The price for initial consultation is £100

If your toe problem is suitable for nail surgery, the procedure and requirements will be explained to you then available nail surgery with redressing dates will be offered. The appointment for the nail surgery is booked in the next suitable appointment.  If unsuitable, we can provide conservative therapy to make you comfortable and provide health education and guidance for your future well-being. 

If your toe is infected or significantly inflamed, a course of antibiotics will be need to be completed before nail surgery is performed; we can prescribe this at your assessment. Mild-medium inflammation and the accompanying pain, most often resolves with the surgery itself.  An additional fee of £15 for medication will be charged. 

The price of the nail surgery begins at £598 with the promotion of a free wound care pack, usually valued at £50.

If surgery is clinically advised and chosen by the patient, we will discuss the procedure and book the date. Please bear in mind, healing usually takes 4 to 6 weeks with a partial nail removal, and 6 to 8 weeks for total nail removal surgery, for the wound to close and a dry scab to form. However, it can take longer with certain health conditions present or if the toe is traumatised. In this time, avoid wearing tight fitting shoes which cause squeezing of the toes. Also avoid sports like running for 2 to 3 weeks, or activities such as football and swimming for 4 to 6 weeks. 

On the day of surgery, please eat as you would normally, as eating will not interfere with the local anaesthetic. It is important that you do not have any other anaesthetic, local or general, in the 24 hours before the surgery. Please continue to take your prescribed  medication (unless otherwise instructed after the initial assessment). 

To ensure it is safe to operate, we will discuss and confirm certain facts critical to the procedure, I.e your general well-being and lifestyle, your weight (for anaesthesia safety purposes) and your previous exposure to certain medications. We will also revise the procedure process and explain the risks again, before obtaining your written consent. 

The surgery entails: 

•  Injection of local anaesthetic into your toe, (usually Mepivacaine). Mepivacaine usually numbs the toe within 5 minutes and will have a duration of 2-3 hours. Like all anesthetics, it works by blocking pain receptors, although you may still feel pressure and movement.  
• Using an instrument, we test the anaesthetised area and surrounding areas, to assess the effectiveness of the local anaesthetic! 
• Once anaesthetic has effectively numbed the desired area, the tourniquet (a medical grade loop) is applied to the toe (this is to reduce bleeding during and post procedure). 
• As discussed, part or all of the nail is removed , with specialised disinfected tools. Certain abnormal tissue growths (hypergranulation) can be removed at this time. 
• Phenol, a weak acid, is applied for 3 minutes; Phenol destroys the remaining nail bed tissue, preventing future nail regrowth. (You may opt to skip the Phenol if you wish the nail to regrow). 
• The tourniquet is removed, and a combination of wound dressings are applied to reduce bleeding, keep wound clean from external contaminants and protect the wound from potential physical hazards. 
• As the dressing bandage is rather large, sandals/slippers (with an open, wide toe box) are advised to return home in. 
• You will have a period of time to recover in the clinic for monitoring purposes. 
• Ideally, and clinically advised, you should be driven home in a vehicle i.e. car/taxi to reduce your time standing on the first day, this will reduce the risk of bleeding through the dressings. Please be advised that public transport is not recommended, as there would be increased risk of bleeding due to standing, accidental trauma from commuting and risk of contamination from transport ‘particles’.

• Your first redressing appointment will be 1 to 2 days after surgery, where you will also be given guidance on redressing the toe yourself. This can be face to face or virtually by video.
• Your follow-up with us will be 2 to 3 weeks after your surgery, but we can amend this around your schedule, and can also provide extra appointments if you would like some assurance. This can be face to face or virtually by video.

• Do not travel home via public transport.  
• It is best to stand and walk as little as possible for the first 24 hours; this gives time for bleeding to stop.  
• At home, elevating the treated foot on a stool or to the couch is advised. 
• When the local anaesthetic wears off, most patients report a dull ache which may last a few hours to a day. If your toe is painful, take your preferred painkiller; usually Paracetomol or Ibuprofen - DO NOT TAKE ASPIRIN, as this encourages bleeding in a fresh surgical wound. 
• Keep the bandage on and dry until you return for the first redressing. 
• A couple small spots of blood leaking through the bandage is not unusual; if they are larger, stick a sheet of folded kitchen paper towel or gauze on top - but make sure to keep the original bandage in place. 

