Ingrown Toenail Surgery
Considering ingrown toenail surgery and want to learn more?
Have a reccurent ingrown toenail and dont know what to do?
Everything about how to treat an ingrown toenail, ingrown toenail surgery recovery and the options available to you. At The Foot Hub, Sydney, we take care of your feet.
Ingrown toenails are a common foot problem we see at The Foot Hub. It is reported that about 20% of people who present to a doctor for advice for a foot problem have an ingrown toenail. The treatment methods vary depending on how advanced the problem is and the individual needs of the patient too, so we’ll always tailor a treatment to you.
For patients whose ingrown toenail issues are long-term and recurring, ingrown toenail surgery is likely to be the best option. When conservative and non-invasive treatments are unsuccessful, surgery removing the nail edge (which doesn’t grow back) can be a better permanent solution to avoid continual discomfort and pain.
If your ingrown toenail problem is not chronic or recurring, visit our ingrown toenail treatment page to see some of the non-permanent options that are available to you.
INGROWN TOENAIL SURGERY IS INDICATED FOR:
- Chronic ingrown toenail
- Recurring ingrown toenail despite frequent conservative care
- Ingrown toenails that are negatively impacting your lifestyle, causing significant pain and footwear use problems
TYPES OF INGROWN TOENAIL SURGERY
PNA surgery permanently removes the side of the nail that is causing damage to the skin. It is a quick and routine procedure, normally used in simple cases of ingrown toenails that can’t be resolved with conservative treatments. It’s also preferred by podiatrists as the majority of the nail can be left attached.
- A quick procedure – just 45 to 60 minutes
- A normal-looking nail is left after healing
- 98 per cent success rate
- Fixes the issue permanently
- A quick recovery time
TNA surgery permanently removes the entire nail, normally carried out only when a severely damaged or thickened toenail causes recurring problems that the more simple PNA surgery will not fix. This is not the preferred treatment, but in rare cases it can be necessary to avoid future problems.
- A permanent solution for the nail, which won’t grow back
- 98 per cent success rate
- A simple and quick procedure – just 45 to 60 minutes
- Rapid recovery rates
What is phenolisation?
Partial Nail Avulsion with phenolisation is the most common solution for ingrown toenails. Safe, simple and effective, it uses phenol (a mild acid) to destroy the nail matrix, with low levels of post-operative pain and infection. With a high success rate (98.5 per cent) and a natural-looking nail, this is the preferred treatment for the majority of our patients.
The liquid phenol is applied to the problem area for at least one minute, allowing the mild acid to destroy the nail matrix and remove the cause of the pain and discomfort. Phenol is safe and approved for use by the Therapeutic Goods Administration (TGA) in Australia.
It’s a safe procedure for use with diabetic patients or those suffering from vascular disease. Although there has not been much supporting evidence to suggest there are risk factors, the use of phenol treatments is not advised for pregnant or breastfeeding patients.
The Procedure
It is a quick and simple solution for painful ingrown nails. Once the toe is numbed, there are just four steps to follow.
- Step one – After the toe is numbed, a tourniquet is applied to limit blood flow (for better visibility and phenol efficacy) and the nail edge is cut and split from the nail plate.
- Step two – The cut nail edge is gently removed from the nail fold and any remaining fragments are removed. Extra tissue that has grown over the site will also be removed at this point.
- Step three – The phenol acid is applied to destroy the nail matrix (in three, 20 second applications) and the toenail is flushed with a clean solution.
- Step four – The tourniquet is removed, the toe dressed with an antibiotic ointment and bandaged, and you can go home and relax.
Prior to booking in ingrown toenail surgery, patients should have a pre surgery assessment discuss suitability for surgery.
Safe
Effective
Fast Healing
LOCAL ANAESTHETIC
This is a crucial step that is never ignored, ensuring that your ingrown toenail surgery is as comfortable as possible. We know that not everyone is a fan of needles, but our skill and expertise will make the process fast and painless. We do these procedures on a daily basis and know just how to help you relax, and get it right first time.
If you have any anxiety around needles and injections, discuss this with your podiatrist. The Foot Hub also offers local anaesthetic without a needle, using the Comfort Injection Technique. If you prefer this option, make sure to mention this during your pre-surgery assessment.
Comfort-in ™ is a spring-operated needle-free injection system. This system is a type of medical injecting syringe that uses high pressure – it uses the narrow jet of the injected liquid instead of a hypodermic needle to penetrate the epidermis (skin). With this we can deliver needleles local anaesthetic to the toe and be able to perform ingrown toenail treatment.
