Surgical Treatments

Procedures

There are two main surgical procedures we use to treat ingrowing toenails. These are Partial Nail Avulsion (PNA) with matrix phenolisation, and Total nail avulsion with matrix phenolisation.

Surgery is the fastest and safest option to resolve an ingrowing toenail long-term.

Suitability factors will be discussed during consultation and surgical recommendation.

This information is provided only as a guide. A full consultation is highly recommended to discuss benefits and risks of the procedure in detail.

Description of the Procedure

A local anaesthetic is used to numb the toe. Using special tools, your Podiatrist will cut the nail down towards the cuticle (bottom of the nail). Then either the whole nail or part of the nail will be removed. A chemical is put on the cuticle to prevent the nail that was removed from growing in again. The toe is covered with a sterile dressing.

Preparation for Surgery

Wear open toe footwear.

Arrange transport to and from your appointment, as it is not safe to drive.

Rest on the day following surgery, keep the wound dry and avoid impact activities

Sign your consent form

How Long Will It Take?

Approximately 1 hour

How Painful Is it?

It will hurt a little when your Podiatrist injects the anaesthetic into your toe, however, this only lasts approximately 20 seconds. During the procedure, you will not feel pain. After the procedure, you will likely have a small amount of pain for about 12 hours. This level of pain is generally much less than the pain of an ingrowing toenail. Your Podiatrist will advise you of appropriate pain relievers if necessary.

Post-procedure Care

Your Podiatrist will advise you in detail after your procedure on how to take care of your toe.

You need to have a few days of minimal walking and standing. If you walk around too much, your toe will hurt.

Complete healing takes about 2-3 weeks. This will not interfere with most activities. You should be able to return to normal activities and footwear one week after your procedure.

Follow up review appointments are booked within 4 weeks post surgery to check things are going well.

Risks of the procedure

Infections are uncommon and can be treated with antibiotics.

Regrowth is exceptionally rare which may require additional surgery.

Reactions to local anaesthetic are extremely rare but can include anaphylaxis.

The risk of reoccurrence is about 10% for matricectomy with phenolisation.

FAQs for Nail Surgery

Is it painful?
You will feel nothing at all while we do the procedure. Many of our patients have had traumatising experiences elsewhere when their treating practitioner has not properly anaesthetised (numbed) their toe. We will never do that to you!

Our highly skilled professionals foot doctors (podiatrists) use advanced techniques to produce a highly effective ‘block’ of your toe, and you will feel absolutely nothing at all during or immediately after your procedure. There will be two quick injections given at the base of the toe. Your toes will go numb within a few minutes, and you will feel nothing at all.

Our podiatrists are experts at doing this, and they will be able to put you at ease to make the whole experience as pleasant as possible

Do I need to take time off work/ sport?
It will depend on your occupation and other activities. A lot of people are able to return to normal duties within 1-2 days, however people on their feet all day may benefit from a few extra days to rest their toe. Your podiatrist will give you a detailed plan of how to return to normal activities, and a medical certificate if necessary. School aged children are best to have 2-3 days off school to rest and prevent any injury to the surgical site.

Is there pain after the surgery?
We perform a minimal incision procedure, with no cutting of the skin or any stitches, almost like a “keyhole” surgery. We send a questionnaire via SMS 4 hours after the procedure, and the average pain out of 10 is 2.2. Most people comment that their toe feels immediately less painful than before the procedure. If there is any discomfort after the surgery, it can be managed with over the counter pain medications.

Do I need to have an initial consultation before the surgery?
Generally, yes. Our front desk staff will be able to triage your case to determine if you will be likely to need an immediate surgical procedure, and allocate enough time for this at your initial consultation if appropriate. However your treating podiatrist will make the final assessment as to what will be your best treatment option and plan this as appropriate.

When considering your eligibility for surgery, we need to assess your overall health, medications, vascular status, and other risk factors. We may need to liaise with your GP in certain cases.

Can I walk immediately after the procedure?
Yes, you can walk! Your toe will still be numb for a few hours, and we advise all patients to have someone else to drive them home. You will need to rest the foot as much as possible for the first 48 hours.

How long does the surgery take?
You will be booked for at least 45 minutes, however a single nail edge takes about 20 minutes in the chair.

When can I start playing sport again?
We advise at least 2 weeks off.

Can I have the procedure if I am pregnant or breastfeeding?
We can but we prefer not to, as there is a very small risk of the local anaesthetic entering your bloodstream. You are best to discuss this with your podiatrist.

What will my toe look like after surgery?
In short, it will look slightly narrower. If it was thickened, or if it had a fungal infection, before the surgery, it will maintain that appearance after the surgery. The amount of nail taken will depend on several factors, including how wide your nail is initially, how severe your ingrown nail is, and how damaged the soft tissue around the nail is. If you have specific concerns about the appearance of your nail after the procedure, you need to discuss this with your podiatrist at your initial consultation.

Does Medicare cover for the procedure?
Medicare assistance is severely limited. We advise you to speak to your GP if you are eligible for an EPC referral.

Will my private health cover the procedure?
Yes most health funds will cover some or all of the procedure. You will need to check with your health fund directly to see what your rebate will be.

What are the risks and complications?
The procedure we perform is known to be very safe and effective. The most common complication is short term infection, and this can easily be treated with oral antibiotics. The long term risk is regrowth of the nail, however the literature shows this happens in less than 10% of all procedures, and we follow up all our cases and have a much lower rate of recurrence of less than 2%.

*https://www.ncbi.nlm.nih.gov/pubmed/18716431?dopt=Abstract

*https://www.pascom-10.com/Nail%20surgery%20outcomes.%20R.%20Modha.%20CLCH.%20August%202015.pdf

*https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001541.pub2/abstract

How long does the procedure take to heal?
The time to complete healing will depend on several factors, such at vascular status and immune status. Most people will have full healing in 2 to 3 weeks. We will have a review at 3 to 5 days, and we will send you questions via SMS to check your progress. We then have reviews as necessary to make sure you are getting a satisfactory and permanent result for your nail surgery.