Nail Conditions
FUNGAL NAIL CONDITIONS
Cold laser nail treatment is now offered at the Centre. Click Here for more information.
INGROWN TOENAILS
Ingrown toenails are one of the most common conditions treated at The London Podiatry Centre. Surgery is relatively safe and effective, being undertaken on an outpatient basis. Often surgery can take place during their first consultation but patients are encouraged to contact the clinic first to discuss their problem.
If surgery takes place on the day of the first consult, then patients may not be able to drive home and should arrange appropriate transport.
The most common operation performed for ingrown toenails involves the removal of wedges from the side of the nail. Phenol is then often applied so that the nail is permanently narrowed. This operation leaves no scar (in the absence of complications which are rare) and a perfectly normal looking nail.
In some cases phenol is not used, with other nail surgery procedures offered at The London Podiatry Centre include the Frost and Winograd procedures.
Further information on the rationale behind our surgical procedures can be seen below:
PHENOL MATRIXECTOMY SURGICAL PROCEDURE FOR INGROWN TOENAILS
Nail surgery using Phenol application is the most commonly performed nail surgery procedure. This involves either the partial removal or the total removal of the affected toenail, before applying a strong chemical called Phenol to the nail matrix (which is the ‘root’ of the nail), to ensure there is no future growth of the pathological nail.
What does Phenol Matrixectomy involve?
- A local anaesthetic is given either around the offending toe or at the ankle to numb the skin and deeper tissues.
- Once the foot is numb, a surgical tool is used to separate the nail from the underlying nail bed. If a partial technique is performed, the pathological nail section will be cut from the healthy section down to the nail matrix, before being excised.
- Once the pathological nail or section of nail has been removed, Phenol is applied to the nail matrix, preventing regrowth of the nail.
- The remaining soft tissues are flushed out with a sterile saline solution to ensure all pathological tissues have been removed
- A sterile dressing is then applied.
- Several follow-up appointments with your podiatrist will then be performed to ensure appropriate healing.
What are the benefits?
- Phenol matrixectomy is relatively low-risk.
- The surgery time is minimal.
- The surgery may be performed concurrently with an infection treatment.
- Phenolisation can be performed concomitantly with infection treatment.
- Relapses are infrequent.
- Post-operative pain is generally minimal.
What are the risks and possible complications?
Risks and complications are uncommon, but they can include:
- Adverse reaction to the local anaesthetic
- Soft tissue infection
- Phenol burn
- Slow or delayed healing
- Recurrence or regression of the ingrown toenail
- Damage to the remaining nail plate
- Thrombosis
- Chronic Regional Pain Syndrome (CRPS)
FROST & WINOGRAD SURGICAL PROCEDURES FOR INGROWN TOENAILS
The Frost and Winograd procedures involve the partial removal of the toenail, the nail matrix (which is the ‘root’ of the nail) and surrounding soft tissues, to ensure there is no future growth of the pathological nail section.
Such procedures are more invasive than traditional nail surgery procedures which utilise chemical matrixectomy using a strong chemical called Phenol. Frost and Winograd procedures are typically indicated in patients who have an allergy to Phenol, when Phenol has failed to prevent the regrowth of the ingrown toenail or when a large defect to the nail or surrounding tissues needs to be removed as part of the procedure.
What do the procedures involve?
- A local anaesthetic is given either around the offending toe or at the ankle to numb the skin and deeper tissues.
- Once your foot is numb, both techniques use a scalpel to cut longitudinally through the nail and nail matrix. The Winograd then utilises an elliptical cut through the surrounding skin, removing the offending nail and soft tissues. Whereas the Frost procedure uses an angled scalpel incision at the nail matrix, creating a skin flap.
- Surgical tools are then used to ‘rasp’ the affected section of the nail matrix, preventing regrowth of the nail.
- The remaining soft tissues are flushed out with a sterile saline solution to ensure all pathological tissues have been successfully excised.
- Several stitches are then administered to hold the skin and nail in place.
- A sterile dressing is then applied.
- Several follow-up appointments with your podiatrist will then be performed to ensure appropriate healing.
What are the benefits?
- Both procedures can be performed to revise previously failed nail surgery techniques.
- The Winograd can be used to address severe cases of chronic ingrown toenails, where there is a significant amount of hyper granulation tissue.
- Both procedures are performed in our special day surgery unit, ensuring optimal infection control practices but without the need for hospital admission.
- Unlike typical nail surgery procedures, phenol chemical matrixectomy is not performed. Such chemical matrixectomies often result in longer healing times and incur risks of chemical burns.
What are the risks and possible complications?
