well as at the assessment, your blood pressure will be checked, along with a recheck of your circulation, and if all is still well, then we will proceed.

The toe is injected with local anaesthetic, and given approximately 6 minutes for it to take.  Out of the whole procedure, this is the only part than can be uncomfortable.  Once this has been done, it's all pain free.  In the event the initial dose of anasthetic does not fully numb the toe, further anasthetic is injected, but you don't feel anything the second time, as the area being injected is already numb.

When the toe is numb, it is washed down in an iodine solution to ensure it's surgically clean, a paper drape or sheet is placed over the foot, with just the toe sticking through, and a toniquet is placed over the digit to reduce blood flow to the toe during the procedure.

From the tourniquet being applied, to the nail coming off takes between 30 to 60 seconds!

Once the required part of the nail has been removed, if it was just dressed in bandages, the nail will regrow as it did previously.  See an example of this through my article on Injured Toe Nails.  To prevent this from happening, a medical grade chemical is applied to the nail bed where the nail has been removed, to kill off the nail bed and prevent the nail from growing back.  This stops the nail from re-growing most of the time.  Where nail does re-grow, which is only about 1 in 10 or 1 in 20, the nail is usually much thinner and usually does not cause any problems.

Ingrowing Toe Nail

Infected Ingrowing Toe Nail

Mild Ingrowing Toe Nail

Mild Ingrowing Toe Nail

Right 1st Toe - No Nail

Toe after the whole nail has been removed

Big Toe Nails, outside edges removed.

Two days after outside Edge removed.

Right Big Toe, 6 weeks after Total Nail Removal

Toe 6 weeks after the whole nail is removed

Edges Removed

Edges Only - 6 Weeks Later

Contact The Footman!

If you've been suffering with an ingrowing toe nail and want a solution sooner rather than later, then book an Ingrowing Toe Nail Assessment with me, and have your feet singing and dancing, rather than barking at you!

Initial assessment is £30 for a 30 minute appointment.  The nail surgery care package, which covers the nail surgery procedure, follow-up appointment 2 days later when the surgical dressings are removed, and you are shown how to re-dress the toe yourself, and all dressings are provided, and then a follow-up appointment 6-8 weeks later to ensure it has fully healed, costs £250 for 1 nail, and a further £80 for a 2nd nail treated at the same time.  If you have and problems during the healing period, I also will see you in clinic as part of the care package.

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Typical Questions I Get Asked

Q. How long am I off work / school for?

A. I advise you rest your feet for the rest of the day that you have surgery, but the following day, provided you are not a professional footballer or sports person, you can return to normal duties, provided you have footwear you can get your feet into with the dressings on.  Once I've seen you for your first review, and removed the intial dressings, all your previous footwear should fit you.


Q. How long before I can return to sports?

A. I normally recommend you wait until the initial trauma is healing well, but this depends upon the sport.  Swimming, for example, should be avoided until the wound had covered over.  Running, football, judo or Karate I'd suggest giving it a couple of weeks, but if you can wear normal shoes without any discomfort, then you should be able to return to sports.  It's a personal choice. Just remember though if you do too much too soon, you can cause the healing process to take longer.