For more information on surgical techniques, please see American Podiatric Medical Association site, Scanner site, Foot Doctors.
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Nail Problems
Many nail problems can be improved by good chiropody and careful self-treatment. Nails that are very curved, hard, thickened and inflamed around the edges may require professional assistance.

When cutting toenails, do not try to shape them like a fingernail. This is likely to cause ongoing discomfort.

There is no evidence that cutting a V in the tip of the toenail relieves the pain of an ingrowing toenail.

Discolouration, crumbling or thickening of the nail may be signs of a fungal infection. Fungal nail infections usually need to be proved by laboratory investigations. The Clinic or your GP can arrange this. Sometimes a fungal infection can be mimicked by other conditions, such as psoriasis.

The area around the toenail becomes painful, swollen, discoloured (reddened) and infected, giving rise to a discharge. Amongst the causative factors are:-

1. Poor nail cutting.

2. Using un-sterile instruments.

3. Tight footwear.

4. Picking the nail and an abnormal walking pattern, usually pronation or flattening of the foot.

Wherever possible, the nail will be treated without surgery. If surgery is required, then the commonest method is a partial nail wedge resection with phenolisation.

Method

The toe is given a local anaesthetic.

The toe is cleaned.

The nail is split with two special instruments and a small section of nail removed from the affected sides.

A saturated solution of phenol (carbolic acid) is applied to the nail matrix, which is the area at the base of the nail section that has just been removed. Phenol is applied for up to three minutes and then flushed away. A tourniquet is applied to the toe for the whole of this operation.

The toe will be bandaged and a special cream, used in burns, applied to encourage healing.

This dressing is changed after three or four days and the patient usually continues these dressings themselves. Healing is normally complete in two to three weeks, but can take much longer. The whole process should be pain free.

Complications

Infection

Re-growth.

Delayed healing.

Total Nail Ablation

In a few cases, the nail may be so badly distorted or damaged that it requires complete removal (avulsion). This is essentially similar to the partial nail wedge resection, but may take longer to heal.

Sub-Ungual Exostosis

Occasionally, a small piece of bone or spur can grow beneath the nail plate. This is called an exostosis and it may be caused by:-

Injury

Chronic, but intermittent pressure from footwear.

A bone defect.

This can be removed in a simple operation and may be combined with corrective nail surgery.

Other Nail Procedures

In a few cases, it may be necessary to remove nail and the soft tissue around it using surgery only. The two usual methods are:-

The Zadick technique, where the whole of the nail may require removal permanently.

Where only a section of the nail and soft tissue requires removal, then the Winograd technique can be used. Both of these procedures often require stitching.

There is also a non-surgical treatment available at the Clinic called thermal correction of the nail. Here, excessively curved nails can be flattened using an instrument, which is essentially a nail plier that heats up. The procedure is painless and does not require local anaesthetic. It normally requires repeat treatment on a 6 month or yearly basis.