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Ingrown Toenail Surgery:  The Truth About What To Expect

In a visit to my podiatrist I asked if we could do anything about my toenails which grow straight down on the sides and were quite painful.  I’m pretty sure his response was something like “Sure, we’ll just cut here and here and kill the root.  No big deal.  It will look just like a normal nail afterward.”  Um, okay?

Thankfully, I found another treatment option that was right for me before submitting to the scalpel.  Not that I think ingrown toenail surgery is a bad option, just not the right one for me.  (As superficial as it sounds, how my toenails look is important to me and there WAS another viable option.)  That being said, sometimes surgery is the answer but you should make that decision with more education than my podiatrist offered.

Partial Avulsion, Wedge Resection, or Ablation?

Researching the surgeries available can be daunting and confusing.  Online resources make it sound like there are many different surgeries when, in fact, there are only a few variations of the same surgery performed in the U.S.

Whether your doctor says partial avulsion, wedge resection, or ablation, he is talking about the same thing.  Avulsion simply means “a tearing away” or “a part torn off”.  Similarly, ablation means the removal by mechanical methods such as surgery.  So partial or full avulsion/ablation is just the removal of part or all of the toenail.  A wedge resection is essentially the same as partial avulsion.

A partial avulsion is preferred to full removal of the nail as full removal of the nail leaves the toe especially susceptible to injury. Most podiatrists will only perform a full toenail avulsion when other options have been exhausted.

The Procedure

The surgery for ingrown toenails is an outpatient surgery usually taking less than an hour.  If infection is present, the doctor may either prescribe antibiotics to clear the infection before surgery or choose to drain the infection during surgery.  Prior to the surgery, the doctor will inject a local anesthetic at the base of the toenail and then tourniquet the toe to limit blood loss.  The surgeon will separate the portion of nail that is to be removed from the toe by sliding an instrument underneath the nail.  Clippers will be used to cut the nail before the now detached part of the nail is pulled from the toe.

After surgery, a compression bandage is placed around the toe to reduce bleeding.  Your doctor will instruct you on follow up care at home.  This may include soaking the foot in water with Epsom salt or antibiotic and/or applying antibiotic ointment when changing the bandages.

Phenolisation

After a standard partial or full nail avulsion, the nail will regrow.  In many patients this will mean a recurrence of the ingrown toenail.  Because of high rates of recurrence, your podiatrist may recommend making the removal permanent by applying a chemical (usually phenol) to the “root” or nail matrix during surgery.  This process has a very high success rate in preventing regrowth of the nail and greater reports of patient satisfaction.

See An Ingrown Toenail Surgery

(I picked the least bloody yet complete video I could find for you.)  :)