Video
Voiceover:
20-year-old Elizabeth came to see Dr Pixie about her manky toenails.
Dr Pixie:
They’re a bit pongy, I’ll be honest.
Voiceover:
They’ve been sent to the Embarrassing Bodies laboratory for Professor Val to investigate further.
Professor Val:
Well, I did see something down the microscope, and I have seen a fungus, but not what I was expecting. This is an Alternaria, which is what you can get in the bathroom. It’s certainly not the fungus that would normally cause problems in nails, but this girl’s nails must be really bad.
Voiceover:
Elizabeth’s fungus-infected toenails require specialist care. Today she’s got an appointment with foot and ankle surgeon Mr Anthony Perera at the Spire Hospital in Cardiff.
Mr Perera:
Let’s have a look at this. Now you have got some, um, ingrown toenails on this side and this side, and here as well, which do leave you prone to having repeated infections.
Voiceover:
Ingrowing toenails occur when the nail cuts into the side of the skin. The cause is unknown, but cut your nails straight across, rather than short and low at the sides, and you’re less likely to develop them.
Mr Perera:
The problem is that the whole of your nail is affected, and so you may wish to consider having the nail taken off.
Elizabeth:
I just want them gone, I really hate them.
Voiceover:
If surgery is successful, Elizabeth’s toenails will never grow back. Although this operation is usually performed under a local anaesthetic, Elizabeth has opted to be put to sleep. First, Mr Perera makes a tourniquet, which reduces blood flow to the toe and ensures a relatively bloodless operation.
Mr Perera:
So to start off with, what I’m going to do is numb the toe so it’s nice and comfortable. And this is really important, it’ll keep her comfortable for a few hours as well, and so she won’t feel a thing. So the first thing we need to do is to take this nail off. So the way we do this is to curve, clip underneath the nail, and then we actually avulse the nail off. Now, you can see where the debris collects in the gutters on either side. I’m going to clean out those gutters and also take away the growing part of the nail bed, where the nail grows from. And that’s just this white line just beneath the nail fold, underneath here. I’m going to do that first of all by scraping out the germinal cells that sit there. Then I’m going to use some phenol to destroy them as well. Sometimes we just cut this area out, but it’s reasonably close to one of the tendons that uh, lifts the toe up. We just need to be a little bit cautious. So this is the phenol, and this is quite a noxious substance, and it’s designed to uh, destroy the germinal epithelium, this growing layer of, layer of cells, and I’ll keep this down in the corner a little bit, as you see that is a troublesome area.
Voiceover:
Then the toe is rinsed in a saline solution before being bandaged up.
Mr Perera:
This is just some petroleum covered gauze, and it just helps to uh, put a dressing on that doesn’t stick to that raw surface of the nail bed once we take this dressing off. And so she’ll just need to keep this elevated for the next hour or so, but she’ll be able to um, walk home. I’m just going to wrap it around her foot just to try and keep this on. She’ll need to have this dressing just kept on for a few days, and then she’ll just need to take some simple painkillers overnight.
Voiceover:
With one toe finished, the procedure is then repeated on the other foot.
Mr Perera:
Elizabeth’s surgery has gone really well today. Fortunately she hasn’t got any infections since the last time I saw her, so this was a fairly straightforward procedure, the nails came off very easily, and we’ve got a good clean out of the sides of the, the nail bed, been able to really scrape out the growing area of nail and then use the phenol to really try and cauterise this area—it’s a real double, double safety technique, just to make absolutely certain that uh, the nail doesn’t grow back. I’ve advised her to keep her feet elevated for the next few hours, she’s going to be driven home by her mum a little later on today, and she’ll be able to walk around the house quite comfortably. Over the next few days she’ll get increasingly comfortable, and when she has her next dressing change, it’ll be a much lighter dressing, and she’ll be able to hopefully return back into normal shoes and really start to get back into normal function.
Voiceover:
When 20-year-old Elizabeth got an infection in her toenails, she didn’t change her dressings for six months. It’s been five weeks since her surgery, and now she’s back to show Dr Pixie the results. But is it a case of deja vu?
Dr Pixie:
That dressing…stinks. How frequently have you been changing them?
Elizabeth:
Last week.
Dr Pixie:
Did you? We’re going to just take this one off…it does smell.
Elizabeth:
This one as well is still leaking, I don’t know what it is.
Dr Pixie:
It’s normal after you’ve had this procedure done to need to dress the toes, because they get a bit boggy and oozy, and that’s just part of the healing process. If you don’t look after them and you don’t dress them regularly and keep them clean, and also give them a bit of air time, get them out into the air and get them aerated, you’re going to get an infection.
Elizabeth:
Okay.