• If the bandage gets soaked with blood as if the toe has not stopped bleeding (which is extremely rare), contact us and attend your nearest A&E / Urgent Care Centre. 

On the day of surgery, please eat as you would normally, as eating will not interfere with the local anaesthetic. It is important that you do not have any other anaesthetic, local or general, in the 24 hours before the surgery. Please continue to take your prescribed  medication (unless otherwise instructed after the initial assessment). 

To ensure it is safe to operate, we will discuss and confirm certain facts critical to the procedure, I.e your general well-being and lifestyle, your weight (for anaesthesia safety purposes) and your previous exposure to certain medications. We will also revise the procedure process and explain the risks again, before obtaining your written consent. 

The surgery entails: 

•  Injection of local anaesthetic into your toe, (usually Mepivacaine). Mepivacaine usually numbs the toe within 5 minutes and will have a duration of 2-3 hours. Like all anesthetics, it works by blocking pain receptors, although you may still feel pressure and movement.  
• Using an instrument, we test the anaesthetised area and surrounding areas, to assess the effectiveness of the local anaesthetic! 
• Once anaesthetic has effectively numbed the desired area, the tourniquet (a medical grade loop) is applied to the toe (this is to reduce bleeding during and post procedure). 
• As discussed, part or all of the nail is removed , with specialised disinfected tools. Certain abnormal tissue growths (hypergranulation) can be removed at this time. 
• Phenol, a weak acid, is applied for 3 minutes; Phenol destroys the remaining nail bed tissue, preventing future nail regrowth. (You may opt to skip the Phenol if you wish the nail to regrow). 
• The tourniquet is removed, and a combination of wound dressings are applied to reduce bleeding, keep wound clean from external contaminants and protect the wound from potential physical hazards. 
• As the dressing bandage is rather large, sandals/slippers (with an open, wide toe box) are advised to return home in. 
• You will have a period of time to recover in the clinic for monitoring purposes. 
• Ideally, and clinically advised, you should be driven home in a vehicle i.e. car/taxi to reduce your time standing on the first day, this will reduce the risk of bleeding through the dressings. Please be advised that public transport is not recommended, as there would be increased risk of bleeding due to standing, accidental trauma from commuting and risk of contamination from transport ‘particles’.

• Your first redressing appointment will be 1 to 2 days after surgery, where you will also be given guidance on redressing the toe yourself. This can be face to face or virtually by video.
• Your follow-up with us will be 2 to 3 weeks after your surgery, but we can amend this around your schedule, and can also provide extra appointments if you would like some assurance. This can be face to face or virtually by video.

At all times monitor your toe and wound for signs of infection, such as:

• Redness
• Swelling
• Hot to touch
• Extreme pain
• Unpleasent smell
• Pus or yellow discharge.

This is fairly rare, but when patients do report it, the anecdotal time frame is week 2 to 3; hence our follow up for this time. If caught early enough, antibiotics can be avoided. Do not hesitate to contact us for any worries. 

If you have an active job, you may need to take a few days off work to rest the affected toe(s). We recommend that you wear open toe shoes until the first redressing appointment.

Please be aware that these may not comply with any Health & Safety requirements at your place of employment so it may be wise to ask for time off or request a temporary change in role.

For children, we recommend they do not return to school until after the follow-up appointment when the toe is re-dressed (typically after about 3 days). If necessary the surgery can be arranged to avoid clashes with other commitments, for example, exam time or holidays.

Important note: Driving when your toe is anaesthetised may make you unfit to drive and/or invalidate your insurance.

Allergies are extremely rare in podiatric nail surgery, but there are times people can be severely allergic (anaphylaxis) to the local anaesthetic. In this case we keep an anaphylactic kit and have emergency procedures and diagnostic tools; if you were to require such care, we would also call an emergency ambulance as routine. Rarely, people are allergic to adhesive tape, however we use a hypoallergenic brand, and can also bandage differently if this is still a problem. 

