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 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?
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i have had my ingrowing toes done and the nail has not gone passed my skin on my two big toes
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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 :(
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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
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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|
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i'v got a minor case of ingrowing toe nails. no where as near as bad as these, but im very worried, and sometimes the pain brings me to tears! iv been prescribed time and time again with pain killers and antibiotics, also a magnesium sulphate thing that i can dress my toe in, however it doesn't seem to hold the pain off for very long. Im desperate not to have my nail removed! As pain scares me really. Help !
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I had green toenails on three toes since I was a kid. Not fungal, just thick and ugly. The nails on my baby toes rectified themselves but the nail on my big toe never grew the full length of my toe. I used to sand it down with emery boards! Finally it got infected as it started growing into the side of my toe and I ended up going to a clinic in Corsica when on holidays. Doctor diagnosed ingrowing toenail and removed not only the side of the nail but a portion of my toe, like a piece of pie from the front of my toe. Turns out I had a bump on the toe which the nail was unable to grow over, once he had taken out a piece from the front, and pulled the skin together it smoothed out the bump. Now my toenail is (more or less) perfect. Just thought I'd share this as many doctors had seen me when I was a kid, and this was finally fixed at the age of 24! Might help someone.
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my toes like that :S it oozes green puss sometimes :\
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Like Elizabeth, I've had both toenails removed from my big toes. I had the nail taken out twice on one toe but it kept growing back ingrown so the third time they took it out by the roots. Then it happened on my other toe so they took that one out by the roots straight away. This all happened while I was a child. I'm 26 now and can't even remember what my toes looked like with their nails! I'd advise anyone who is holding back getting their toes looked at to just go ahead and do it. It's so much easier once they are gone. Plus it's a great conversation starter, "You know, I only have 8 toenails..."!!!
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I have had this surgery although I didn't get knocked out! I stubbed my toes and had been on antibiotic for about a year and had a good few attempts at trying to save the nails. Nail removal was the best option and the surgery was bareable so don't keep puting it off thinking it's going to be agony! The attemps to save the nails were sorer than the removal. When it's all healed I have been told I can put a false nail on so I can still wear my nice shoes!!
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