Risks and complications are uncommon, but they can include:
- Adverse reaction to the local anaesthetic or sutures
- Soft tissue or bone infection
- Painful scar formation
- Recurrence or regression of the ingrown toenail
- Damage to the remaining nail plate
- Thrombosis
- Chronic Regional Pain Syndrome (CRPS)
OTHER NAIL CONDITIONS
The London Podiatry Centre treats many forms of different nail pathology. Examples include
- Discolouration
Some patients complain of discolouration of the nail, in which case careful consideration has to be given to some types of skin cancer. However, this is a rare condition. In most cases discolouration is due to a fungal infection or trauma. Lanula cold laser treatment, offered at the Centre is often effective at dealing with this condition.
- Onychophosis
Other conditions include the build-up of callus and corns at the side of the nails and this is called onychophosis. The London podiatry Centre offers specific type of surgery for this condition.
- Periungual Fibroma
This is when a small fibrous module grows at the site or underneath the nail and these types of problems require surgery which is performed at our Centre.
- Onychogryphosis
This is a severe deformity of the nail. This condition is also known as a ram’s horn nail and requires reduction, and in some cases surgery.
- Koilonychia
This is a nail abnormality that is reflective with a more general abnormality in the patient’s health. Certain types of anaemia can cause the nail to become spoon shaped and in other cases, the nail can become very clubbed which is sometimes associated with certain heart conditions.
The practitioners at The London Podiatry Centre have many years of experience in dealing with every type of nail condition. Please do contact us if you require further information.
Nail Conditions FAQ
How do you get rid of an ingrown toenail?
Sometimes you can gently file the side of the nails to reduce pain. Bathing in salt water with a little antiseptic such as TCP could also help. Ultimately, if the ingrown toenail is well established, then it would be preferable for you to visit The London Podiatry Centre for treatment as this can usually be resolved during the consultation.
How do you get rid of an ingrown toenail at home?
Home treatments for ingrown toenails can be attempted if there is a very mild problem by gently filing the nails, using salt water and some antiseptic. If the nail is more problematic, please contact The London Podiatry Centre.
Will an ingrown toenail heal itself?
Once a nail starts to grow inwards it often remains a problem. Sometimes if you allow the nail to grow forward it can resolve if the nail is gently filed.
What happens if you leave an ingrown toenail?
Leaving an ingrown toenail may result in developing an infection and more serious problems which can result in the loss of the nail and nail deformity. In a worst-case scenario, the toe can become infected and in some cases can even cause deeper infection of bone which could put the toe at risk. We recommend that you contact The London Podiatry Centre to schedule a consultation.
What is the fastest way to get rid of an ingrown toenail?
The quickest way to resolve an ingrown toenail is to visit one of our podiatrists at The London Podiatry Centre who will readily be able to resolve this problem often at the time of consultation. Sometimes local anaesthetic is required depending how bad it is.
What will draw out an ingrown toenail?
Salt foot baths with some antiseptic can sometimes help an ingrown toenail if it is not too developed. If the problem persists or worsens, please contact The London Podiatry Centre to schedule a consultation.
How long does it take to recover from ingrown toenail surgery?
This depends on the operation. If the nail simply has to be reduced without the use of anaesthetic, the benefit can almost be immediate. If you require an operation with local anaesthetic, then it can take a few days. If you require an operation under anaesthetic involving a chemical to stop the nail growing back in the corner, then this could take 6-8 weeks although patients continue with their general activities and bathe the nails themselves. The London Podiatry Centre performs various types of toenail surgery, please contact us for further information.
Is it worthwhile to get ingrown toenail surgery?
Yes, please call The London Podiatry Centre and we will be able to schedule this.
Is ingrown toenail surgery expensive?
Not when one considers the immediate benefit that can be obtained but it does depend on the type of surgery. It is a low-risk procedure with a very high success rate and some types of ingrown nails can be resolved on the day during the consultation without the use of local anaesthetic and therefore this would be done within the cost of the consultation. However, if local anaesthetic is required, then the cost will increase. Ingrown toenail surgery which involves removal and destruction of part of the nail will vary in price usually costing several £100’s. For a more detailed quote, please contact The London Podiatry Centre.
How much does it cost to remove an ingrown toenail?
This varies according to the type of operation. If the nail can be removed without anaesthetic, it will only cost the consultation fee. If you require a local anaesthetic then there will be an additional fee and ingrown toenail surgery costs several £100’s. Please contact The London Podiatry Centre for further information.
How long should you rest after toenail surgery?
This depends on the type of surgery. Removing a small section of nail without the use of local anaesthetic usually means that a patient can return to normal activity immediately. If you require local anaesthetic then a few days of rest is sensible. If you have toenail surgery then the recovery is usually several weeks during which time you can still be active but you should avoid putting to much stress on the nail such as running, and high-impact sports. However, most patients return to sports after only a few weeks.
