Podiatry is a the treatment of disorders of the foot and ankle. It is the new name given to chiropody in 1993. Podiatrists are healthcare professionals. They have been trained to diagnose and treat abnormal conditions of the feet and lower limbs.
Podiatry includes the treatment of minor ailments, such as ingrown toenails. It can also include surgery to improve chronic conditions such as bunions or foot pain. It is used increasingly to help reduce complications associated with long term medical conditions. These medical conditions include diabetes, rheumatoid arthritis and heart disease.
14 universities in the UK and Republic of Ireland offering a full time Bachelor of Science Honours degree in Podiatry / Podiactric Medicine in the UK. The course takes 3 or 4 years to complete depending on where you choose to study. The degree course involves clinical work with patients, both in academic & placement environment.
Continued growth in the demand for medical and surgical care of the foot and ankle will stem from the aging population. Useful in helping to maintain mobility in the elderly, disabled or injured. Employment is projected to grow 6% from 2018 to 2028.
Heel pain can be very distressing and can stop you enjoying life or taking part in active pursuits. Here are some recommended at home tips from us and lets heal heel pain.
What can you do to help yourself
Footwear review/change – wear footwear that is suited for the activity you are doing and be mindful to choose footwear that supports the length, breadth and form of the foot. Footwear that has inbuild support under the arch is good and with fastenings that can be adjusted such as laces.
Icing the heel 3 times a day can be beneficial as an analgesic. Although most heel conditions are not due to inflammatory causes so icing is used as a therapy to reduce swelling.
Wearing an orthotic with a supportive heel cup and supportive heel cushion may be beneficial.
Simple stretching programmes – calf muscles and the big toe complex.
Taping the heel.
Modify activity to reduce load onto heel or change to non weight bearing activities – cycling/swimming.
Weight loss.
Not easing? Lets get professional help and lets heal heel pain.
A podiatrist is an expert in the lower limb, especially the foot and ankle. They are degree trained and can diagnose, treat and improve pain, form and function.
A podiatrist is to feet what a dentist is to teeth
What can a podiatrist do for heel pain
Podiatrists can clinically diagnose the structures involved with the heel pain, and if necessary facilitate further diagnostic tests.
They can build a treatment plan with patients which would typically involve taping, stretching and strengthening exercises, orthotics, shockwave therapy, steroid injection therapy, night splints.
Make Your Appointment Today
To book your appointment with Zest Podiatry & Physio book online, call us or contact us for further details.
Are you or someone you know suffering with heel pain? Scared to take that first step in the morning or has it stopped you from enjoying walking and sports.
If you have heel pain you are in the company of many people who have foot pain, accounting for many visits to healthcare professionals – including podiatrists, physios and GPs. It is the most common foot disorder encountered by podiatrists (college of podiatry).
Who gets heel pain
Young children can get heel pain especially those who are active and sporty. Adults who enjoy running and high impact sports can get heel pain. Adults whose occupations require them to be on their feet for long periods are susceptible. As we age, the soft tissue within the heel can degenerate leading to heel pain.
What is the structure within the heel that can be injured
The heel consists of bone (calcaneus) and soft tissue structures that attach to the bone including tendons, fascia, ligament.
The foot is a key structure for walking and running and whilst it is very well designed to withstand such load, it can suffer from over -use, overload or degeneration.
Causes of heel pain or injury
Degeneration of the soft tissue is the most common cause and in particular, Plantar heel Pain syndrome PHPS (commonly known as Plantar Fasciitis) especially amongst runners and those who stand for long periods at work.
Are you a runner?
PHPS is a degenerative condition rather than an inflammatory condition, and affects 10% of the population and 15% of all foot related complaints being seen by medical staff. 10% of all runners experience plantar pain and most common in those who run long distances.
Some of the common conditions include
PHPS
Baxter’s Nerve
Heel spur
Tarsal Tunnel Syndrome
Fat Pad Contusion
Distal Tear
Tibialis Posterior Dysfunction
How can we help
Treatment from a podiatrist will be tailor-made for each patient but likely to include advice, taping, stretching and strengthening exercises, orthotics, shockwave therapy, steroid injection therapy, night splints.
