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Ingrown Toenail Surgery

The Ingrown Toenail Clinic is a speciality clinic operated by Mint Foot Care Podiatry Clinic. This clinic specialises in scheduled medicines (prescription medicines only if necessary) that can be combined with our ingrown toenail surgeries to provide a safer and pain-free experience.

This clinic was developed due to our patient’s basic needs not being met with current podiatry practices for analgesia, antibiotic coverage, anxiety and needle phobia as well as pain management. In 2019, founder Katrina Taylor decided to gain her speciality in endorsement for scheduled medicines to offer this unique service in Wynnum and surrounding areas.

Our podiatrist Dr Katrina Taylor has 19 years of experience and a wealth of knowledge in performing ingrown toenail surgeries, one of her main interests of podiatric medicine. With her endorsement for scheduled medicines, she can prescribe and supply medicines for foot conditions such as antibiotics for infections, analgesics for pain management, benzodiazepines for anxiety and inhalational anaesthetics for anxiety and needle phobia, pain and sedation where required.

Types of Surgery

If you’re suffering from chronic or recurring cases of ingrown toenails, our podiatrist can carefully assess your ingrown toenails and perform surgery to resolve it. An initial consultation is required prior to ALL surgeries to assess if you are a candidate for surgery, if antibiotics are required prior to surgical intervention and if sedation with lorazepam and methoxyflurane is required.

We perform partial nail wedge resections or total nail avulsions with phenolisation under local anaesthetic in our clinic. The offending piece or entire nail is removed painlessly after administration of a local anaesthetic. The nail matrix (root) is chemically cauterised (burnt) using a chemical called Phenol. This will stop the nail from growing back permanently. A dressing will be applied. You will be supplied with:

  • Additional dressings for one week. Extra dressings can be purchased from the clinic
  • A written antibiotic prescription (if required)
  • A written pain medication prescription (if required)
  • Aftercare instructions

Anxiety and Needle Phobia

Injections are never pleasant. Being conscious during a surgical procedure can be an anxiety provoking experience particularly in young children.

Acute procedural anxiety is an excessive fear of medical or surgical procedures that results in acute distress or interference with completing necessary procedures. Patients may experience anxiety in anticipation of painful procedures such as injections or surgery. Avoidance of clinical procedures due to acute procedural anxiety can have a negative impact on health . Anxiety has been shown to reduce pain tolerance, increase pain sensitivity which can exacerbate pain perception in a clinical setting. leading to an increase in heart rate, blood pressure, and cardiac excitability.

Pre-procedural sedation and analgesia is used to:

  • Reduce the patient’s fear, anxiety and distress.
  • Minimise physical discomfort and pain.
  • Minimise psychological trauma.
  • Pose minimal threat to the patient’s safety.
  • Allow the procedure to be completed safely, reliably and effectively.

We can prescribe a premedication, Lorazepam a benzodiazepine and methoxyflurane (Penthrox) which is given during the procedure that both reduce anxiety (anxiolytics). Methoxyflurane also provides analgesia to improve pain tolerance of patients. We can also apply topical anaesthetics to the skin for numbing prior to injections.

Pain Free

At Mint Foot Care we employ various methods to reduce discomfort and pain for our ingrown toenail surgery procedures and other uncomfortable procedures. We can prescribe various medications (at an additional cost) and utilize various non-medication techniques such as:

  • Application of a topical anaesthetic usually 30 minutes prior to the procedure to numb the skin prior to injection.
  • Inhalation anaesthesia called methoxyflurane (Penthrox also known as “the green whistle”) given during the procedure.
  • Anti-anxiety medication, Lorazepam a benzodiazepine. Given one to two hours prior to the procedure.
  • We establish a trusting clinician-patient relationship. We explain to the patient why an indicated procedure is necessary, the steps of the procedure , potential outcomes, risks , what to expect after the procedure and allow the patient to ask questions and bring up concerns.
  • We provide patients with as much control as possible during the procedure. The patient may interrupt or end the procedure  if anxiety becomes intolerable, if it is safe to do so.

Procedure

The surgery takes up to one hour. You may eat prior to or after surgery. You must arrange for someone to drive you home such as a responsible adult, taxi or Uber.

