At Compleet Feet we are experts in nail surgery, having performed many an ingrowing toenail procedure. We recently had a University student who had one of the most chronic ingrowing toenails I had witnessed in a long time. It was over 6 months before he came to our clinic for treatment, having been failed by the NHS.
He had been prescribed numerous courses of antibiotics and eventually given appointments to seek a surgical solution which never transpired, that he was desperate and in a lot of discomfort when he eventually attended our clinic.
On examination the right big toenail was partially occluded from both sides by inflammed, infected ‘over-healing’ tissue called hypergranulation. No antibiotics in the world would ever treat this, but sadly GPs keep prescribing them, without referring the patient to a podiatrist. Once the nail begins to irritate the sulci (nail folds, cuticles), ingrows, the body responds by forming granulating tissue. This is very vascular and easily bleeds. Infection can also set in not to mention pain. The pain caused by an ingrowing toenail is acute. The big toe is heavily innervated with nerve endings. In Relexology is represents your head so no wonder it gives you a headache!
Unless the offending nail is removed the process of hypergranulation can continue, hence surgery is the only option. Our student was advised his big toe needed urgent attention with a bilateral partial nail avulsion procedure, and phenolisation being recommended. In simple terms this is to have both sides of the nail removed, and a chemical called phenol introduced into the exposed nail matrix ( where the nail grows from) to stop the sides growing back. We only phenolise to stop small sections of nail growing back if there have been or will be ongoing problems of the nail ingrowing.
The big toe is firstly anaesthetised at the base with 2 injections to block the nerve pathways to the nail. A torniquet is applied to stop bleeding, then the sides on the nail gently elevated for the relevant sections of nail to be easily cut off. The phenol is applied for a couple of minutes then neutralised by spirit. Hypergarnulating tissue is cut away if there is any. Sutures are not required. The toe is dressed with absorbant dressings and left intact for 4-5 days until the patient returns back to clinic for redressing. After the surgery the local aneasthetic wears off very quickly, but there is not unbearable pain. Patients are often really amazed how little pain there actually is.
We advise patients not to drive directly after surgery and to rest up and elevate the treated foot. The next day they can return to normal activity as long as they wear suitably roomy footwear and don’t stub the toe! Activities which potentially could involve traumatising the healing toe are not recommended, as this could prolong healing times. Healing times depend on how well the patients keep the toe clean, redress it, activity, health and how chronic the condition was to begin with. The application of phenol can add a week or 2 on healing times otherwise it is generally 2-4.
In the case of our student it took much longer than 4 weeks. The hypergranulation despite beginning partially excised would not shrink back. The body kept wanting to over-heal, so we had to intervene by using cryotherapy to shrink it. The application of liquid nitrogen cut off the blood supply, and the unwanted fleshy tissue literally shrunk and scabbed off. We are now delighted as he has a healthy pain free big toe, which will continue to impove as the treated nail plate grows forward. The offending sides will never return, but it seems like the left big toenail wants to get in on the act! If it does start being an issue the quicker we act the quicker the healing time, the quicker the required result.