Nail growing into the toe requiring conservative measures or surgery
Ingrown toenails occur when the nail curves and grows into the skin. This may be related to recent trauma, footwear, how the nail is cut, and unfortunately it may also be genetic. Most people seek treatment due to the pain they experience but you may also experience swelling, redness or infection.
Initially, management will be conservative through a general treatment with the offending nail piece removed. We can also use ‘nail bracing’ techniques that aim to guide the angle of the nail using a glue/wire arrangement that is similar to the braces used in dentistry.
If this does not produce the desired outcome then nail surgery will be recommended. This surgery is called a partial nail avulsion or PNA. This is a minor procedure that involves the permanent removal of the offending section of nail. It is performed in our rooms and generally takes about one hour. Best of all you are able to walk out.
A complete medical history will be taken and an assessment of your blood supply to your feet will be performed. These will determine if you are a suitable for a PNA. If suitable, you will be given a local anaesthetic, which lasts for 2-3 hours. Once numb, a tourniquet will be applied to your toe to reduce blood flow, and the area prepared to reduce the risk of infection.
The offending portion of nail is then lifted and cut away. Depending on your case one or both sides of the nail may be treated. A chemical is then applied to the now open area. This chemical is used to “kill” the cells that grow the nail, further reducing the chance of regrowth of the nail. It is this practice that essentially ensures that old portion cannot grow back.
Once the procedure is completed the tourniquet is removed and sterile dressings are applied. You will be given post surgical instructions, which you are expected to follow as these will help in your healing and reduce the risk of infection. You are then free to go home, and although you will be able to walk, it is recommended that you have some assistance in driving.
You are expected to attend the clinic for at least 2 follow up dressings/reviews. These reviews help in your healing process. You may need to come in for extra reviews if you are experiencing pain or infection. For the first couple of days post surgery we recommend open toed footwear. You may also need to modify your activities.
Outcomes and complications.
PNA’s are known to be a relatively safe and very effective procedure. However, as with all surgeries there can be complications. The most common of these is post operative infection. The risk of this can be significantly reduced by following the post surgical instructions you are given.