  1. The surgery is performed in our clinic in a sterile environment.
  2. A topical anaesthetic cream can be applied to the toe for numbing 30 minutes prior to the injection. The toe is injected with local anaesthetic. The podiatrist will wait until the toe is fully numb until proceeding with the surgery. Another injection of local anaesthetic may be required.
  3. A tourniquet is applied to reduce blood flow to allow the podiatrist to work in a bloodless operative field. The nail edge is cut and split from the nail plate.
  4. The nail is removed from the root (nail matrix). The nail matrix is roughened with instruments and debris removed.
  5. Phenol acid is applied to the root to stop it from growing back. The area is flushed with sterile antiseptic.
  6. The tourniquet is removed, the toe is dressed with a thick sterile dressing and antiseptic.
  7. The toe will be wrapped with a thick bandaged. We recommend bringing open toed shoes such as sandals to the surgery. You can walk out of the clinic and do not require crutches or a wheelchair.
  8. The toe will be numb for a few hours post-surgery contributing to post-operative analgesia. Patients usually have minimal pain following the procedure. Post-operative analgesia can be prescribed such as non-steroidal anti-inflammatories (NSAIDs) and panadeine forte as well as antibiotics if required.

Post-Care

It is recommended to not wear footwear and limit weightbearing for a minimum of 48 hours. The wearing of open-toed shoes is advised for a minimum of 2 weeks. The patient will be required to perform daily foot soaks and dressing changes at home for a minimum of 30 days after the initial post-operative review.

Refrain from wearing tight-fitting shoes that places pressure on the toe which can impair healing and increases the chances of a post-operative infection. Vigorous physical activity (including the gym and weightlifting) must be avoided for four weeks after surgery.

Follow Up

The patient must return for a post-operative review within 24-48 hours following surgery. A total of three reviews are provided in the cost of the surgery at the podiatrist’s discretion. The healing time of surgical ingrown toenail treatment can vary from 4-6 weeks.

Risks

Nail surgery is considered quite safe but not without some complications.

  • Infection
  • Regrowth of nail
  • Pain
  • Swelling
  • Nerve damage

 

The risks of surgery will be discussed in more detail in the pre-operative consultation.

Additional Costs

Methoxyflurane, Lorazepam and topical anaesthetic are additional items not included in the surgery. Their requirement, benefits and risks including cost will be discussed in the initial consultation prior to surgery.

Medications

Antibiotics

Cephalexin | Mint Foot Care

Antibiotics may be prescribed prior to surgery if an infection is present. The prescription of antibiotics for post-surgery can be prescribed if there is an increased potential risk of infection at the surgical site or if there is a current infection present.

Lorazepam

Lorazepam | Mint Foot Care

Benzodiazepines enable patients with acute procedure anxiety to tolerate procedures by reducing anxiety and/or inducing sedation. All benzodiazepines have a similar mechanism of action and clinical effects include hypnotic, sedation, anxiolytic, and amnestic effects but offer no analgesic (pain) relief. At Mint Foot Care we can prescribe Lorazepam which is supplied to the patient in the clinic on the day of surgery one to two hours prior to surgery.

Methoxyflurane

Penthrox inhaler | Mint Foot Care

Methoxyflurane is an inhalational anaesthetic agent that provides profound analgesia and anxiolytic (reduces anxiety) effects at concentrations that do not cause unconsciousness. However, it does not provide full analgesia and you may still feel some slight pain. A topical anaesthetic can also be used in conjunction with methoxyflurane prior to injection.

It is self-administered by the patient under observation from the podiatrist using a the hand-held Penthrox Inhaler. Children less than 5 years may have difficulty self-administering the inhaler and may require assistance from the parent/guardian. Onset of pain relief and sedation will occur after 6-10 breaths. A small dose will give pain relief for a total of 20 to 30 minutes.

Non-Steroidal Anti-Inflammatories (NSAIDs)

NSAIDs are prescribed to manage pain and inflammation associated with surgery. They are usually prescribed in combination with paracetamol. NSAIDs can cause significant adverse effects and their use is contraindicated in some patients.

Panadeine Forte

A combination of paracetamol and codeine (Panadeine Forte) can be prescribed to manage patients with moderate to severe pain or patients who cannot be prescribed NSAIDs. Panadeine Forte can cause significant adverse effects and their use is contraindicated in some patients. It cannot be prescribed for children aged 12 years or less.

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