Nail surgery advice/information

Nail surgery is offered as a solution to many nail problems: 

• Infected or ingrowing toenails
• Involuted nails (nails that are curved in at the edges)
• Painful, thickened nails

If you require nail surgery, your local NHS podiatrist will first assess your suitability by completing an assessment form.  If nail surgery is deemed appropriate, you will be placed on a waiting list for the procedure.  You will be categorised based on urgency and our aim is to see

• Emergency within 2 weeks
• Urgent within 6 weeks
• Routine within 16 weeks.  

You will be contacted with 2 week’s notice for an appointment and may be offered an appointment across one of our locations across Fife – Adamson Hospital, Carnegie Unit QMH, Glenrothes Hospital or Whytemans Brae Hospital. The appointment will last approximately 1 hour and you should not drive after the appointment.

Nail Surgery

Nail surgery is a minor procedure carried out under a local anaesthetic. It is minimally invasive and is undertaken by a registered podiatrist, or a suitably qualified Student.  Nail surgery is carried out on adults and children after all other forms of treatment to fix a nail problem have been unsuccessful. Nail surgery is also an option if your nail is repeatedly infected.

Procedure

• Before nail surgery is performed, your health assessment will be reviewed and your consent will be obtained.
• A local anaesthetic is administered into your toe. As with all injections, this can cause some discomfort. Once the toe is numb, you should still feel touch and pressure, but no pain.
• The toenail will not be removed until you feel no pain and the podiatrist will ensure this has been achieved before removal.
• Once the nail, or part of it, has been removed, a chemical called Phenol is applied. This prevents the nail growing back. Phenol is a caustic which kills the cells the nails needs in order to grow by burning the local area.
• The longest part of the treatment can be waiting for the anaesthetic to take effect. Your toe can numb slowly if you have an infection in this area or if your feet are very cold. Removal of the nail itself does not take long and is the quickest part of the treatment.

We expect you to go home and elevate your foot for a couple hours after the procedure has been completed.  You should not drive until your foot is no longer numb or your insurance will be invalidated. 

Time off Work/School

If you are employed or in education, it is normal to only require the day of the procedure off.  Your usual footwear can be worn following surgery as long as there is no pressure on the toe.  

What to Expect Afterwards 

Your toe will take anywhere between 6-12 weeks to heal.  However, healing time can vary depending on; age, general health, the procedure you had carried out (for example section of a nail, one full nail or more than one nail).

Longer healing times can be due to various factors, including infection, trauma and patients who are immunosuppressed. Your toe will look worse before it gets better. As it starts to heal it can look as if you have an infection, however this is the Phenol (chemical mentioned earlier) working. There is no need to obtain antibiotics unless there are other signs of infection such as, inflammation, severe pain, heat and odour. Providing you are as careful as possible, normal activities can be resumed as soon as your toe has healed.

Points to Note 

• It is not advisable to drive immediately following the procedure, you should wait until your foot is no longer numb and you should have transport home from your appointment arranged.
• Your toe will be numb for a few hours following the nail surgery. If you experience any pain as the anaesthesia wears off you should take whatever you would normally take for pain – avoiding Aspirin based products in the first 24 hours.
• It is possible that some nail regrowth may occur. If this causes you any problems, the procedure can be repeated.

Advice for the day of procedure

• Eat and drink as normal on the day of the procedure
• Take all medication as normal – unless directed by the Podiatrist to do otherwise
• Attend on time for your appt – you may not be seen if you are late
• Do not have a local anaesthetic in the 24 hours before your procedure – if you do, please rearrange your nail surgery appt
• You may want to bring an open toe shoe or slipper to replace your footwear with immediately following the procedure.
• You are more than welcome to bring someone with you to support you. 

NHS Fife provides accessible communication in a variety of formats including for people who are speakers of community languages, who require Easy Read versions, who speak BSL, read Braille or use Audio formats. NHS Fife SMS text service number 07805800005 is available for people who have a hearing or speech impairment. 
To find out more about accessible formats contact: fife.equalityandhumanrights@nhs.scot or phone 01592 729130.