Nail Surgery

  • By Judith Sullivan
  • 03 Apr, 2017
21 May, 2016

Total and Partial Nail Avulsion for the Treatment of Ingrown Nails

I've been in the process of designing a new patient information leaflet on Nail Surgery for Betafeet Podiatry and have been asked to share this information with you on our blog page:

What is nail surgery?

Nail surgery is the removal of all of the toenail or part of the nail. A local anaesthetic is used so that you will feel no pain during the procedure. After the removal of the nail, a chemical may be applied to the exposed nail bed to prevent regrowth by destroying the nail cells. (However, it is possible that some nail regrowth may occur). Healing takes between four to eight weeks.

Pre Surgery Guidelines

1. Please avoid alcohol on the day of surgery.

2. You may continue to eat as normal.

3. Bring suitable footwear, as your toe will have a bulky dressing on it. Open toe sandals with adjustable straps are best. You will not be able to wear a normal shoe directly after surgery.

4. Do not to drive or use public transport after surgery, please arrange adequate transport. A friend or relative who drives or a taxi is best.

5. Some people may feel faint. We advise that you come accompanied for extra support. If you do come alone do not worry, the podiatrist will ensure you are ok before you leave.

6. After the anaesthetic has worn off, your toe may be painful.

7. If necessary, take your usual painkillers,  BUT NOT ASPIRIN   (Aspirin is not advisable as it thins the blood and can cause undue bleeding).

Nail Surgery Procedure

1. The procedure will be performed by a podiatrist and normally takes less than 1 hour.

2. You will be asked to sign a surgery consent form and check medical history.

3. The Podiatrist will inject your toe to make it pain free.

4. A local anaesthetic will be injected into both sides of the base of the toe. The sensation of both touch and pressure are not affected, this is normal. The local anaesthetic may cause some discomfort when being injected into the toe.

5. When your toe is numb, part or the whole of the nail will then be removed.

6. A chemical may be applied to an area of the nail bed to prevent re-growth.

7. After the surgery, the tourniquet will be removed, the toe will be checked for return of your blood supply to the toe and a sterile dressing will be applied.

8. You will then remain for a short period of time in the clinic with your foot up and the dressing will be checked to make sure there is not too much bleeding before you leave the clinic.

9. If undergoing a partial nail removal, the appearance of the nail will be permanently altered in width. 10. The anaesthetic will take about 2-3 hours to wear off; please take extra care not to damage the toe in this period.

11. You may feel tired afterwards, and it is advisable to rest your foot in an elevated position.

12. Avoid driving or excessive walking and ensure footwear is not too tight.

13. The dressing on your toe should be kept dry until your first re-dressing.

14. Any damage or infection in this period will increase the healing time.

15. The wound will discharge a lot of dark red/brown fluid which will gradually dry up. This is the dead nail tissue sloughing away and is quite normal.

16. Should you experience any increased pain in the treated area or excessive bleeding, please contact your podiatrist. Outside clinical hours contact your doctor or A&E clinic.  

Aftercare Dressing Plan

1. After your first check up soak the wound in lukewarm salt water daily. Boiled water left to cool is best - always test temperature first.

2.The wound will need to be dressed with clean gauze dressing and tape, after each soak.

3.Dressings need to be continually changed daily until toe heals. This is usually 4-5 weeks.

4.You may bath and shower.

5.Wear only spacious shoes that cause no discomfort.

6. You will be given a final check up appointment in about 6 - 10 weeks to ensure that the toe is healing satisfactorily.

7. Avoid strenuous exercise or sport until the nail bed has fully healed.

8. If in doubt contact your podiatrist.


By Judith Sullivan 18 Jul, 2017
Andre was an associate podiatrist at Betafeet for five months.  His contributions to the practice were considerable.  Sadly we lost him to a higher professional and personal calling.

After a stellar educational background and career, Andre joined babylon Healthcare Services, UK based, with a view to helping them set up and deliver the first digital healthcare pilot services to the NHS.   Digital healthcare is a cluster of new and emerging applications and technologies that exploit digital, mobile and cloud platforms for treating and supporting patients. Digital Healthcare is being applied to a  wide range of social and health problems, ranging from monitoring patients in intensive care, general wards, in convalescence or at home – to helping doctors make better and more accurate diagnoses, improving drugs prescription and referral decisions for clinical treatment.

Rwanda then beckoned.

Since joining babylon Rwanda in April 2016, Andre has been instrumental in successfully setting up and launching Africa's fastest growing digital healthcare service.  According to Lindsey McConaghy, babylon's PR manager, 'Rwanda has a population of around 12 million but doctor numbers are in the hundreds. There’s an imbalance between supply and demand'.  

Digital Healthcare is not without its sceptics nor controversies - at what point do you let an app do the diagnosis?  Will GPs embrace technology in this way?

Here is Andre's report about his experiences in Rwanda:  

Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.

This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.

As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.

Now you are probably wondering what this has to do with podiatry?

Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.

As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.

The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.

How did all this lead me to Africa, I hear you say?

In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.

This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.

Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care. 

'Footnote'

It is with this experience I now look to move on to my next adventure focusing on Aboriginals and the utilisation of technology in the prevention of major non communicable disease such as diabetes.

Final comment from Reggie Simpson and Betafeet Podiatry

 We wish Andre the very best in his future and thank him for this interesting blog account.  We look forward to his next blog focused on his work with the Aboriginal population.  

By Judith Sullivan 12 Jun, 2017
By Reggie Simpson
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