Also, please let us know if you have ever suffered postural hypotension (light headedness), or become faint from needles/injections (vasovagal syncope). 

• Nausea/fainting - Some patients suffer anxiety or shock due to syringe needles and injections; we have certain protocols to help you cope with this. 
• Complex regional pain syndrome - In the unlikely event you experience this extremely rare condition which causes severe pain and inflammation as a result of injury, you can take painkillers (NOT ASPIRIN) or call us if you are concerned. If painkillers like paracetamol are not helping you may try stronger tablets like Co-codamol (however, not to be used with paracetamol).
• Excessive bleeding - This can be avoided by elevating the foot or adding more bandage.
• Delayed healing - Potentially caused by certain health conditions, physical trauma or infection. 
• Anaphylaxis - An allergic reaction affecting breathing, heart rate or blood pressure, which is possible in any clinical environment however extremely unlikely. We have anaphylaxis kits and protocols to manage such an emergency, with extensively experienced and trained clinicians at hand.
• Nail Regrowth - Approximately 5% patients experience nail regrowth, such as a spike, which can be operated on again if it is too significant for conservative care. Avoiding treatment may lead to worsening of the condition or soft tissue infection, which in itself can lead to sepsis if left untreated. Occasionally an antibiotics course is the only viable treatment without podiatric intervention, however this is rare. 
• Unsightly nail and bruising - Onychauxis (thick nail) or Onychogryphosis (elongated and curved, in a ‘horn’ like formation). Prolonging treatment may increase the risk of the nail catching on objects and ripping off, which is a fairly traumatic and painful incident. Otherwise the thickened nail can put pressure on the nail bed, causing pain in some footwear; and may lead to problems in the future, such as ulceration beneath the nail. 
• Nerve trauma - On extremely rare occasion (1 in 5000 patients) the needle used to administer anaesthesia may damage the nerve of the toe. Numbness or altered sensation will eventually recover with time, but may last up to a year.
• Phenol Flare - A mild chemical burn is very rare as we take precautions to protect your skin during the procedure, however the phenol used to prevent nail regrowth may react with the skin, appearing red, causing nail discolouration and a mild burning sensation.
• Periostitis - An extremely rare condition as a result of inflammation of the periosteum, a layer of connective tissue that surrounds bone. This may occur before, during or after  Local Anaesthetic injection.  General Practitioners will be able to treat the symptoms with medication.
• Please be advised that all surgical procedures carry some level of risk. While we make every effort to ensure the safety and success of our surgeries, there is a possibility that complications may arise. By agreeing to undergo minor surgery at this clinic, you acknowledge and accept these risks. It is the patient's responsibility to inform the practitioner of any medical conditions or allergies, and to follow the practitioner's pre- and post-operative instructions.

Also, please let us know if you have ever suffered postural hypotension (light headedness), or become faint from needles/injections (vasovagal syncope). 

