What is it?
Your toenail can cause trouble in two main ways. First, it can make the skin fold at the side and become very swollen and red (ingrowing toenail). Second, it can become very thick, curved and painful. Both these conditions can be treated by an operation.
The toe is made numb with an injection of local anaesthetic into its base. Then, for an ingrowing toenail, a sliver of the nail and of the nail bed is cut out on each side that is tender and swollen. The nail is then always a little narrower.
The skin fold settles down. For a thick curved nail, the whole nail and all the nail bed are cut out so that instead of a nail there is just skin.
You should be able to go home within one hour of the operation.
If you leave things as they are the trouble with your toenail will stay about the same. Antibiotics can be helpful, especially when the area that is swollen and painful is infected. However, if you don’t have any other treatment, the infection might very well come back . Taking off the nail and letting it re-grow does not give good results. Killing the nail bed with Phenol is sometimes used. Taking away the whole nail bed is needed only if the whole nail is diseased.
Before the operation
Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests, to make sure that you are well prepared and that you can have the operation as safely as possible. . Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. For the operation, you will be lying on an operating table. The anaesthetic injection will be given into your toe. This is uncomfortable, but the feeling soon wears off. Your toe will be cleaned with antiseptic, and sterile towels will be draped around it. A tight band will be clipped around your toe to prevent bleeding. The operation is performed. This takes about 15 minutes per toe. The toe is covered with a dressing and a bandage to apply gentle pressure on the wound and to prevent any bleeding
After - In Hospital
There is no feeling in the toe for an hour or so. After this you may need painkillers such as paracetamol, to control any pain. This gradually improves after a day or so. You should be able to eat and drink normally. The wound has a dressing which should not be removed for one week. You will need shoes with a large area for your toes to accommodate the bandages, or shoes with no toes. Keep the dressing dry and as clean as possible. There may be stitches in the skin. Wash around the dressing to avoid wetting it. Some hospitals arrange a check-up about two weeks after you leave hospital. Others leave check-ups to the General Practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
You will be uncomfortable for a day or two and will be a little hampered by the dressings and the tender toe. You can drive as soon as it its comfortable to do so. You should be able to return to a light job within 24 hours and a heavy job within three weeks.
Complications are rare and seldom serious. If you think that all is not well, ask the nurses or doctors. Bleeding in the first 12 hours may be troublesome. Apply pressure with a bandage on the toe wound and contact your doctor straight away. Pain in the toe that cannot be controlled with simple painkillers, or pain that is bad enough to keep you awake, means you should contact a doctor. The wound is tender and delicate for a week or so after the dressings are taken off. This rapidly gets better. There is also a very small chance of infection, which can be controlled by taking antibiotics for a few days. The chance of the nail trouble coming back is about 1 in 20.
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