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Toenail Surgery FAQs

A picture of an infected and inflamed toe with an ingrown toenail.

What is toenail removal surgery? 

Toenail removal surgery is the removal of a toenail which is performed under a local anaesthetic ‘block’ which numbs the toe. 

Why do I need toenail removal surgery? 

Toenail removal surgery is often needed when someone has severe ingrown toenails or recurrent pain with mild ingrowing toenails. The whole nail might also be removed if you have a fungal infection in the whole of the nail. Generally speaking, I would not recommend having the whole nail removed if it can be avoided.

What are the common reasons for undergoing toenail removal surgery?

Toenail removal surgery is often needed when someone has severe ingrown toenails or recurrent pain with mild ingrowing toenails. The whole nail might also be removed if one has a fungal infection in the whole of the nail. 

What is ingrown nail surgery?

Ingrown nail surgery involves the removal of the section of toenail which is digging or pressing into the skin at the side of the nail. If the nail is ingrowing because of it’s shape, then it is often wise to have the nail bed killed so that the ingrowing section does not grow back. 

What is a partial nail avulsion?

A partial nail avulsion involves the removal of the section of toenail which is digging or pressing into the skin at the side of the nail. If the nail is ingrowing because of it’s shape, then it is often wise to have the nail bed killed so that the ingrowing section does not grow back. 

How does ingrown nail surgery work?

Nails ingrow because the nail is either too wide for the toe or it has curved around and has a jagged edge. The jagged edge can then catch on the skin as it is growing up, meaning there is a battle between the nail and the skin. The nail invariably wins (until it meets this podiatrist!)

Ingrown nail surgery works by cutting out the section of nail that is ingrowing, along it’s length, and then applying an acid (phenol) in the area where the nail grows from. This destroys the cells that grow the nail and prevents the nail in that section from growing back meaning that the nail should never grow back in that spot. Approximately 5% of the time it will grow back though, no matter how good the treatment is.

What are the benefits of ingrown nail surgery?

Ingrowing toenails are rarely a one-off event. Even when a patient tells me it is the first time or they have never had an ingrowing toenail before, it is sometimes quite clear that it was just a matter of time before it happened, due to the shape of the nail. 

As a result, the biggest benefit is the peace of mind that the nail surgery gives patients that they won’t need to worry about that bit of nail becoming ingrown in the future. 

This can often mean that you don’t need to worry about it becoming ingrown at an inopportune time, such as whilst you are on holiday; or worry about not being able to do certain activities (say swimming or cross country running) because of the risk of infection.

Is nail surgery available through the NHS?

At the time of writing (February 2024), Swansea Bay Health Board offers nail surgery through the NHS Podiatry service. My podiatry colleagues locally have told me the waiting time is between four and eight weeks to have nail surgery from the time of your triage appointment, which can be an extra four weeks of lead time.

What nail conditions does the NHS cover for nail surgery, such as total nail removal surgery and partial nail removal surgery?

The information that I have been given is a bit more variable about this. I have been told that different NHS podiatrists will have different thresholds for referring patients for nail surgery. Some podiatrists will only refer cases that have had multiple episodes of infection or where the nail is severely ingrown. Other podiatrists will be happy to refer for nail surgery with a much lower threshold. 

N.B. This is not the case for patients seeking surgery at Keep On Your Feet, where the philosophy is that you will get the best care according to your needs. 

How can one access nail surgery through the NHS?

At the time of writing (February 2024), the podiatry department for Swansea Bay Health Board has a self-referral form to allow you to refer yourself into the podiatry department. This is available on the Swansea Bay NHS Podiatry website. You can also go to your GP who will be able to make the referral for you.

If you want to be seen quickly, but have nail surgery done through the NHS, you can book an appointment with Keep On Your Feet podiatry for a ‘Routine Initial Consultation’ and then the podiatrist will be happy to talk you through your options and assist you with making the self-referral (as it is technically not possible for a private podiatrist to refer you into the NHS… but we can definitely help you write the self-referral form out so it says all the right things!). 

Does the nail grow back after ingrown toenail surgery?

Any part of the nail which did not have the nail bed destroyed with phenol will grow back after nail surgery. Healthy nail can be damaged during nail surgery and so it may not look how you want it to. This usually returns once the rest of the nail has grown out. Obviously this is not ideal, and everything possible is done to avoid this happening.

Does the nail grow back after nail removal surgery?

It depends on which technique was used. If the nail was removed, but the nail bed was not damaged by the chemical, then the nail will start growing back once the wound has healed. You should notice new nail coming through after 6-8 weeks, and will notice a decent amount of nail (enough to attach a false nail to) after 3-4 months. It usually takes 6-9 months for a full nail to appear. Occasionally you may need to wait for one or two growth cycles for the nail to return to a normal appearance.