• • Nausea/fainting - Some patients suffer anxiety or shock due to syringe needles and injections; we have certain protocols to help you cope with this. 
  • Complex regional pain syndrome - In the unlikely event you experience this extremely rare condition which causes severe pain and inflammation as a result of injury, you can take painkillers (NOT ASPIRIN) or call us if you are concerned. If painkillers like paracetamol are not helping you may try stronger tablets like Co-codamol (however, not to be used with paracetamol).
  • Excessive bleeding - This can be avoided by elevating the foot or adding more bandage.
  • Delayed healing - Potentially caused by certain health conditions, physical trauma or infection. 
  • Anaphylaxis - An allergic reaction affecting breathing, heart rate or blood pressure, which is possible in any clinical environment however extremely unlikely. We have anaphylaxis kits and protocols to manage such an emergency, with extensively experienced and trained clinicians at hand.
  • Nail Regrowth - Approximately 5% patients experience nail regrowth, such as a spike, which can be operated on again if it is too significant for conservative care. Avoiding treatment may lead to worsening of the condition or soft tissue infection, which in itself can lead to sepsis if left untreated. Occasionally an antibiotics course is the only viable treatment without podiatric intervention, however this is rare. 
  • Unsightly nail and bruising - Onychauxis (thick nail) or Onychogryphosis (elongated and curved, in a ‘horn’ like formation). Prolonging treatment may increase the risk of the nail catching on objects and ripping off, which is a fairly traumatic and painful incident. Otherwise the thickened nail can put pressure on the nail bed, causing pain in some footwear; and may lead to problems in the future, such as ulceration beneath the nail. 
  • Nerve trauma - On extremely rare occasion (1 in 5000 patients) the needle used to administer anaesthesia may damage the nerve of the toe. Numbness or altered sensation will eventually recover with time, but may last up to a year.
  • Phenol Flare - A mild chemical burn is very rare as we take precautions to protect your skin during the procedure, however the phenol used to prevent nail regrowth may react with the skin, appearing red, causing nail discolouration and a mild burning sensation.
  • Periostitis - An extremely rare condition as a result of inflammation of the periosteum, a layer of connective tissue that surrounds bone. This may occur before, during or after  Local Anaesthetic injection.  General Practitioners will be able to treat the symptoms with medication.
  • Please be advised that all surgical procedures carry some level of risk. While we make every effort to ensure the safety and success of our surgeries, there is a possibility that complications may arise. By agreeing to undergo minor surgery at this clinic, you acknowledge and accept these risks. It is the patient's responsibility to inform the practitioner of any medical conditions or allergies, and to follow the practitioner's pre- and post-operative instructions.

  Also, please let us know if you have ever suffered postural hypotension (light headedness), or become faint from needles/injections (vasovagal syncope). 

• Complex regional pain syndrome - In the unlikely event you experience this extremely rare condition which causes severe pain and inflammation as a result of injury, you can take painkillers (NOT ASPIRIN) or call us if you are concerned. If painkillers like paracetamol are not helping you may try stronger tablets like Co-codamol (however, not to be used with paracetamol).
• Excessive bleeding - This can be avoided by elevating the foot or adding more bandage.
• Delayed healing - Potentially caused by certain health conditions, physical trauma or infection. 
• Anaphylaxis - An allergic reaction affecting breathing, heart rate or blood pressure, which is possible in any clinical environment however extremely unlikely. We have anaphylaxis kits and protocols to manage such an emergency, with extensively experienced and trained clinicians at hand.
• Nail Regrowth - Approximately 5% patients experience nail regrowth, such as a spike, which can be operated on again if it is too significant for conservative care. Avoiding treatment may lead to worsening of the condition or soft tissue infection, which in itself can lead to sepsis if left untreated. Occasionally an antibiotics course is the only viable treatment without podiatric intervention, however this is rare. 
• Unsightly nail and bruising - Onychauxis (thick nail) or Onychogryphosis (elongated and curved, in a ‘horn’ like formation). Prolonging treatment may increase the risk of the nail catching on objects and ripping off, which is a fairly traumatic and painful incident. Otherwise the thickened nail can put pressure on the nail bed, causing pain in some footwear; and may lead to problems in the future, such as ulceration beneath the nail. 
• Nerve trauma - On extremely rare occasion (1 in 5000 patients) the needle used to administer anaesthesia may damage the nerve of the toe. Numbness or altered sensation will eventually recover with time, but may last up to a year.
• Phenol Flare - A mild chemical burn is very rare as we take precautions to protect your skin during the procedure, however the phenol used to prevent nail regrowth may react with the skin, appearing red, causing nail discolouration and a mild burning sensation.
• Periostitis - An extremely rare condition as a result of inflammation of the periosteum, a layer of connective tissue that surrounds bone. This may occur before, during or after  Local Anaesthetic injection.  General Practitioners will be able to treat the symptoms with medication.
• Please be advised that all surgical procedures carry some level of risk. While we make every effort to ensure the safety and success of our surgeries, there is a possibility that complications may arise. By agreeing to undergo minor surgery at this clinic, you acknowledge and accept these risks. It is the patient's responsibility to inform the practitioner of any medical conditions or allergies, and to follow the practitioner's pre- and post-operative instructions.

Also, please let us know if you have ever suffered postural hypotension (light headedness), or become faint from needles/injections (vasovagal syncope).