Make Your Appointment Today
To book your appointment with Zest Podiatry & Physio book online, call us or contact us for further details.
At Zest Podiatry & Physio we enjoy running and want to help you to start or continue running. We have decided to make 2021 a focus in the clinic for runners. You will find lots of useful information in online runners section.
1. Set yourself some running goals.
Setting your running goals is invaluable as they act an impetus to get started but also help to keep you motivated too.
Goals need to be part of a plan, as this allows you to break the challenge into manageable chunks, increasing your likelihood of success (and enjoyment!). Examples of a running plan include:
It is easy to have an initial boost of energy when taking up a new activity or during certain times of the year such as January. Below are a few ways to maintain your motivation, read How do I remain motivated?
Set yourself a goal, based on emotion
Make it a habit
Join a club
Keep a diary
3. Focus on your health benefits.
Health benefits of running include reducing your risk of heart disease and stroke, boosting self-esteem and reducing your risk of Alzheimer’s disease. It can help you to live longer and healthier. There are huge benefits on the mind, body and lifestyle, find out more at Health Benefits.
4. What will Run3D do for you?
Run3D helps you move better. It can reduce injuries, assist you to run faster and feel better with its 3D Gait analysis. Click here to see how it can help you Run3D.
Not started yet – thinking about running?
1. Why should you start running.
There are many reasons why you would choose running as your activity.
It is free.
Running can be done anywhere.
it burns more calories than any other mainstream exercise.
At Zest Podiatry & Physio we hall have a keen interested in running. We have decided to make 2021 a focus in the clinic for runners. Launched in January 2021 our new online runners section will continue to grow through the year. As of January we have the following information.
Online runners section includes:
1. Are you thinking about running?
There are many reasons why you would choose running as your activity.
Running can be done anywhere.
it burns more calories than any other mainstream exercise.
2. The health benefits from running in our online runners section.
Health benefits of running include reducing your risk of heart disease and stroke, boosting self-esteem and reducing your risk of Alzheimer’s disease. It can help you to live longer and healthier. There are huge benefits on the mind, body and lifestyle, find out more at Health Benefits.
3. Remaining motivated.
It is easy to have an initial boost of energy when taking up a new activity or during certain times of the year such as January. Below are a few ways to maintain your motivation, read How do I remain motivated?
Run3D helps you move better. It can reduce injuries, assist you to run faster and feel better with its 3D Gait analysis. Click here to see how it can help you Run3D.
6. Lastly in our online runners section is a first description of a local marathon
The first in our section on marathons is the Abingdon marathon, based in South Oxfordshire. The course is mainly flat, great for first-time marathoners, and those chasing personal bests. As a business supporter of this marathon we felt it appropriate to start here.
What is the difference between a podiatrist and a chiropodist?
Podiatrist versus chiropodist. Podiatry is the modern name for a Chiropodist, but with a few differences.
When did Podiatry become the new term?
Podiatry became the new term in 1993, in the UK. It was to ensure that the UK was in line with podiatry across the world.
What training do Podiatrists undergo?
All students training since 2005 have undertaken a 3 year BSc degree at university. Degree education has given podiatrists the skills to diagnose and treat conditions of the feet and lower limb. We are known as foot and ankle specialists.
Podiatrists are allowed to access, use and supply certain drugs. These include local anaesthetic, antibiotics and corticosteroids to broaden their treatment remit and skills.
Would you like a career in podiatry?
If you are interested in a career in podiatry, please check out a career in podiatry.
Podiatrist versus chiropodist
Chiropodist as a term is commonly used by the general public but less so be health professionals, we are podiatrists. Podiatry comes under the allied health professionals.
What is the scope of practice for a podiatrist?
The treatments that podiatrists offer range from nail cutting and nail surgery to sports injury through and injection therapy.
Training includes in depth knowledge of anatomy, physiology and the skills in treating conditions.
Podiatrists regularly use high tech kit to aid diagnosis and treatment. Such as ultrasound to see images of soft tissue and dermatoscopes to diagnose skin conditions.
Shockwave therapy is used for sports injury, microwave therapy for verrucae, 3D camera imaging for detailed gait analysis.
Extended scope of practice for podiatrists
Podiatrists can become further skilled in podiatric surgery, research and forensic science, to name a few. Specific masters degree courses are available.
