At Foot Focus Podiatry we can offer all treatment options for your ingrowing nail. If an ingrown nail has occurred, all measures will be taken to treat it conservatively by one of our expert podiatrists. Nail surgery is an option should conservative measures not provide adequate relief. Either one of our podiatrist our Reza Naraghi, a podiatric surgeon who attends Foot Focus, can perform nail surgery. You may be required to take a course of antibiotics prior to procedure and or post procedure when evaluated by our podiatric surgeon. Most ingrown nail procedures are done in office with the use of local anaesthetic with or without sedation. The following are the most common procedures that may be performed in our rooms and or in hospital.
- Matrixectomy with phenolization – This procedure involves removing the nail partially or totally and ablating (destroying) the root using a weak acid called phenol. This will cause permanent ablation of the root of the offending nail and prevent ingrown nail recurrence. This procedure is successful 95% of the time. The procedure takes about 10-15 minutes and can be performed in our rooms using local anaesthesia with or without sedation. Post operatively you will be required to soak your toe and apply a daily dressing. Wearing open toe shoes for at least 3-4 days is recommended. You maybe required to take oral antibiotics. Most patients do not require pain medication following the procedure, and if needed Panadol is sufficient for pain management. You can go back to regular shoes after one week.
- Winograd procedure- This procedure will be done in hospital setting under local and or general anaesthesia and it is reserved upon failure of the phenolization or if there is significant amount of skin overlapping the nail with soft tissue growth. This procedure involves removing a portion of the skin along with the nail down to the level of the root. Sutures (stitches) will be applied to close the surgical site. The procedure takes about 10-15 minutes to be performed and your foot will be bandaged. You will be seen within first 5 days and then the sutures will be removed in 10-14 days. Currently this procedure can only be performed by Reza Naraghi (podiatric surgeon). He will prescribe appropriate pain medication for your post-operative pain management. You will be in open sandal and or post op shoe for 2 weeks.
- Zadik Procedure- This procedure is used with permanent total nail removal is desired. The indications for the procedure are significant ingrowing nail on both borders, thickened and painful nails and bony growth under the nailbed. This procedure can be done under local with sedation and or under general anaesthesia at a hospital and or day surgery centre. Sutures will be applied and will be removed 14 days post surgery. You can not get your foot wet and your foot will be in a sterile bandage for 2-3 weeks. You may need pain medication post surgery. On average it will take six weeks for your nail bed area to heal. Following that you can wear most close shoes.
With all of the procedures above you are not to drive any machinery for 24-48 hours. You may drive after 24 hours so long you are not taking any medication that can cause drowsiness and upon the advice of your surgeon.
Our Podiatric surgeon can discuss with you in your consultation the risks and benefits of each procedure. Possible complications of both procedures are infection, recurrence, delayed healing and possible need for additional surgery. Generally phenolizations are associated with no scarring and less pain post surgery comparing to winograd and is a preferred method to manage ingrown nails not responsive to conservative care. A study done by Herold et al in 2001 on 110 ingrown nails that were randomized to 55 phenolization and 55 wedge resections or winograd, the recurrence rate for phenolization was 0% vs 5.5% for wedge resection and the phenolization group did better with pain and were more satisfied post surgery. If you would like to see images of the surgical process click here. Dr Naraghi can discuss both options and advise you on the outcome of each procedure during your consultations.