Don't like injections? Don't worry, we offer needless injection for local anaesthetic.
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Download our guide on some steps you can do to overcome needle phobia.
Preparing for your ingrown toenail surgery
So you’ve had your pre-surgery assessment and your surgery date is scheduled – what do you need to do before the day?
- Arrange for someone to drop you off, or book a taxi
- Take enough time off work – we recommend a period of 48 hours of limited weight-bearing after the surgery
- We advise the use of open-toe shoes for a week after the procedure.
- If your job requires safety footwear then this period can be reduced to 48 hours.
- Have a meal before your surgery
- Bring open-toe shoes to wear after the procedure
- Mention all known medical allergies during your assessment
- Provide an emergency contact to the clinic
- Stay off YouTube! If you need more information or have questions, simply ask the experts at The Foot Hub
Ingrown Toenail Surgery Aftercare
Do you want to make sure you get your nail removal surgery recovery right? When you leave the clinic after your surgery, we will provide you with the dressings to keep your toe clean and healing well, as well as information about how to apply them effectively. We will also schedule a follow-up appointment within 48 hours to ensure a successful post-surgery recovery. You’ll notice the difference in your ingrown toenail before and after surgery
There are some important things to keep in mind after your surgery.
- You won’t be able to drive home, so book a taxi or ask someone to take you. Driving with the local anaesthetic still active is not advisable
- Your podiatrist will apply the first dressing, however it’s quite normal that some bleeding can become visible after the procedure.
- Leave the dressing intact and apply another over the first, then rest and elevate your foot above hip-height.
- Keep the toe dry and clean until your first dressing-change appointment
- That first dressing will be quite bulky, so make sure you wear open-toe shoes that can accommodate a little extra
- Sometimes patients experience a little pain and discomfort after the local anaesthetic wears off so you can take paracetamol for the pain.
- If the pain is severe, please contact the clinic immediately
- Attend your free follow-up appointments until your podiatrist discharges you
- Avoid wearing tight-fitting shoes that put pressure on the toe
- Avoid weight-bearing and strenuous activity (including the gym and weight-lifting) for two weeks after your surgery.
Follow up appointments
You will have a follow-up appointment with your podiatrist after 48 hours, and this is also when you’ll have your first dressing change. Your first dressing will be removed and the toenail will be flushed with saline solution and an antiseptic dressing applied to ensure good healing. You’ll also receive a complimentary pack of dressings as well as clear instructions on how to apply them to avoid toenail fungal infection.
Until your podiatrist discharges you, weekly reviews are necessary to monitor healing and recovery – and it is all part of our inclusive and friendly surgery package. In order to achieve the fastest and most effective healing possible, and avoid post-surgery complications, we ask all our patients to attend each of their planned appointments.
Ingrown Toenail Surgery Recovery
- Nail avulsion surgery has a 98.5 per cent success rate, but in the rare case that the surgery is unsuccessful, we will organise to re-do the procedure at no extra cost to you.
- Depending on your medical history and whether there is an infection due to the ingrown toenail, healing can vary from person to person.
- Most patients can return to work after 48 hours of rest, especially if they take all the advised post-surgery steps.
- Full healing of the surgical site can take between two to six weeks, and in some cases longer. The most common post-surgery complication is infection, especially if there was an infection present before the procedure. We will help you treat any infection with oral antibiotics.
- We work to give our patients the best cosmetic outcome possible, particularly in the case of partial nail avulsion surgery (where a small section of the nail is removed). For larger toes, the change in size and shape is unlikely to be very noticeable, although smaller nail plates may be more affected. If you have concerns about how your toe will look post-operation, talk to your podiatrist about this during your pre-surgery assessment.
Guarantee
Nail Avulsion surgery has a 98.5 per cent success rate. For The Foot Hub patients who have had ingrown toenail surgery and in the rare case it grows back, we will redo the surgery at no charge.
The Foot Hub
Contraditions
We can perform ingrown toenail surgery on most patients, and the procedure is quick and safe, however we do not recommend surgery if the following applies to you:
- You are pregnant or breastfeeding
- You have diminished blood supply to your feet (Peripheral Vascular Disease)
- You are allergic to local anaesthetic
- Your toenail is severely infected – we advise a one to two-week course of antibiotics to ensure the surgery is as effective as possible
The Foot Hub
Side Effects
The most common side-effect of ingrown toenail surgery is pain. With the majority of patients this is mild and can be managed with over-the-counter painkillers like paracetamol.