Dentists treat the mouth and teeth. Podiatrists treat the foot and lower limb.
Where can podiatrists work?
Private practices see patients with all foot and ankle conditions.
Podiatrists work both in the NHS and in private practice to cater for all patients’ needs.
It is recommended by NICE the podiatrists manage footcare of long term conditions. These conditions include diabetes, peripheral arterial disease and rheumatoid arthritis should be available on the NHS.
As we write this piece we reflect on a first year that none of us could have predicted.
Victoria North & Brenda Rogers. Directors & Podiatrists.
We opened our doors in late September 2019 and welcomed lots of familiar, and new, faces to our new clinic. We were very proud of what we have achieved to get the new clinic open and we were delighted to receive such encouragement and loyalty from our patients.
After a flurry of excitement, an introduction to new staff and lots of new treatments, we were rudely interrupted by a global crisis. Along with the rest of the nation, we closed our doors on 23 March not knowing the next steps were and certainly not knowing how we would all fare.
For those of you who know Victoria and Brenda, will know that we are not good at sitting back and certainly not in a crisis. With our doors closed but skills aplenty we signed up to our local NHS to help in whatever way we could.
Victoria joined the NHS to help fill the gap with high risk podiatry patients in the community and Brenda worked in both the community hospital and a local dementia care home. Never has so much plastic been worn in such hot conditions but our struggles were few compared to so many others.
Covid19 is still a threat but we are so pleased to have been allowed to reopen our doors at the end of June. Those of you who have been in, know about our strict infection control guidelines and the new measures that we have had to put in place to keep everyone safe.
So forgive us that we no longer allow our patients to wait in a relaxed reception areas reading glossy magazine whilst sipping a hot drink but as I am sure you will agree, keeping you safe is our priority. Full details of our new clinic arrangement.
With regards to treatments, we are able to offer a normal podiatry service, we are still doing nail surgery and verruca surgery/treatments. Edward, our MSK podiatrist is able to full MSK assessments whilst offering steroid injection therapy, shockwave and 3D gait analysis.
Christmas Dinner Drink recommendations for Christmas 2020
Edward Henstridge – MSK Podiatrist
Oh God Christmas!! Comes exclamation when the decorations had to be taken down from the loft. All my life I’ve suffered from a December birthday so the thought of having to decorate the house in November makes me shudder. Bah humbug!
You might exclaim you need a bit of cheer this time particularly this year. And I can’t help but agree. The looks on my children’s faces as the boxes come down from the loft is superb, I must admit I’m getting quite excited myself despite the changes we’ve had to make over this last year. Less on my mind are the material things are Christmas and more in my mind are taking time out with my family and hopefully getting the chance to see our friends. I do hope my parents and brother make it over to us. Perhaps even sneak out to the pub for a beer. Though I’m not sure they will be open.
It’s usually my responsibility to prepare the Christmas menu and when the Christmas decorations come down from the loft, I like to start thinking about the food we are going to have on the build-up to and on Christmas day.
Wine …
One of things I do really get excited about is the wine that we are going to have, I start looking at the options available to combine with my Christmas menu. All my adult life I have been a beer drinker and only recently I’ve made attempts to try and educate myself about wines and matching them with food. So, when I do start to think about the Christmas menu naturally, I start to think about what we can have a drink with. Traditionally Christmas morning, once the presents started to be opened the wife and I might try and sneak a glass of something bubbly. This year we had to be a little more economical so instead of bottles of champagne we were trying different types of Prosecco and Cava I must admit in many cases I prefer them.
I have a Cava from Funambul squirrelled away and I think that will be our treat in the morning.
Starter
As a starter on Christmas day I have a cold starter of smoked fish with some nice fresh bread and butter to attend to go for a white wine with this this year I’ve the Chardonnay by the name Bread and Butter which is a rich but refreshing wine from California. It’s also one that you can drink through into the main course if you desire.
Dinner
For Christmas we usually have turkey with all the trimmings particular pigs in blankets which are my own personal favourite. My wife likes white wine so she will often carry on with the Chardonnay we had from the starter but myself and my dad will tend to move on to red. We tend to prefer something Italian which is a bit smoother. In the past, as it is Christmas, I have had a Banfi Brunello di Molalcino, I could drink that all day but is a wine for a special occasion, this year we are going to southern Italy around the heel (no pun intended) with a Primitivo from Puglia or possible a new world Grenache.
