You have been directed to this section of the website because you have a problem with one or more of your toenails.
Troublesome toenails can be due to poor nail cutting technique, an unusually shaped nail or damage to the nail or the surrounding skin. Toenails can become thickened due to a fungal infection or trauma. There may also be a problem with the bone beneath the nail plate.
Symptoms of nail problems include a painful or swollen toe or soreness between the toenail and the surrounding skin, which can become infected. If there is a problem with the bone beneath the nail, the shape of the nail may change.


Nail Surgery London UK
Nail Surgery London UK

The diagnosis is made from an examination of your toe. If Mr McCallum suspects that there is a problem with the bone beneath the nail then he will arrange for an x-ray to be taken of your toe.

LEFT: In-growing toenail with a low-grade infection.
MIDDLE: An involuted nail showing no sign of infection.
RIGHT: An x-ray showing an exostosis growing from the distal phalanx of the 1st toe.

Treatment Options:

Conservative Management
• Routine nail care
• Antibiotics

Surgical Management
In-Growing Toe Nails:
• Incisional Nail Surgery

nail repair London uk
Nails Surgery

This technique is useful when there is extra flesh around the edge of the nail or if the surgery has been done before and failed.

• Total Nail Avulsion with Phenolisation
The nail plate is removed without a skin incision and a chemical called phenol is applied to the nail matrix (the part of the toe where the nail grows from). This stops any new nail growing back where the phenol has been applied. The procedure can be performed without the use of phenol but the outcomes are unpredictable and the new nail that grows can become problematic.

Subungual Exostectomy

The approach for this surgery will depend on the size and location of the bony growth. There are two common techniques and Mr McCallum will advise which is most suitable in your case.
1. An incision is made on top of the toe. This is performed through an incision over either site of the nail (similar to the ‘incisional nail surgery’ diagram above) or alternatively, the nail will be removed so that an incision can be made through the center of the nail bed. This can result in unavoidable damage to the nail and may result in uneven or abnormal nail growth thereafter.
2. An incision is made over the end of the toe. This approach allows access to the exostosis but can cause damage to the nail plate and nail bed with temporary loss of the nail.


Protocol for incisional nail surgery/Subungual Exostectomy
A protective shoe will be put onto your foot before you leave the hospital. This is removable and can be taken off when resting. Crutches are not necessary.
You should travel home by car and keep your foot elevated on the back seat where possible. When you go home, you must rest with the leg elevated for the first 2-4 days (essential walking only). It is important that you do not interfere with the dressings and that you keep them dry. You can buy a purpose made waterproof device from the chemist if you wish.
Mr McCallum will review you within one week of your operation for a change of dressing and at the 2-week mark, the dressings will be removed and the sutures will be removed. You can now wash your foot as normal and return to a comfortable shoe and normal activities. A final follow up may be made at the 6-week mark to ensure that all is well.

Protocol for nail surgery with phenolisation

A protective shoe will be put onto your foot before you leave the hospital. This is removable and can be taken off when resting. Crutches are not necessary.
You should travel home by car and keep your foot elevated on the back seat where possible. Excessive bleeding can result in the phenol being less effective.
Mr McCallum will review you within one week of the surgery although after 24hours, you should remove the dressing and commence salt-water footbaths. You should boil a kettle of water and pour into a clean bowl/basin. Add plenty of regular table salt and wait for the water to cool then submerge your foot in the salt water for approximately 10minutes. After this, pat the toe dry and apply a simple plaster. This should be repeated until the wound bed has dried out. It is important to remember that phenol is a chemical and it causes a burn. This will result in the wound “oozing”. This is normal and not a sign of infection. It can take up to 6 weeks for the wound to completely dry out. Mr McCallum will review you at the 6-week mark to ensure that you are progressing as expected.

Possible Complications:

Outlined below are the possible problems or the rare complications with serious outcomes. In cases where there are no accurate audit results, published results from podiatric literature have been used.
• Prolonged swelling taking more than 6-months to resolve can occur in 1 in 500 operations.
• Haematoma- a painful collection of blood under the skin. This can increase the risk of developing an infection and may require further surgery to resolve.
• Thick or sensitive scar.
• Adverse reaction to the post-operative painkillers. 1 in 50 patents report that codeine preparations make them feel sick.
• Infection of the soft tissue. 1 in every 83 operations.
• Infection of bone- osteomyelitis. This is a serious complication and in severe cases, can lead to amputation.
• Delayed healing of soft tissue or bone.
• Circulatory impairment with loss of tissue.
• Loss of sensation can occur although this is not normally permanent and can continue to improve over 18-months.
• Deep vein thrombosis (blood clot) can result in the clot travelling to the lung and this can be a life threatening condition. Deep vein thrombosis incidence is 3 in 1000 cases.
• Complex pain syndrome- a condition where the nervous system dealing with pain over reacts. This is a very painful condition that can result with even with minor trauma. It normally requires management by specialists in this condition and does not always resolve. This is a rare condition that occurs in 3 in 2500 cases.
• Recurrence of deformity or failure of the surgery.
>The risk of developing a complication can be minimised when the patient and all those concerned with the operation and aftercare work together. This starts with the pre-operative screening and continues through to the post-operative regime.
The pre-operative screening helps us determine whether you are fit for surgery or if any extra measures need to be considered to minimise your risk of developing a complication. It is important that you disclose your full medical history. If there is a query regarding your health then further investigations may be required and Mr McCallum will liaise with the appropriate medical specialists. Mr McCallum and the there team will ensure that your operation is carried out safely and effectively.You can improve your healing process and reduce the risks by:
• Adhering to the post-operative instructions, which include resting and elevating the operated foot. Keeping the wound dry and clean until advised otherwise. Please ask Mr McCallum if you are not sure what to do.
• Having a healthy diet is important; this provides the nutrition required for healing.
• Alcohol can interact with the drugs that are prescribed and can impair wound healing.
• Post-operative mobilisation will be advised; this helps improve flexibility, strength and stability of your foot.