Post-operative infections can also be present, normally within the first few days after the procedure. These are normally caused by bacteria (Staphylococcus aureus) or fungus (Candida).
On rare occasions the surgery is not as effective as desired and ingrown toenails can re-occur.
Pricing
Cost Ingrown Toenail Surgery
One Toe/ Two Sides
Partial Nail Avulsion With Phenolisation
One toe/ One Side
Partial Nail Avulsion With Phenolisation
One Toe/ Entire Nail Plate
Total Nail Avulsion With Phenolisation
frequently asked questions
We recommend you keep your toenail dry for seven days after your operation. After this, you can swim and get it wet, preferably with a waterproof dressing. To prevent infection and to maximise healing, ensure that debris like beach sand is cleaned from the area.
Recovery normally takes between four to six weeks. Walking is possible immediately, and patients can return to work after 48 hours. Our advice is to wear open-toe shoes for seven days after the surgery to promote healing and comfort.
If you are eligible under the Chronic Disease Management plan, you can receive a rebate of $58.00 from Medicare under the Enhanced Primary Care Programme. Only your GP can refer you on this plan and you would need to meet the inclusion criteria.
Yes it does; with private health insurance you can claim for your ingrown toenail surgery. See our relevant pricing table and item codes to be able to accurately communicate with your insurer. Our clinics are registered HICAPS terminals, and can offer on-the-spot rebates. We also accept AfterPay for ingrown toenail surgery too.
Yes absolutely – multiple research studies have proven Partial Nail Avulsion with phenolisation to have a success rate of 98.5 per cent.
Partial Nail Avulsion and phenolisation have lower post-operative pain compared to more aggressive ingrown toenail surgery methods. There may be some post-operative pain once the local anaesthetic wears off, and this should be managed by over-the-counter painkillers like paracetamol.
We suggest you wait two weeks before resuming vigorous physical exercise, to assist in the healing process.
As Partial Nail Avulsion involves removing only a small portion of the nail, most patients will retain a cosmetically satisfactory result. If you have an especially small or delicate nail plate, then extra care will be taken to give the best possible cosmetic result.
Total Nail Avulsion surgery removes the entire toenail, and this procedure normally results in a good appearance with limited scarring.
We recommend you wear open-toe shoes for the first 48 hours. You should also avoid wearing constricting shoes until the nail has fully healed, for the best result.
Although your toe will be numb after the procedure, you can still walk out of the clinic. We recommend that you rest and avoid activity for the rest of that day to minimize pain and ensure good healing.
Although our surgery methods have a 98.5 per cent success rate, there are rare cases where the nail grows back. At The Foot Hub, we are here to look after you, so if this happens after your ingrown toenail surgery, we will re-do the procedure at no extra cost.
From start to finish the whole procedure only takes an hour. If there are more toenails being operated on, the procedure may take longer.
We recommend a minimum of 48 hours off work. Your podiatrist will be able to write a medical certificate if needed.
No. You will be able to walk after your ingrown toenail surgery. We recommend not to drive to and from your surgery. And we also recommend to raise your feet after your surgery.
- AlGhamdi KM, Khurram H. Nail tube splinting method versus lateral nail avulsion with phenol matricectomy: A prospective randomised comparative clinical trial for ingrown toenail treatment. Dermatol Surg 2014;40(11):1214–20.
- Boberg JS, Frederiksen MS, Harton FM. Scientific analysis of phenol nail surgery. J Am Podiatr Med Assoc 2002;92:575–9.
- Bos AMC, van Tilburg MW, et al. Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail. Br J Surg. 2007;94(3):292-296
- Bryant A and Knox A. Ingrown toenails: the role of the GP. Am Fam Phys. 2015 Mar; 44 (3) : 102-105.
- Byrne DS, Caldwell D. Phenol cauterization for ingrowing toenails: A review of five year’s experience. Br J Surg 1989;76:598–99.
- Chabchoub I., Litaiem N. Ingrown toenails. [Internet] StatPearls Publishing LLC; 2019 Aug 24 [cited 2020 Jan 20]. Available from: INTERNET [PMID: 31536303]
- Chang P. Diagnosis using the proximal and lateral nail folds. Dermatol Clin. 2015; 33(2): 207-241
- Cho SY, Kim YC, Choi JW. Epidemiology and bone-related comorbidities of ingrown nail: A nationwide population-based study. J. Dermatol. 2018 Dec;45(12):1418-1424.