Dessert
Pudding this year will be a Pavlova for the children and Christmas pudding for the adults. Although at this stage you may not feel like very much more to drink I think I would offer up a Pedro Ximenez sherry. Great with Christmas pudding it is silky smooth and like drinking liquid raisins. It is something you can open and have a glass and keep coming back to it over the new year. A great winter warmer.
Beer
Beer wise I tend to prefer light ales so would suggest you try XT, the brewery in Thame, XT1 is excellent and really hits the spot for me. If you like something a little darker than Roasted Nuts from Rebellion Brewery in Marlow is a good ale.
Lockdown 1.0 presented us with a whole load of new changes, challenges and discoveries with our physical and mental health, both positive and negative. In clinic I have seen the effects of this with even more neck, shoulder and back pain from stress, reduced movement and makeshift home working setups.
Advice floating around the internet encourages stretching, regular breaks from your screen, walking 30 mins a day, not working from your sofa, adjusting your chair and raising the computer screen. All these are great, until they aren’t and the pain you are experiencing just won’t go away, no matter how long you stretch.
So what are we missing? Stretching, foam rolling and finding trigger points with a massage ball has worked in the past? Why not now? Time to try something else… mobility. The terms mobility and flexibility are often used interchangeably however they have different definitions.
MOBILITY = The range of uninhibited motion around a joint allowed by the surrounding tissues of tendons, muscle and ligaments, combining a person’s strength, coordination and balance.
FLEXIBILITY = The absolute range of motion in a joint or system of joints, and the length of muscle that crosses the joint involved… a static pose such as touching your toes or the splits.
Someone with a good level of mobility is able to perform daily movement tasks without restriction, but a person with good flexibility may not be able to do the same movement as they don’t have the strength, coordination or balance. Being flexible doesn’t automatically mean good mobility. Ultra flexible yoga teachers aren’t immune to back, neck or shoulder pain.
Have you got 5 minutes? Spending extended hours hunched over a desk encourages forward head posture and rounded shoulders. A lot of the time it’s your thoracic spine (the upper back) not moving enough that is the source of issues such as neck, shoulder and low back pain. Try this 5 min mobility routine for your T-spine.
5 min T-spine Mobility Routine
Helping the homeless & vulnerable in Oxford this winter – It’s going to be PANTS this Christmas is the campaign for 2020. Building on the SOX APPEAL campaign from 2019, we are supporting The Gatehouse again this year, in even harder circumstances.
Christmas shopping? Buy an extra gift this year!
This year we would love PANTS as well as SOCKS. We would also welcome POTS of noodles, pasta or similar. Due to COVID clients are unable to access all centres and food and drink needs to be in takeaway containers. Gifts can be dropped into the clinic, please call to arrange drop off.
Mini Yorkshire puddings with beef and béarnaise sauce
20-25 mins
Ingredients:
For the Yorkshire puddings
1 cup flour
1 cup milk
1 cup eggs
Vegetable oil
For the filling
Beef fillet
For theBéarnaise sauce
White wine vinegar
Lemon
Sprig tarragon
1 Shallot
Egg yolks
Butter (clarified)
Method:
Preheat the oven (fan) to 180 degrees.
Mix the flour, eggs and milk together, leave to rest while you cook the meat.
Cut the beef fillet into smaller pieces, wrap cling film around and leave in fridge to hold its shape.
Place oil in the muffin tray and heat up in oven, once heated pour a little of the pudding mix into each muffin hole.
Cook this for 8 – 10 minutes or until golden brown.
Sear the meat in a hot pan until medium rare or however you desire.
To clarify the butter you need to heat it in a pan till foaming, then remove off heat and leave to stand until the white solids float to the bottom.
Place the butter through a sieve to remove the lumps.
Chop the shallots and tarragon and heat gently in the vinegar, keep seasoning to taste and continue to heat until it starts to reduce.
Strain this and set it aside, but do not pour the vinegar away.
