Your nail surgery appointment

Your podiatrist has looked at your problem toenail and discussed with you what can be done to help. You have agreed that nail surgery to remove all or part of the toenail is the best way to solve your nail condition. This leaflet provides information about what to expect on the day of surgery.

What you need to do before your surgery

• Please remove all traces of Nail Varnish.
• Arrange transport to and from your appointment as your toe will be numb and you should not drive.
• Bring a sandal, flip flop or open toed shoe that will have room for a large dressing.
• Have something to eat, you do not need to fast as you are not having a general anaesthetic.
• Plan a restful day at home with your feet up.
• Have some paracetamol (not aspirin) at home in case you need it after the surgery.
• Please weigh yourself and note your weight here:

Weight in Kg: ……………………………………..

or

Weight in Stones/lbs:……………………………….

• PLEASE BRING THIS BOOKLET TO YOUR APPOINTMENT

On the day of surgery

• Please arrive on time for your appointment and bring this booklet with you.
• Before your surgery the podiatrist will go over everything with you and ask you to sign a consent form.
• NOTE: If you are under 16 years of age you will need a parent or legal guardian to accompany you to the appointment.
• The whole nail surgery appointment should last no more than 60 minutes.

The surgery

• You will be given an injection of local anaesthetic to each side of the base of your toe to make the toe go numb.
• A tourniquet will be applied to stop any bleeding during the procedure.
• When you and the podiatrist are happy that the toe is numb, the problem nail or side of nail will be removed.
• A strong chemical (Phenol) is applied to the nail bed. In most cases this should stop the problem pieces of nail from growing back again.
• A large dressing will be applied to your toe but you will be able to walk normally in a sandal, flip flop or open toed shoe.
• You will be sent home with advice to REST that day.

What to expect after the nail surgery

• Your toe will be numb for one to two hours after the surgery, so be careful not to knock it.
• Do not drive while your toe is numb.
• Ensure your footwear does not cause pressure on the dressing.
• If there is pain, throbbing or discomfort as the anaesthetic wears off, take the recommended dose of a paracetamol-based pain killer, as you would for a headache.
• You will need to keep the dressing on and keep it dry.
• Plan to ‘put your feet up’ and rest for the remainder of the day.
• Avoid smoking or drinking alcohol.
• If there is further bleeding or oozing through the dressing add extra gauze to the outside of the dressing and raise your leg.
• Eat and drink as normal.
• In most cases you should be able to go back to work or school the next day.

Redressing instructions

You will need to change your own dressings 1 to 2 days following nail surgery (if there is no bleeding through the dressing, wait until day 2), as per redressing instructions below.

Follow this redressing process every other day until the wound(s) are dry and have fully healed:

• Carefully remove the old dressing. Take time to soak off any ‘stuck-on’ dressing in a warm saltwater footbath if needed.
• Bathe/cleanse your foot for up to 5 minutes in lukewarm salty water and allow to dry fully. Please try not to touch the wound as this could lead to it becoming infected.
• If more than one foot has had surgery, use fresh water for each foot.
• Apply the dressing to the toe(s) as you have been shown by the Podiatrist.
• We will supply you with enough dressings to last two weeks. After this you will need to obtain further dressings from a pharmacy.

Long-term advice

• Avoid swimming and reduce strenuous sporting activities until the toe is healed/ dry.
• When bathing/ showering for the first few weeks, it is best to try and keep the toe(s) dry to reduce the risk of infection – using a waterproof limb/foot dressing protector may be helpful. After your bath/ shower, remove the old dressing and cleanse and redress your toe(s).
• Sometimes the toe will look like it is getting worse before it starts to get better.
• Often it can look infected because it can get red and weep. This is normal – and simply a reaction to the ‘chemical burn’ from the Phenol used to prevent nail regrowth. This may be at its worst around weeks 1-3
• It is normal for the wound to take 6 to 8 weeks to stop weeping and heal up. If you have had the whole nail totally removed it can take 10 to 12 weeks to stop weeping and heal up.
• If the toe(s) get VERY red, swollen and painful the wound may have become infected and you may require a prescription of antibiotics from your GP. Please seek medical advice.
• If you are concerned about your toe(s) please contact your clinic – ideally via email to podiatry@oxfordhealth.nhs.uk attaching a photo of the toe(s) and detailing which podiatry clinic you attended and include your name and NHS number. A clinician will review your concerns and contact you to provide further advice.

Follow-up appointments

The following appointments have been made to review your toe. Most patients will be DISCHARGED from the service following the review appointment.