SURGICAL PODIATRY

A Partial Nail Avulsion is a minor surgical procedure where a specialist podiatrist will remove 8-10% of the outer aspect of your toenail (including the root), which can otherwise dig into the skin, resulting in an ingrowing toenail.  A local anaesthetic is used to numb your toe and the edges of your toenail are cut away. A chemical called phenol is then applied to the affected area to prevent the nail growing back and becoming ingrown in the future. The procedure is 98% successful, and after surgery the nail appears perfectly normal again.

If you’re tired of the debilitating pain caused by an ingrowing toenail, or fed up with having to see a Chiropodist or Podiatrist every few weeks to merely palliate your condition, then we would love to help.

Surgical Podiatry is a branch of Podiatry associated with the surgical treatment of the foot and its associated structures such as nails. It is carried out usually as a day case procedure and often under local anaesthetic. Podiatrists (formerly known as Chiropodists) work to improve the mobility, independence and the quality of life for their patients by providing assessment, diagnosis, treatment and preventative care of a wide range of problems affecting the feet, ankles and lower limbs. However, most people will simply see a podiatrist for Nail Cutting, Corn and Callous care etc.

Surgical Podiatry can be differentiated from other branches of Podiatry such as Clinical Podiatry and Biomechanical Podiatry, for which we have a separate facility here in Henley In Arden, Warwickshire, offering services in Gait Analysis and Custom Orthotic Prescription. 

An ingrowing toenail is a toenail that irritates or even pierces the adjacent flesh of the toe. In the beginning, it can merely feel as if you have a splinter. However, eventually, it can become extremely painful, inflamed, or even infected, resulting in localised pus formation and bleeding. The most common nail to be affected is that of the Big-Toe (Hallux), but other nails can be affected too.

Numerous genetic influences can make you prone to developing ingrowing toenails, in addition to your posture (the way you hold yourself), your gait (the way you move) and various foot deformites such as a bunion, hammer toes or pes planus (flat foot). Your nails may also have a natural tendency to splay or curl out instead of growing straight, encouraging your nail to grow outwards or inwards into the flesh. Tight footwear, hosiery and socks can also push your toe flesh onto the nail so that it pierces the skin. Also, if you sweat excessively or don’t change/rotate your footwear, this makes the skin soft and weak so that it is easily penetrated by the nail. If you suffer from brittle nails, or find that you’re prone to breaking off bits of nail, you are also more likely to suffer from an ingrowing toenail. Furthermore, the wearing of an ill- fitted support hose that excessively squeezes the toes, or likewise, the wearing of shoes with a tight toe box, can increase your risk.

One of the most common and obvious contributory factors to developing an ingrowing toenail is not cutting your toenails properly. Some people make the mistake of cutting nails too low in attempt to reduce/relieve pressure and discomfort from an involuted nail.

Less common causes of an ingrowing toenail include fungal infection, and in some cases, types of medication, eg. isotretinoin.

In the early stages; not at all. However, be aware that if left untreated, the toe can become severely infected. This infection can potentially spread to the rest of the foot and could lead to surgery. The standard advice is, the quicker you treat an ingrowing toenail; the less painful the treatment.

This answer is often a surprise to people: Athletic and sporty individuals are particularly prone, simply because they sweat more. Also, people who do jobs where they spend a lot of time on their feet can be more vulnerable. It’s thought that younger people are more likely to get an ingrowing toenail, merely because they ‘pick’ at their nails more; compared to elderly people whom might not be quite able to reach their toes as easily…

The most obvious symptom is pain/discomfort, possibly accompanied by visible redness/swelling (inflammation) around the area of pain.

However, there can be a a few ‘red herrings’ here, and not every patient we see identifies an ingrowing toenail accurately.  On occasions, patients have a curled/curved nail which can accumulate dirt/fluff/dead skin cells underneath it, or a corn/callus along the side edge of the nail. However, pain from a corn tends to be more throbbing in nature, in contrast to the more sharp pain you experience from an ingrowing toenail. If it becomes evident that this is the case, our podiatrists will be able to remove the debris, and possibly thin the nail.

Most importantly: Learn how to correctly cut your nails. Nail cutters aren’t usually the best tool for the job, because their curved-cutting-edge can catch the flesh at the edge of the nail. Nail scissors can slip easily. The best tool to use is called a ‘Nail Nipper’ which has a smaller cutting blade but a longer handle. Cut your nails straight across, without curve. Make sure not to cut too low at the edge or down the side of the nail. The corner of the nail should remain visible above the skin surrounding the nail. Cut your nails after a bath or shower when your nails have softened from the water.

Foot hygiene can also assist in preventing ingrowing toenails. Try to avoid letting your feet become moist and sweaty by rotating your footwear, allowing each pair a chance to dry out thoroughly. For socks and shoes alike, choose natural materials over man-made (synthetics). Make sure that both your shoes and socks fit properly. In the summertime, keep your feet clean and dry. Try wearing open-toed sandals in order to allow your toes to breathe as much as possible.

If you are diabetic, are on steroid based medication or anti-coagulants medication (blood thinners) DO NOT attempt to remove the ingrowing spike of nail yourself.

Prior to seeing one of our podiatrists, you may be able to partially relieve your discomfort by preparing  saltwater foot bath. This can assist in preventing infection and reducing inflammation. After soaking your foot for few minutes, dry the foot with a towel, and apply a clean sterile dressing; especially if you are experiencing redness or fluid discharge from the skin around the nail.

The treatment your podiatrist will suggest will depend largely on the severity and presentation of your condition:

‘We suggest you see one of our podiatrists if you experience persistent pain in your toe from the ingrowing nail; furthermore if you develop symptoms of infection, and especially if you are known to have diabetes or a poor immune system.’