How long will my toe hurt after ingrown toenail surgery?
Ingrown toenail surgery performed at The London Podiatry Centre is painless because we administer local anaesthetic. Patients tend to describe the pain similar to dental injections. After ingrown toenail surgery, most patients experience very little pain and most have near immediate relief.
What can I expect after ingrown toenail surgery?
This will depend on the type of operation that you have at The London Podiatry Centre. In some cases you can expect immediate relief and correction of the problem. In other cases, you will have some discomfort although this is often less than the original toenail problem.
Can I walk after ingrown toenail surgery?
Yes, you can walk immediately after ingrown toenail surgery performed by The London Podiatry Centre. If you have one of the more extensive operations, then it is often sensible to rest for 24 hours before resuming greater levels of activity.
What types of ingrown toenail surgery are there?
At The London Podiatry Centre we perform various types of ingrown toenail surgery. These can be categorised as follows:
- Simple removing of the nail without the need for local anaesthetic. This simply means that we can remove the offending section of nail with a nail nipper file and this usually results in immediate relief. There is a small chance that the problem may recur in some instances in which case a more extensive operation will be required.
- Ingrown toenail with local anaesthetic. In some cases it is necessary to administer some local anaesthetic so that the offending nail section can be easily removed. Patients typically describe this being similar to a dental injection.
- Ingrown toenail with phenolisation of the nail matrix. What this means is that we add some chemical to the nail bed where the nail is too wide so that it grows back in a narrower position. This chemical is an acid called Phenol and it does take several weeks to evade your tissues. As a result, you can have an open wound for several weeks but most people can remain active during this period and you would be able to work. Please contact The London Podiatry Centre for further information.
- Incisional nail surgery. At The London Podiatry Centre we have a Consultant Podiatric Surgeon who sometimes needs to do a more extensive surgery to remove the nail. This involves cutting out part of the nail root and stitching the area. The advantage of this type of surgery is that it is quicker and does not involve the use of Phenol. However, we will only do this in specific circumstances.
- Subungual exostosis (bony lump growing underneath the nail). This is performed at The London Podiatry Centre. In some cases, there is bone growing underneath the nail which has to be reduced and this is typically called a subungual exostosis. This is removed with nail nippers or with a small micro saw. Please contact The London Podiatry Centre for further information.
What happens if you get an ingrown toenail on your toe?
It can be very painful and become infected.
How is partial nail avulsion used to treat ingrown toenails
It is an extremely effective low risk way of resolving an ingrown toenail. It involves local anaesthetic and often the application of a chemical called phenol which stops the ingrown section of the nail from growing back.
I prefer not to have toenail surgery. Is there another option?
Sometimes, The London Podiatry Centre can gently file the ingrown section of nail away without surgery.
How can I tell whether or not I have an ingrown toenail?
If you have pain, swelling and redness around the nail you may well have an ingrown toenail.
Can an ingrown toenail be mistaken for anything else?
Yes, you could just have soft tissue infection / cellulitis or athlete’s foot.
What should I do if my child has an ingrown toenail?
In many cases, babies and infants will respond to gentle filing and non-surgical treatments.
What causes ingrown toenails?
Various causes exist and include, tight footwear, sports such as football, naturally wide nails (genetic causes) and sweaty feet.
How can you prevent ingrown toenails?
Cut nails straight across and not into the corners.
Can I have toenail surgery if I have diabetes?
Yes, this is generally not an issue but your diabetes should be controlled and stable as possible when you have surgery.
If I am pregnant or breastfeeding, can I still have toenail surgery?
This depends. If the toe is infected and painful, surgery can proceed because there is some risk from infection to both mother and baby. If possible, we avoid certain local anaesthetics and operations in the first trimester. If the ingrown toenail is very mild, we may treat non surgically. During breastfeeding, mother has the option to express milk so that breast feeding is not undertaken for 24 hours after. We generally avoid the use of phenol during pregnancy.
What are the potential complications?
All surgery has a risk of complication. The complication rates with ingrown toenail surgery are very low. Complications such as infection, thrombosis, complex nerve pain, recurrence, regression, pain, swelling, reaction to phenol and nail deformity can derive.
Are certain people at greater risk?
Yes, patients who are immune-suppressed or “poor” healers are more at risk. Some patients take medication that can reduce their healing potential and sometimes they need to stop these drugs at the time of surgery.
How will my toenail look?
If the surgery is successful, the nail will usually look completely normal with no evidence that surgery ever took place. The nail will appear narrower but this is often subtle and difficult to tell.