Lightly beat the egg yolks and cooled vinegar, ensuring to not go too fast or you can scramble the eggs adding a little bit of lemon juice to this.
Pout mixture into bowl and suspend over a pan of hot water, whisk constantly until the mixture thickens.
Remove from heat and carefully fold the butter into the mix, until the mixture is thick and smooth. Fold in some chopped tarragon leaves and season to taste with salt and pepper.
To serve place beef onto the Yorkshire puddings and dress with béarnaise sauce, reheat in the oven for 1 – 2 minutes.
Lockdown has been tough on everyone, in the summer it was easier to get outside to be active. The last month has been dark and dreary, with indoor and outdoor gyms closed it has been difficult to find a safe space to exercise.
Leah’s Fitness At The Farm is now back open for business and the farm offers a wonderful place to get outdoors in the fresh air and start enjoying exercise again. Leah is all about encouraging people to find the joy in movement. It doesn’t matter what your level of fitness or experience is, everyone is welcome at her Circuits classes.
Check out her timetable and book your first class for free using the code FITFREE2020
Chilblains present as small, itchy red/purple swellings on the skin which can cause cracking ulceration, exposing the skin to risk of infection. The skin can feel like it is burning and may be painful to touch. Covid toe is when patients who have the covid 19 virus present with a similar presentation and treatment.
Where do they occur?
Chilblains typically affect the smaller toes and areas of foot pressure such as a bunion but also occur on fingers, face and ear lobes.
What is a chilblain?
A chilblain (also called pernio) is where a tiny blood vessels under the skin has leaked into the surrounding tissue. The blood vessel constricts under cold conditions reducing the flow of blood to the area. They can hurt.
How do I get them?
You can get chilblains if you have rapid changes in temperature from cold to hot. This can occur though use of hot water bottles, exposure to extreme in temperature such as heaters and open fires, or cold leisure activities like skiing.
Who gets chilblains?
In the UK 10% get chilblains during their life. Chilblains are more prevalent in people with poor circulation and existing health conditions i.e anaemia.
Seasonally in damp, cold winters when temperatures drop to freezing or below, is when people are most at risk especially young children and older adults. Those who are homeless and vulnerable are at risk of this condition as are adults who work outside in cold damp conditions.
Chilblains or covid – what do they look like?
Chilblains are similar to Raynaud’s condition where extremities , in response to cold, become white in colour due to the vessels constricting thin as the vessels dilate the skin becomes red and very painful with numbness and tingling.
Chilblain like symptoms are now being seen in patients with patients who have had Covid 19, but the remarkable aspect is that they are commonly presented in children and young adults.
The symptoms typically appear 12 days after infection from Covid 19 and occur rapidly. For those patients with Long Covid, Covid toe has been seen to last up to 130 days or more.
Treatments available?
If you have chilblains symptoms:
dry skin: creams containing camphor or local anaesthetic such as Balmosa can be used to prevent further symptoms.
itchy skin: avoid scratching and use calamine to calm the irritation.
broken skin: cover the wound and have it checked by the podiatrist or nurse as soon as possible especially if the patient has Diabetes or Peripheral Vascular Disease.
How do I prevent it?
The best way to prevent chilblains is to keep the extremities warm and dry. This can be achieved by:
wearing 2 pairs of thin socks rather than one pair of tic socks.
Shoes can be lined with an insole to reflect the cold from the ground and sheepskin can be used to insulate the foot too.
Avoid walking on cold floors without shoes or slippers.
Regular exercise helps circulation.
Stop smoking.
Eat a well balanced diet.
Once the feet become cold and symptoms occur, avoid warming them too quickly in front of a heater or open fire, as this will dilate the vessels too quickly and pain will occur as a result.
How long do chilblains last for?
Chilblains last for 7-14 days and any complications such as ulceration or deterioration, can be treated by a podiatrist or nurse.
If you are concerned or worried please contact us, as podiatrists we are able to help.
Covid toes and nails is becoming increasingly more discussed. The Covid19 pandemic has so far infected over 30 million people globally and as it continues to spread across the world, new information about the disease is emerging all the time.
What is covid toe?
Covid toe is a term being noted when patients who have the covid 19 virus present with symptoms in the hands and feet, on toes and nails.
What does covid toe look like?