What am I allowed to do after nail surgery and how long is the recovery time?

It takes between 2 weeks (without nail bed destruction) and 6 weeks (with nail bed destruction) for the toe to fully heal. If you have an office job, you can usually return to work the day after nail surgery. You can usually also return to work from the next day if you have a job that requires you to be on your feet a bit more, but letting your work know that you may need to take a break or sit down more is worthwhile so that they can make reasonable adjustments for you.

You might find that your toe throbs and possibly bleeds a little bit if you do too much, too soon after nail surgery. 

You should not go swimming in a public pool until the surgical site has dried out (normally 4-6 weeks after nail surgery). Likewise, going swimming in the sea would not be recommended, especially if you have to walk on a sandy beach as the sand may get into the wound. 

What aftercare is needed following nail surgery?

The day of the procedure, you should go home and put your feet up. This will help to reduce swelling and reduce the likelihood of you having pain in the recovery period. 

The day after nail surgery, you can normally shower as usual and then you will need to change the dressing. This involves bathing your clean foot and toe in warm salty water, applying an antiseptic if you were instructed to, and then applying a simple dressing. I usually recommend a Mepore 6cm x 7cm dressing is applied to the toe. 

What is nail bed surgery?

Nail bed surgery can either refer to surgery for ingrowing toenails or it can refer to surgery for damage done to the nail bed. 

The nail bed contains special cells which form the nail plate and allow the nail plate to grow out. If you injure the nail plate severely, it can also cut the nail bed and this will affect how the nail grows out. 

In some instances, it can be beneficial to repair the nail bed so as to prevent the nail from growing out poorly.

Can you get ingrowing fingernails?

Yes, it is possible to get an ingrowing fingernail. The most common times that I have seen this is when patients are taking an oral retinoid such as Roaccutane

What is fingernail surgery?

Like toenail surgery, fingernail surgery involves an injection of local anaesthetic into the base of the finger, and then the section of the nail that is ingrowing can be removed painlessly. It is rarer to need fingernail surgery and, in a lot of cases, it is far more likely that a section of nail would be removed with local anaesthetic but the nail bed would not be destroyed with phenol. 

What is nail ablation surgery?

Nail ablation is the removal of a part of or the whole nail. This means that nail ablation can be either partial or total and may be done for a variety of reasons. The most common reason for a total nail ablation is either severe involution (curving) of the nail plate, or more commonly it is for severe fungal infections or severe thickening of the nail as a result of previous trauma. 

Partial nail ablations are much more common and are the treatment of choice for anyone with an ingrowing or involuted nail which is likely to become infected, if it hasn’t already been infected. 

Is ingrown nail surgery painful?

Ingrown nail surgery is a quick and almost entirely painless procedure. It involves two injections into the base of the toe (on either side) and these completely numb the toe. Quite often, patients say that ‘although the injections are the worst bit, they weren’t as bad as I thought!’. 

Infections after ingrown nail surgery?

Ingrown nail surgery often leaves patients with a wet wound for about 4 weeks after the surgery and it is very easy for the wound to be misdiagnosed as being infected, even when it is not. This being said, of all the complications that can occur with nail surgery, infection is one of the more common complications (although it does usually occur after a couple of weeks). 

Infections are easily managed by your podiatrist as podiatrists are able to provide some of the common first-line antibiotics if they suspect that you have an infection after ingrowing nail surgery. 

Can I have nail surgery if I have diabetes?

Yes, it is possible to have nail surgery if you have diabetes. The reason that some podiatrists will not do nail surgery on diabetic patients is that they are concerned about delayed healing. 

Delayed healing is a concern, however, if you have diabetes and an ingrown nail, there is also a risk every time the toe becomes infected that you will develop a non-healing wound. 

On top of this, the non-healing wound will not get better because the nail will continue to ingrow.

What can I do to reduce my risks if I have nail surgery and I’m diabetic?

One of the most useful things that you can do is to maintain your blood sugars throughout the period after nail surgery. This is because it is high blood sugars (and the follow-on effects), that cause delayed healing. You can discuss how to do this with your GP or diabetes specialist nurse, but making sure that you take your medications as prescribed and eating a healthy diet will mean that your blood sugars do not go too high.

If you are a smoker, it is also worth stopping (or reducing as much as possible) how much you smoke, as this can also cause delayed healing.

Do I need to remove nail polish before I have nail surgery?

Yes, if you are having nail surgery done then you need to thoroughly remove the nail polish from the toe which is being operated on as the nail varnish can harbour bacteria that might cause infection.


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