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  • Mike Curtin

Ingrown toenails and nail surgery- The PNA.

It seems that just about everybody knows someone who gets bad ingrown toe nails. This condition known as onychocryptosis for the technical among us is one which can have massive negative effects on our lifestyles. When we are in pain, we tend not to want to move around too much causing change in behaviour both in the activities and footwear that we choose. Interestingly, this condition is one which only affects the shod population. There are no cases of ingrown toenails in populations that do not wear shoes! So it is reasonable to assume that shoes and footwear in general are a major contributing factor to the ingrown nail.

So, we have identified that poor footwear choices can cause an ingrown nail putting pressure on it and forcing the nail to pierce the skin. What are some of the other causes of the condition? Poor cutting of nails, or nails cut too short can predispose a person to the condition. Trauma such as dropping something or stubbing a toe can force the condition with genetics definitely having a part to play. Finally there can be a bacterial infection in the area. On many occasions it is no single cause that creates the problem but rather a perfect storm of contributing factors leading to the pain.

Often, conservative treatment of the area will allow the condition to heal itself. This usually involves removal of the offending piece of nail from the toe. Once this piece of nail is removed, the wound that the bacteria have infected is able to close up and resolve sometimes with antibiotics from your GP. This is often the case with chronic ingrown toe nails in four out of five cases. The patient feels instant relief and a skilled podiatrist will be able to clear the area with minimal discomfort to the you. However sometimes, conservative treatment will not work due to the patient’s choices of footwear, the continual reoccurrence of the condition or participation in activities that put large amounts of pressure on the toes.

When this occurs, the patient is given a more permanent option. This generally involves nail surgery, commonly referred to as a PNA (partial nail avulsion). Many people seek this procedure so that they can continue their activities with minimal disruption. Young women, who want to wear fashion shoes, teenagers who are growing rapidly and playing lots of sport, older people who through a life time of walking have changed the shape of their nails through pressure are all examples of the kinds of people who are seeking a more permanent solution to their discomfort.

So what does a PNA involve? It is a procedure carried out in the podiatry clinic under local anaesthetic that permanently removes the portion of nail that causes problems. As you can see from these pictures, this is the same toe, immediately before and 3 weeks post-surgery.

The picture on the left shows an ingrown nail in full flight! The right side of the toe is inflamed with bulbous, red granulation tissue in the area. This granulation tissue is the body’s immune system desperately trying to heal the area but in this case it is failing dismally. The area is sore to touch and at this point the patient could no longer wear closed in shoes due to the pain. The picture on the right is the result 3 weeks after surgery. As you can see, although there is still much healing to occur, the granulation is gone and there is some dry skin and callus slowly being shed as the nail returns to normal.

So what is involved in a PNA?

You will generally have a pre-op visit a few days before and the surgery takes about an hour to complete. We do ask that you have someone to drive you home from the clinic but your podiatrist will give you all the information you need at the pre-op appointment.

After written consent is given, the toe receives 2 small injections to take any pain away. Once the patient can not feel any discomfort, a small sliver of nail is removed from the side of the nail that is infected and a chemical known as phenol is used to kill the cells responsible for growing the nail in that corner permanently. The rest of the nail is unharmed and will continue to grow normally. Once this is complete, the area is flushed and dressed and you are able to walk out of the clinic. The patient then visits the clinic within 24-72 hours after the procedure and then a follow up one week after that. The great thing about this procedure is that within 24 hours you can return to normal activity with little more than a band aid sized dressing on the toe. There are no stitches to remove and generally the area is pain free when the anesthetic wears off.

So, be in pain no more! There is a simple solution to your problem and I promise you, the anaesthetic needle is nothing compared to the pain and discomfort from an ingrown toe nail. Your podiatrist can get you back on the field or court, happily back into you heels or have you simply enjoying wearing shoes again.

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