The symptoms they present with are purplish or red lesions on their toe(s) that are often painful. They could easily be confused with frostbite, chilblains or Raynaud’s disease.
Common lesions patterns include:
Morbilliform (measles-like) rash
Urticaria
Macular erythema
Vesicular (blistering, chickenpox-like) eruption
Papulosquamous presentation
Retiform (net-like) purpura
Chilblain-like lesions
Bristow (2020)
What is covid nail?
Unusual nail changes have been noted by a number of covid positive patients, these findings are still coming to our attention.
“a red-violet band or flare developing in her fingernails, just distal to the lunula. This lasted a week and then disappeared.”
College of Podiatry (2020)
Who gets covid toes or nails?
The other remarkable aspect is that they are commonly presented in children and young adults.
Typically symptoms appear 12 days after covid infection and occurs rapidly. For those patients with long covid, covid toe has been seen to last up to 130 days or more.
The exact cause of these symptoms is still unknown but a vascular rather than thermal aetiology is the current view and will be researched fully in time.
Do you have covid toes or nails.
If you have had or currently have covid19 , please self isolate in accordance to Public Health England guidelines. If you have or suspect you have covid toes or nails please contact your podiatrist or us at Zest Podiatry to gain some valuable advice as to how to manage the symptoms.
College of Podiatry, 2020, COVID toes – now be on the lookout for COVID nails, College of Podiatry, viewed 21/11/2020, <https://cop.org.uk/news-and-features/covid-19/covid-nails>
Bristow, I., 2020, COVID toes, College of Podiatry, viewed 21/11/2020, <https://cop.org.uk/news-and-features/covid-19/covid-toes>
At an ingrown toenail surgery appointment you will see a qualified podiatrist who will assess, stage, diagnose, treat, offer advice and a treatment plan based on your medical conditions, background and medication.
Assessment for ingrown toenail surgery
Your podiatrist will assess your toenail, including the severity of your ingrowing nail and discuss the treatment options available.
Part of the assessment will be differential diagnosis, such as:
subungual exostosis
pyogenic granuloma
subungual verruca
glomus tumour
nail unit tumours
inclusion cysts.
What stage is my ingrown toenail?
When you see the podiatrist, they will examine and assess the ingrown nail, they will often let you know what stage it is, in order to guide you with treatment options. Ingrown toenails are not self limiting, which means if it is NOT treated it will progress through all the stages.
Stage 1 (Mild)
Stage 2 (Moderate)
Stage 3 (Severe)
Symptoms
nail fold swelling oedema erythema pain with direct pressure.
as stage 1 granulation tissue, within & local to the affected nail fold pus pocket formation (paronychia) discharge (ulcer formation) localised infection pain local nail fold hypertrophy
as stages 1 & 2 signs of long-standing chronic inflammation epithelialisation of the granulation tissue chronic infection discharge from the affected sulcus localised nail lysis marked nail fold & generalised swelling of the affected toe.
Treatment
Conservativenail resectionuse of nail packingadvice on nail care & footwear
Nail surgery (partial or total) with phenolisation under local anaesthetic.
Nail surgery (partial or total) with phenolisation under local anaesthetic.
Unresolved
stage 1 will progress to stage 2 then stage 3.
Stage of ingrown nail and treatments
What is conservative Treatment?
Conservative treatment means non surgical treatment. This includes nail resection (cutting back) to remove the nail spicule or reduce the nail width temporarily. If the toe is infected, antibiotics may be given, but once the nail spicule has been removed, daily wound care should allow natural healing. This is the case for stage 1 as above.
The podiatrist would give you advice about how to best look after your toenails going forward, they may demonstrate how to cut your nails, what tools to use and what to do should it worsen.
Ingrown toenail surgery
Ingrown toenail surgery (Nail surgery) is a treatment carried out by medical specialists such as podiatrists, and also by general practitioners, podiatric and orthopaedic surgeons.
It is a common procedure throughout the world. It is a treatment for pathological nail conditions but is most commonly used to treat ingrown toenails (onychocryptosis).
For nails that repeatedly grow in, the option to remove part of all of the nail (partial nail avulsion/total nail avulsion) under a local anaesthetic is recommended.