- Cordoba-Diaz D, Becerro de Bengoa Vallejo R, Losa Iglesias ME, Cordoba-Diaz M. Effectiveness of standard lavage with supplemental chlorhexidine in patients undergoing chemical matricectomy for ingrown toenails: A clinical trial. J Am Acad
- Daniel CR, Iorizzo M, Tosti A, Piraccini BM. Ingrown toenails. Cutis. 2006 Dec;78(6):407-8.
- Dermatol 2014;70(6):1092–5.
- DermNet NZ. Ingrown toenails. DermNet NZ, 2013. Available from: www.dermnetnz.org/hair-nails-sweat/onychocryptosis.html (Accessed Nov, 2014).
- Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC.
- Ezekian B, Englum BR, Gilmore BF, Kim J, Leraas HJ, Rice HE. Onychocryptosis in the Pediatric Patient. Clin Pediatr (Phila). 2017 Feb;56(2):109-114
- Freiberg A, Dougherty S. A review of management of ingrown toenails and onychogryphosis. Can Fam Physician. 1988 Dec;34:2675-81
- Gera SK,PG Zaini DKH,Wang S,Abdul Rahaman SHB,Chia RF,Lim KBL, Ingrowing toenails in children and adolescents: is nail avulsion superior to nonoperative treatment? Singapore medical journal. 2019 Feb ;60(2):94-96
- Gohil K. Nail Surgery Guidelines. College of Podiatry V2. 2019 Mar 2, p. 3-54.
- Güler O, Mahirogulları M, Mutlu S, Çerçi H, Seker A, Mutlu H. An evaluation of partial matrix excision with Winograd method for the surgical treatment of ingrown toenails. JAREM 2014;4:7–11.
- Haneke E, Controversies in the treatment of ingrown nails. Dermatology research and practice. 2012. PMID: 22675345
- Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician 2009; 79:303-8.
- Interventions for ingrowing toenails. Cochrane Database Syst Rev 2012;4:CD001541.
- Iorizzo M. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin. 2015; 33(2): 175-183
- Kayalar M, Bal E, Toros T, Özaksar K, Gürbüz Y, Ademoglu Y. Results of partial matrixectomy for chronic ingrown toenail. Foot Ankle Int, 2011; 32:888–95.
- Khunger N and Kandhari R. Ingrown toenail. IJDVL: Symposium nails part II. 2012; 78 (3) : 279-289.
- Khunger N,Kandhari R, Ingrown toenails. Indian journal of dermatology, venereology and leprology. 2012 May-Jun. PMID: 22565427
- Kose O, Celiktas M, Kisin B, Ozyurek S, Yigit S. Is there a relationship between forefoot alignment and ingrown toenail? A case-control study. Foot Ankle Spec. 2011 Feb;4(1):14-7.
- Langford DT, Burke C, Robertson K. Risk factors in onychocryptosis. Br J Surg. 1989 Jan;76(1):45-8.
- Park DH, Singh D. The management of ingrowing toenails. 2012 Apr 03; 344: e2089.
- Richert B, Andre J. Nail disorders in children: diagnosis and management. Am J Clin Dermatol 2011; 12:101–12.
- Richert B. Surgical management of ingrown toenails – an update overdue. Dermatol Ther 2012; 25:498–509.
- Romero-Pérez D, Betlloch-Mas I, Encabo-Durán B. Onychocryptosis: a long-term retrospective and comparative follow-up study of surgical and phenol chemical matricectomy in 520 procedures. J. Dermatol. 2017 Feb;56(2):221-224.
- Royal Australian College of General Practitioners, eds. Ingrown toenails. Am Fam Phys. 2015 Jul; 44 (7) : 438
- Royal Australian College of General Practitioners. Partial nail avulsion and chemical matricectomy: ingrown toenails. 1st [Internet] 2016 Aug [cited 2020 Jan 20].
- Schulte KW, Neumann NJ, Ruzicka T. Surgical pearl: nail splinting by flexible tube–a new noninvasive treatment for ingrown toenails. J Am Acad Dermatol 1998;39:629–3
- Vaccari S, Dika E, Balestri R, Rech G, Piraccini BM, Fanti PA. Partial excision of matrix and phenolic ablation for the treatment of ingrowing toenail: A 36-month follow-up of 197 treated patients. Dermatol Surg 2010;36:1288–93.
- Watabe A, Yamasaki K, Hashimoto A, Aiba S. Retrospective evaluation of conservative treatment for 140 ingrown toenails with a novel taping procedure. Acta Derm. Venereol. 2015 Sep; 95 (7) : 822-5.