Dr Pixie:
You have to start looking at them and looking after them.
Elizabeth:
Now I’ve looked at them, I’ll be fine, I’ll be able to look at them again.
Dr Pixie:
They’re your toes.
Elizabeth:
I know.
Dr Pixie:
So you’re going to have to, you’re going to have to do it, ‘cause look at that, that’s not…that was on too long, so you should be changing them on a regular basis. Do you think you’ll be able to do that?
Elizabeth:
Yeah. I think now I’ve looked at them.
Dr Pixie:
So. Dressings please.
Elizabeth is particularly ashamed of the state of her toenails, so-much-so that she’s kept them hidden for 6 months. Dr Pixie diagnoses an ingrown toenail whilst tests on clippings also find fungal infection Alternaria. Elizabeth is soon whisked off to see foot and ankle surgeon Anthony Pinnera who suggests having the nails completely removed which Elizabeth quickly agrees to. Elizabeth undergoes treatment to remove both nails and clean out the infected areas. 5 weeks later Elizabeth returns to the clinic to discuss the results of the procedure. On examining Elizabeth’s toes, which are still healing, she notes that Elizabeth has not been changing the dressings frequently enough and that she really must if she doesn’t want the same symptoms to occur.
Patient Name: Elizabeth Patch
Condition: Ingrown toenails
Specialist: Mr Anthony Perera, Orthopaedic Foot & Ankle Surgeon
Hospital: Spire Cardiff Private Hospital
Length of operation: Approx 20 minute
Yes
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I had both my big toe nails removed years ago as they were very badly ingrowing. Everything went fine, but now im wondering if there's anyway I can have false nails fitted? The actual nail bed has shrunk quite a lot so that there is only a small space left to fit a nail to. Any suggestions of how I could get normal toe nails fitted?
I have had the sides of my toes packed and am in lots of pain. Does anyone know if this is normal?
I had both my big toe nails removed years ago as they were very badly ingrowing. Everything went fine, but now im wondering if there's anyway I can have false nails fitted? The actual nail bed has shrunk quite a lot so that there is only a small space left to fit a nail to. Any suggestions of how I could get normal toe nails fitted?
im 20 n iv nerver had a problem with my feet befor but i notice my big toe nails have both started to go black n i thought it might be because i drop things on my feet all the time but wen i canged my nail vanish the other day i also noticed my top layers of my nail is coming away at the bottom its bit hard to explain but dose anyone no wot this might be?
hi i'm 24 years old and i have badly infected toe nails on both feet especially the 1st three toes they are black and thick i've had it since my teens. I've tried curanail and clearzel and it doesn't work at all. I hate being the 1 person that still wears his socks on the beach while with my friends its just embrassing. I'm running out of options
Is there a podiatrist in the london area?
i was just wondering if you could tell me how to treat onycholysis for a nine year old girl she has it for at least 2 months and it is really badly infected she has been to the doctor and they have giving her 2 courses of antibotic but this hasnt worked are they any thing else i can try?
see a podiatrist.
My podiatrist assistant had my sister and i start using Vaseline, it works, but you have to be vigilant and use it every day, you will see the difference in about 3 days to one week. I does work!!
Hi, I have been suffering from nail fungus for about 13 years, all of my 20s....I have tried everthing and nothing works. I've had enough and am gong to just get the 4 toenails removed - backpacking beckons and I cant take it any longer. However i want to make sure I go to a good surgeon who will do it properly - can anyone recommend one in London please?
I have had fungal nail infection on both big toes and have had it for about 2 years! ive been to the doctors so many times and all they jkeep doing is try and give me more creams and tablets to try and kill the infection, after watching the video i want it done but worried about not having a toenail afterwards, does the nail grow back?
i have had my ingrowing toes done and the nail has not gone passed my skin on my two big toes
the choice would be yours ,if you want your nail to grow back in .The podiatrist normally uses phenol to kill the nail bed .However you could choose to let the nail grow back in but there is no guarante that the nail would grow back in normally
I have a fungal nail infection its flaky and discoloured and i had it since i was 15 (25 now). The doctor gave me creams that dont work... i dont know what to do :(
just had me nail removed yesterday under a local anesthetic. Didn't feel a thing, it got quite uncomfortable later on as the anesthetic wore off today it's still a little painful but not any worse than having the ingrown toenail
I've also had a nail infection which has been diagnosed as fungal for many years. I have rheumatoid arthritis also. Gels and creams have been suggested in the past, but the infection still persists. Tablets were not thought to be a good idea. I have recently seen that laser treatment is available for infections such as these. However, the above cases seemed to have been treated differently. Which is the best route to take - I would love to be rid of this infection finally :o|