It is recommended that phenol is used during the surgical procedure to permanently cauterise the nail cells to prevent nail regrowth at the edges. (A Cochrane review found that surgical treatments were more effective than non-surgical treatments).
Do you have to keep up to date?
Podiatrists are trained and registered to carry our nail surgery and they must keep their skills up to date through annual training in Basic Life Support (BLS) and triennial courses to update them in the use and administration of Local Anaesthetics (LAs) and other prescription-only medicines (POMs) .
What can I expect when I have ingrown toenail surgery at Zest?
Nail Surgery – Partial/Total Nail Avulsion with phenolisation
Do I have to go to a theatre or hospital to have this done?
Toenail surgery is performed in our podiatry clinic in Oxford, with follow up appointments the day after surgery and 4 weeks later. The procedure is done under a local anaesthetic, enabling a quick recovery. We work with aseptic /sterile techniques to ensure infection control.
Will I need an injection?
The toes need to be numb in order to perform the treatment, we must inject both sides of the offending toe(s) at the base. This can take from 5-20 minutes to become fully numb, and shall remain numb up to 2 hours.
In order to ease any discomfort and to help those who are needle phobic, an icepack can be applied to the toe beforehand or we can apply cutaneous vibration. (Cutaneous vibration can help stimulate interneurons in the spinal cord, down regulating the activity in the pain conducting fibres)
How much nail do you take away?
The amount of nail removed depends on how severe the problem is. For a partial avulsion only the side(s) of the nail are removed, this can be one side or both depending on how ingrown the nail is, occasionally we may decide to take the whole nail, this is a total avulsion. This is fully discussed at the initial appointment, where we agree a plan. Phenol is applied to the base of the nail plate to cauterise the nail to prevent regrowth.
On your first return the wound is checked and the dressing replaced to a smaller plaster style dressing to allow for comfort and a gradual return to normal activities, you shall be given guidance on how to manage the toe(s) as it heals
What do I need if I’m having ingrown toenail surgery?
Appropriate shoes to wear home (flip flops/slidders)
A lift home or taxi – you cannot drive
Had food and drink before you arrive
Update us on any medical changes since your pre operative appointment
Have paracetamol incase of mild discomfort (if suitable to take)
Plan a few hours of rest after surgery to allow initial healing
What are the risks of ingrown toenail surgery?
Infection – most common. The toe may be infected when it arrives for surgery, and the use of phenol means the wound is present for longer, thus higher risk. We use aseptic techniques throughout the procedure and can supply antibiotics if appropriate.
Regrowth – 3% More common on bilateral feet procedures, surgery can be offered again.
Anaesthetic reaction – rare. anaphylaxis . We are fully trained.
Phenol Burn – rare. We will monitor and work with you to manage these skin changes.
Nerve irritation/damage – rare. We are trained in local anaesthetic and will work to perform at the highest standard.
How does the toenail not grow back?
Phenolisation is the term used for the chemical ablation that podiatrists apply to the nail matrix to prevent it from growing back, 97% do NOT grow back. If you are having a partial nail surgery, it will only be applied to the side, not the whole nail. We will assess if you are suitable for chemical ablation.
If healing capacity is reduced we may recommend a surgical procedure without the chemical known as Winograd or Zadeks procedure, performed by a Podiatric surgeon or an orthopaedic consultant.
How do I look after my toenail after surgery?
Pain is often less after the procedure as the chemical we put on (phenol) helps to reduce the pain and acts like an antiseptic. The action of phenol is to cauterise the nail matrix epithelial tissue and as such this causes some oozing for approximately 14 days.
It is recommended that you soak the toe in saline and change the dressings daily at home and we see you in the clinic again in 4 weeks to check progress and agree discharge.
Should you have any concerns or get any post operative infection we can manage this and provide antibiotics and additional wound care, as necessary please contact us, don’t wait.
I think ingrown toenail surgery is right for me, what should I do?
If you feel this is the right treatment for you, please contact us or book in for an initial consultation, if we are in agreement we can get you booked in at a suitable time. Don’t wait as it will not improve without help.
An ingrown toenail occurs where a piece of nail pierces the flesh of the toe. It can be painful on use, in shoes and when in bed with the covers on it. It affects around 10,000 people per year in the UK, of which 20% of GP foot appointments are due in ingrown toenails.
