you normally take for pain relief (not
asprin) you may feel some discomfort
at the injection site due to bruising.
• Wear open toed shoes or no shoes
(except if you have diabetes) at home
to keep the pressure off the site.
• After the procedure the dressing
should be kept clean and dry and
left in place until the first follow-up
appointment
• You may be asked to return for
regular re-dressing appointments at
the discretion of your clinician who
will advise you.
• After the first re-dressing you
may initially be given dressings to
use at home but you will need to
obtain further dressings either on
prescriptions or over the counter
• As phenol has been used in the
procedure, the toe may appear red
and inflamed at the base, a discharge
is normal. This may be mistaken
for infection – please discuss these
changes with the podiatrist if you are
concerned.
Other information
You should not undergo any other
procedure within 24 hours which
requires a local anaesthetic e.G. Dental
extraction.
Patients under 16 should be
accompanied by a parent/guardian on
the day of procedure.
On the day of surgery to reduce the
effects of the anaesthetic following
surgery drink plenty of fluids avoiding
alcohol and caffeine
What if you are unable to attend
If this appointment is inconvenient and you are unable to attend,
please contact the podiatry department on:
Patient Information
NAIL SURGERY
www.hacw.nhs.uk
What does the nail
surgery entail?
Nail surgery (or nail avulsion)
involves the removal of a small
section of a nail - partial nail
avulsion (pna) or the whole nail
(total nail avulsion (tna), under
local anaesthetic, in order to
relieve the pressure on the toe.
The nail is prevented from growing
again by the use of phenol which
destroys a small section of the nail
bed.
Advantages of toenail
avulsion
• Reduction in symptoms.
• Reduced risk of toe infection
once healed
• Whilst it cannot be fully
guaranteed that you will never
have further problems with the
toe, it is highly likely that your
toe will be much improved.
Risks and possible
complications
Every effort is made to minimise
the risk of complications which are
rare, however some specific ones
include:
• Delayed healing/prolonged
weeping – during the healing
process, it is normal for the nail
to appear inflamed to discharge
and may take approximately 4 –
6 weeks to completely heal.
• Infection may develop during the
post-operative healing period.
• If at any time following nail
surgery your toe or foot is
excessively warm, swollen or red,
contact the podiatry clinic. If out
of normal working hours contact
your gp or primary care centre.
• Re-growth of the nail occurs
in less than 1% of patients
undergoing a partial nail avulsion
or a total nail avulsion (cochrane
2005). The re-growth is often less
troublesome than the original
problem but it may necessitate
repeating the nail surgery.
• Anaphylaxis is a risk, although
it is extremely rare. It is a
hypersensitivity (allergic) reaction
which can be caused by a trigger
such as local anaesthetic
• The first dressing will be bulky
and will not fit into ordinary
shoes, so please bring an opentoed sandal, or a slipper cut away
around the toes.
What preperation is
needed on the day of
procedure?
What will happen during the
procedure?
• On arrival you will be taken into
the clinic. Bring a friend/relative
with you into clinic if you wish.
• Please inform us if there are any
changes in your health, medical
history or medication.
• Your foot will be prepared and
cleansed and the anaesthetic
administered into the base of the
toe. This may cause some brief
stinging or discomfort. Once the
toe is anaesthetised, a band will
be placed around the toe and
procedure performed. Sterile
Please wash your foot/feet in warm
water on the morning of your
appointment. Remove any nail
polish.
• Eat your normal meal, e.G.
Breakfast, before attending clinic
• As you are going to have a local
anaesthetic, you will be unable
to drive home, so will need to
arrange a lift or book a taxi.
What if you are diabetic?
No special preparation is necessary.
Eat your normal diet and take your
medication as usual.
What information do we need
from you?
• Please inform the podiatrist
of any change in your general
health or medication since your
last appointment and bring a list
of the current medication you are
taking.
• An assessment will already
have been made at your initial
appointment, and you will be
requested to sign a consent form
for the local anaesthetic.
dressings will be placed on the
toe and you will be able to leave
as soon as you feel ready.
• Your appointment for nail
surgery will take approximately
one hour
What happens after the
nail surgery?
• Do not drive immediately after the
procedure and check your motor
insurance policy as regards to driving
following surgical procedure/local
anaesthetic
• Keep your foot elevated while you
are waiting to go home by putting
your foot up on a chair.
• You are advised to go straight home
and rest and elevate the foot (to hip
level) for the remainder of that day.
This will help to reduce the postoperative bleeding. Make sure you
flex and stretch your legs to keep the
circulation flowing.
• Limit walking and standing until
the next day and then keep this to
a minimum on the day following
surgery.
• Keep the dressing clean dry and in
place to reduce the risk of infection.
• A small amount of bleeding is
normal and may come through the
bandage. If this occurs leave the
dressing in place and cover with the
additional sterile gauze that you
were given and elevate the foot to
reduce bleeding.
• The local anaesthetic will take
between 2 and 4 hours to wear off.
• Once the anaesthetic wears off,
there may be some discomfort in
which case you should take whatever