If you have ingrown toenails and this has been causing pain, swelling and infection for some time, then you may have decided to have a partial or full nail removal. The most common procedure we perform is the PNA w/matricectomy (or partial nail avulsion with phenol or laser matricectomy). While this procedure is relatively minor there are some things you and your foot specialist should know;
If you are pregnant in your 1st trimester, have ischaemia (very poor arterial blood flow in your lower limbs), have been diagnosed with RSD/CPRS (a chronic pain syndrome), or have allergies to local anaesthetics, then you should consider postponing the procedure and trying alternative treatment. In addition, if you have an infection at the site of injection, are under the age of 5, or have porphyria (a disorder which affects heme and the distribution of oxygen in the tissue), then you should also consider conservative (non-operative) treatment.
Your foot specialist should also tailor your procedure and recovery based on other considerations.
Your healing may be affected if you have diabetes, take steroids, have anaemia, leukaemia, autoimmune disorders, connective tissue disorders, kidney disease, liver disease or thalassaemia. The use of a toe tourniquet during the procedure may cause problems if you have Sickle cell anaemia, Raynaud’s or other connective tissue conditions. Healing could also be impaired if you are taking blood pressure medication such as ACE inhibitors, ARBs or have severe calcification of the blood vessels.
While there is little risk in using modern local anaesthetics for this procedure, your specialist should also be aware if you are taking beta blockers, anti convulsants, diuretics, MAOIs, procarbazine or benzodiazepines, or if you have kidney and liver disease. Also if you are under extreme anxiety, let your specialist know.
Conditions like MS and Parkinsons need to be taken into consideration also. Allergies to betadine, iodine, shell fish, chlorhexidine, latex, silver and bandages should also be discussed.
To assess the risk of infective endocarditis (or inflammation, of the inner tissue of the heart) your specialist should ask about your history of heart valve damage, prosthetic heart valves, and any history of rheumatic fever.
To assess the risk of post-op bleeding your specialist should also ask you about anticoagulant and antiplatelet medications, or haemophilia. Adjustments in your medication may be needed prior to the procedure. Also if you are having chemotherapy, treatment for AIDS/HIV or on medication for severe acne or psoriasis, your specialist should know. Other drug or tobacco use should also be candidly discussed.
All of this information should be collected in a medical history and consent for special procedure process. This will significantly increase your chances of a successful procedure. Evidence shows that following standard post-op regimes, this procedure is safe and effective in more than 95% of cases and results in resolution of your ingrown toenail problem.
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