Who gets ingrown toenails?
It is seen in every age group but is common amongst adolescents with a higher incidence in males. Adolescents are common due to incorrect nail cutting, picking, sports such as football and ill fitting shoes (feet grow faster than shoes replaced). Adults get changes in foot shape due to arthritis or nail condition such as fungal infections, and some are long term sufferers, not realising that nail surgery can correct the condition.
Ingrown toenails are thought to be caused most commonly by trauma and poor nail cutting technique but ill-fitting footwear, excessive sweating, poor hygiene, biomechanical factors and obesity can all contribute. Systemic disease, the aging process and congenital malformation are also causative factors.
What can go wrong?
The first toe is the most common site, but lesser toes can also be affected. The condition ranges from mild, which can be treated conservatively, to progressively more painful stages which need surgical measures to resolve.
It often presents with pain on the side or the top of the nail. Bacterial infections are common, especially if the nail is ingrown for a while.
If the nail remains grown into the skin, it means there is an open wound, even if you cannot see it. The body will attempt to close this hole by producing more tissue, this can build up next to the hole and become painful. It is known as hypergranulation tissue. This process makes the ingrown nail worse as the toe becomes enlarged and struggles to sit comfortably in a shoe.
This will impede walking and the ability to wear certain footwear affecting daily working and social life.
What can I do to help my ingrown toenails?
Regular toenail care
Cut your nails regularly
It is best to cut after a bath or shower as it will make them softer
Use nail nippers not scissors
Cut straight across, leaving the corner of the nail visible if possible
Wash your feet daily, and change your socks daily
Wear well fitted footwear
Have children measured regularly
Avoid footwear made by man-made materials (synthetics)
Choose socks and shoes of natural fibre
Be cautious when cutting if you have long term conditions such as diabetes, are taking steroids or are on anticoagulants
Do NOT remove spikes of nails yourself – seek a podiatrist
If you have a PAINFUL toenail – seek a podiatrist
Are concerned or worried – seek a podiatrist
In the case of any symptoms of a bacterial infection – seek a podiatrist
When the toenail is painful
Things that will help before you see the podiatrist:
Bathe your toes – relieves discomfort and helps to clean the toes
Use warm water – not HOT or COLD
Dissolve a spoon of salt into boiling water then add cool water
Soak for 2-3 minutes
Leave to dry before adding a dressing
Apply a sterile dressing – this will help to keep out dirt and minimise infection
Wear footwear that will accommodate your toe with a dressing
Avoid high impact sport whilst the toe is very painful (squash or climbing)
Avoid adding creams to the toenails as bacteria may grow in it.
Remove all nail varnish, the body treats it as a foreign object and may react worse.
We advocate the use of clinisept+ LINK
Order a nail care pack from us
For any patients that have foot care issues that do not resolve themselves naturally or through routine foot care within two weeks, it is recommended that you seek the help of a podiatrist
Will antibiotics get rid of my ingrown toenail?
Antibiotics will help with the bacterial infection from the ingrown nail, it will help reduce inflammation and may reduce your pain. These are symptoms, the nail unless removed will remain in the toe and will continue to cause you pain. You must treat the cause as well as the symptom. Antibiotics on their own will not get rid of your ingrown toenail.
What treatment is available for ingrown toenails?
Podiatrists treat ingrown toenails daily. The severity of the ingrown toenail would be assessed and treatment options offered accordingly.
These may include a small removal of offending nail (nail resection) or nail spike (nail spicule).
This treatment may not require anaesthetic and advice about long term treatment would be given including cutting and footwear.
Should the toenail be at a more severe stage that requires long term nail removal this will be advised. Long term includes the use of a chemical to prevent it growing back. The podiatrist will suggest this if they feel the nail is beyond regular management. The surgery known as Nail Avulsion is often a side (partial) removal of the nail and if required a total nail removal. This would be with local anaesthetic. It has a success rate of 97% in the UK when actioned by a podiatrist.
As podiatrists we are able to manage infected toes with antibiotics and administer all foot anaesthetics within our clinics. If you think you have an ingrown toenail please contact us we can help you at Zest Podiatry & Physio, alternatively you can book online.
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