About Nail Surgery

At Perfect Balance, our expert podiatrist team are equipped to carry out minor nail surgery in London, Hertfordshire and Bedfordshire and will work with you to get you great results. Nail surgery is a common procedure carried out by a podiatrist to remove part, or all of a problem toenail. If the whole nail is removed it is call a Total Nail Avulsion, often abbreviated to TNA. If only part of the nail is removed, which is the most common operation, then it is termed a Partial Nail Avulsion (PNA).

Problem nails include infected, ingrowing toenails or damaged, distorted thick nails that are causing pain and have not responded to conservative treatment. Phenol is applied to the underlying nail matrix to help stop regrowth of the nail. This procedure is known as Phenol Matricectomy and has a success rate of around 95% in preventing re-growth.

We often see people who have medical conditions that cause recurrent issues. Nail surgery is carried out to provide permanent pain relief and / or preventing recurrent infections in problem toes. Occasionally, it is carried out for cosmetic reasons.

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What to expect from your first appointment

It is usual for you to be assessed first, and an appointment made for surgery at a later date. During the initial assessment, the podiatrist will explain the procedure and answer any questions you may have.

They will carry out a careful examination of your toe(s) and will also assess your general health. They will ask questions to find out whether you are taking any medication, if you may be pregnant, have any blood disorders or phobias to ensure that you are suitable for surgery.

What to expect from the nail surgery procedure

Nail Surgery is carried out in the clinical room of your selected clinic. We perform nail surgery in London, Hertfordshire and Bedfordshire. Please ensure that you arrive early for your appointment. If you are late there may insufficient time to carry out procedure and the appointment will have to be re-booked for a later date. Please allow 1 hour for your appointment (although procedures usually only take around 20 minutes).

Patients are fully awake during the procedure, but we usually recommend that you do not watch in case it makes you feel uncomfortable. A local anaesthetic is injected in the toe to stop you feeling any pain. You may feel a slight discomfort when injecting the anaesthetic, but this only lasts a couple of minutes. Once the toe has been anaesthetised (numbed), you will be able to move the toe but will not feel any pain.

A tight rubber band, called a tourniquet, is put around the toe to reduce bleeding. The nail, or piece of nail, is then removed. A chemical called phenol is applied to the nail bed to stop the nail from growing back (however, in rare cases re-growth can occur). The tourniquet is removed and an antiseptic dressing is applied, along with another special dressing that will help stop any post-operative bleeding.

These dressings are then covered with sterile gauze which helps pad and protect the wound. You will be asked to return in a few days for the wound to be inspected and re-dressed. After that you’ll be given advice about how to look after your toe and to continue any re-dressings yourself.

After your surgery

The local anaesthetic usually wears off in 2-4 hours, so it is important to exercise caution during this period and avoid any unnecessary activity.

Wear an open toe sandal or similar shoe on the day of your procedure. This will allow room for the large dressing that will be applied. Wear loose, comfortable clothing that can be rolled back to the knee. Please remove all nail varnish from toenails before attending the clinic.

We would advise you not to use public transport or walk home after the procedure, as this may prolong any bleeding or increase the likelihood of accidental damage to the toe while it is still numb . Please arrange for someone to take you home in a car, or make arrangements for a taxi. Important note: Driving when your toe is anaesthetised may make you unfit to drive and/or invalidate your insurance.

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What will my toe look like afterwards?

The result of your surgery will depend on your particular toenail problem and the exact procedure used. In the days following surgery it is usual for there to be a temporary discharge from the wound, and bruising around the injection sites.

Phenol may cause some inflammation at the base of the nail and the area can be a little red and tender for a few weeks. These should all settle in time. If you have a total nail avulsion with phenolisation your toe, after healing, will have skin covering where the nail once was.

If you’ve had just a small section of nail removed then the result will be a narrower nail plate as the fold(s) of skin at the side(s) closes up.

How will the surgery effect my ability to work?

If you have an active job, you may need to take a few days off work to rest the affected toe(s). We recommend that you wear open toe shoes until the first redressing appointment.

Please be aware that these may not comply with any Health & Safety requirements at your place of employment so it may be wise to ask for time off or request a temporary change in role.

For children we recommend they do not return to school until after the follow-up appointment when the toe is re-dressed (typically after about 3 days). If necessary the surgery can be arranged to avoid clashes with other commitments, for example, exam time or holidays.

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Is there an alternative to nail surgery

There may be instances when the patient’s general health indicates that surgery is not recommended. In these cases careful, regular nail cutting from a podiatrist may help, and they may apply padding to the inner edges of the nails to provide relief.

Sometimes, just wearing footwear with adequate toe space may be sufficient in keeping the problem manageable. Your podiatrist will advise you of the options open to you.

Rarely, a local anaesthetic cannot be used for a particular patient, in which case a referral can be arranged for the procedure to be carried out under general anaesthetic in a hospital setting.

Book an appointment

Our expert team is available for appointments in London, Hertfordshire and Bedfordshire. If you would like to speak to someone to find out if nail surgery is right for you, please call us on 0800 0724 012 or our central landline number 01707 229871.

Alternatively please tell us a little about your circumstances using the contact form and we will ensure that the right person contacts you to discuss how we can help.

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