What is Nail Surgery and under what circumstances is it used?
Nail Surgery majority of the time is the process of removing the offending edge of an in-grown-toe-nail (when the edge of the nail grows into the nail sulci instead of straight causing pain and sometimes infection). Nail surgery may be required for a number of reasons. It may be a reoccurring problem that the patient is facing and is unable to control with conservative measures, it may be infected or it may just be an incredibly painful nail spike that needs removing. Generally nail surgery is recommended when the Ingrown toe nail starts to impact daily activities and affects work, school and sporting activities.
The surgical procedure to manage in grown toe nails is called a Partial Nail Avulsion (PNA), also known as a nail wedge resection. Nail surgery may involve taking one or both edges from the nail or in some severe cases the entire nail can be removed. Surgery is a long standing treatment option designed to remove the need to have repeated visits to the podiatrist few months!
In some cases nail surgery may also involve removing fungal nails for those who have tried topical and oral treatments and failed and need a more aggressive treatment.
Ingrown nails can be caused from numerous factors, the most offending is footwear. Often shoes hat are too narrow although looking good place excess pressure on the sides of the nail and cause its rout of growth to be disrupted. Other reasons can be playing sports that involve a lot of kicking in boots such a soccer and football or just genetics.
The procedure is performed under local anaesthetic with two injections into the top of the affected toe. The needle is small and only a small volume of local anaesthetic is required to anesthetise the toe. The anaesthetic takes a few minutes to numb pain in the toe. For a short period, a patient will still be able to feel touch but not pain in the local area.
The toe requiring the PNA is cleansed with betadine surgical solution and a rubber ring is placed over the toe to temporarily restrict blood flow. A small portion of nail is gently lifted and removed from the affected side of the toe. Usually this portion is so small that cosmetically it is unnoticeable to most people. It is important to note that we do not cut the skin or suture the area as part of this procedure.
Importantly, a part of the nail removal procedure, a chemical, called Phenol, is applied to the growth area to prevent the nail regrowing in this section. This is successful in 99% of cases. Once the Phenol is applied it is then flushed out with more betadine surgical solution and the rubber ring is removed restoring normal blood flow to the toe. Sterile dressings are then applied which should be kept dry for a few days. Patients can walk immediately following the procedure but we recommend having someone drive you home.
Your podiatrist will discuss with you the need for follow-up appointments. This varies depending on age, medication taken and other factors. Initially an appointment will be made to remove the dressings and clean the area well before a smaller dressing is applied. In some instances, your podiatrist will direct you to change dressings at home.
Most people manage pain relief after the procedure with paracetamol. Aspirin should be avoided for at least 48 hours as it may make the wound bleed. Patients should be able to return to work or school the following day. Initially some patients are unable to wear their regular footwear while the bulky dressing is on.
All surgical procedures carry risks, however the risk of complication following PNA is very low. Please discuss with your podiatrist if you have any questions.
Our nail management surgeries are performed by our Podiatry team.
Appointments can be made by calling the clinic on 9889 1078.
Because these procedures take a longer time, surgical appointments cannot be made through our web portal at this time.
Nail surgery is usually a simple procedure, but is something that can take some time.
For this reason we recommend that patients leave up to 90 minutes for their nail surgery appointment.
Follow up review appointments are required to check the progress of healing and to change dressings. These are sually short appointments taking up to 15 minutes. As always please contact our reception team is you have any queries.
Shorts or leggings are best to allow us to perform relevant assessments, and for us to be able to clearly see and analyse
As the toe will be dressed and bandaged after the procedure. We recommend that you bring slides or open toed shoes to the appointment to wear on the way home, so to not put any pressure on the toe.
Not at all. Whilst we receive a lot of referrals from GP’s and other health professionals seeking the best foot care for their patients. A referral for nail surgery and in-grown toenail management is not necessary, if you feel that you have anm issue with in-grown toenails – give us a call. .
The initial cost of this procedure is $350 which includes removal of a single edge, phenol sterilisation of the affected nail matrix and two follow up appointments to check the status of the nail.
If edges on other affected toes are suggested by your Podiatrist to be removed, they can be done on the same day for $90 for each additional edge. It is quite common that the other edge on the same toe requires removal.
This procedure is claimable under Podiatry with your Private Health Insurer if you have appropriate cover. These procedures are also claimable through DVA or TAC where relevant.
Nail care and nail surgery are covered under your podiatry allocation within your private health insurance. Please contact your health insurer to determine your eligibility and level of cover.
CSSM is equipped with a HICAPS facility to enable on the spot claiming for your convenience.