Permanent Toe Nail Removal Surgery

Ha - I discovered this unfinished post as a draft. I'll publish it unfinished, nearly a year after the event. I should write an update on this situation, as my toe has not healed yet... 

The post:



Ooooookkkkkkkkk..... this is not a pleasant one. Permanent toenail removal. 

I'm NOT going to share photos of the wound. Unlike other bloggers... I didn't want to see their photos.

It would make you squeamish. I want to share my story to be helpful, and I know that gross photos will scare people away. I am going to share a few photos of bandages, shoes, and how my toenail used to be. These shouldn't be too much for anyone. 

PART 1: The Story

I had my left big toenails (yes plural) removed on October 18th. The damage began in 2018. The nail broke off the cuticle, a new nail grew in under it and pushed the original dead nail up. Then that new nail would break off and the cycle would repeat. I had 3 nails on my toe ever since, until this surgery. The nails were curling more and more as the years went on, and the pinching feeling was becoming unbearable at times. I didn't have a choice. It had to be done. 

Why did this happen? Well a Pulmonologist and Neurologist both thought that it was a side effect from taking Metaprolol to manage my tachycardia from POTS. Metaprolol did help lower my tachycardia, but it worsened my already poor circulation. My feet are normally icy and purple, but Metaprolol amplified the problem. I was going numb from cold, and my fatigue intensified too much. I had to stop taking it. These doctors said I probably cut off oxygen to my toes and I'm very lucky I only damaged the big toenail. I have had streaks on my other nails ever since, but I didn't lose them. 

My surgery was a horrible experience. Be warned, this story is something of a nightmare!

It wasn't exactly planned - my appointment got moved up a few weeks early, and I only wanted him to trim the sides down to reduce the pinching. I thought I could hold off on the surgery for another year, at least. Nope, he took a look and said I can't wait. So I had to get mentally prepared VERY quickly. I agreed to it, I knew it was coming eventually and already accepted the fate of my toe, but I didn't know it was going to be right then and there. 

The podiatrist has good bedside manner and has been good with me since I started working with him in 2018. I thought he was a good doctor. The trouble is that he works as quickly as possible, and he leaves the room quickly every time he isn't needed to do something for me immediately. He injected the numbing serum, I waited 10 minutes, then he came in and immediately started to put the tool under my nail. I could feel it! He didn't test my toe before starting the operation. He injected more numbing serum in a few spots closer to the nail until I was numb. Then he asked me to explain what POTS was. I looked away while talking, and in what was probably less than 2 minutes he said he was done. The top two nails came off very easily, almost without effort from him. That could have been a problem for me if I hadn't gone in for the surgery. And then he was gone and I never saw him again. 

His nurse is incredibly kind and friendly, gave me the attention I needed to pull myself together, and I loved her, but... and I don't know how much of this is her or the fault of the hospital being stingy...

She sprayed the wound with cold alcohol, then put gauze directly on the wound then wrapped it tight. Gauze absorbs blood and the blood will stick and dry to it. I'll follow up on this point soon. Then she did not give me a post-op shoe. She stuffed my sock back on my foot, then stuffed my foot into the boot I came in wearing. Which is a tad narrow because my feet at are a tad narrow, but they were no longer a tad narrow after swelling up my toe and putting a thick bandage on me. My big swollen toe was STUFFED into my tight shoe. Was as tight as possible. And I wasn't given a mobility aid. I walked myself to my car. I drove myself, not expecting this surgery. 

I was not prescribed antibiotics or anti-inflammatories, which I later learned is the gold standard of this surgery. No mobility aids. I was given bandages with padding smaller than the size of my nail bed. And told to go home and soak in epsom salt water. She told me to take aspirin or ibuprofen as needed... and let me tell you, I WISH I was given something stronger. I needed a lot over 3 weeks, which is so bad for my liver.

I made it home, pulled my boot off with a very uncomfortable tug, rested, and the numbing serum slowly wore off. I needed extra of it and it wore off within about 1.5 hours. I was told it could take up to the rest of the day to wear off, but no, that's not how my body is.  

Then it was time to change the bandage and soak in a foot bath. The gauze was glued to my wound, and I didn't know how bad it was going to be. She did put a thin amount of antibiotic gel over the cuticle, so it should have prevented the sticking, right? No, because the worst wound was up higher where the dead nail was attached. So I pulled at it a little. OUCH. I definitely swore loudly. So, not knowing what else to do, I sprayed it down with water until it detached. I was bleeding, but I did exactly what my instructions told me to do: put my foot into a foot bath with SALT. Epsom salt. To reduce swelling and clean it. An open wound on the most sensitive area of the body. In epsom salt. I screamed so loudly that I'm sure the entire block could hear me. I shook so hard from the shock of the pain that my husband had to hold me still. OUCH. OUCH. OUCH. No swear words were strong enough for that situation. 

But I continued to follow my instructions, and I put gauze on the wound and bandaged it. Guess what happened when I had to change that bandage? Yep. Screaming and crying.

So... the wound kept getting ripped open, despite my soaking the wrappings to peel them off. The wound couldn't heal. 

That's when I sought advice from friends who are medical professionals and got creative with the supplies I had.

My husband bought me whatever he could find at CVS. I couldn't do the foot baths for the first week, even without adding epsom salt. I tried and it had me in tears every time. So instead I sprayed iodine liberally all over my foot and the wound. I let it soak in, then I sprayed an antibiotic with lidocaine mix. I used witch hazel soaked pads with alcohol in them to clean all around the wound, but I couldn't touch the wound itself. Way too painful. Cleaning the wound with any pressure was going to have me in tears. 

I used extra large bandages and tented it over the nail bed, so that the pad could not touch the wound. That was the only method that was working for me. The trouble was when I accidently moved my toe in such a way that the padding did touch the wound, which was still bleeding after more than a week, and the padding stuck the wound... then rippped at it. There went any healing progress! I tried a different method of bandaging the wound with smaller bandages, and the adhesive touched the wound just enough that I couldn't rip it off.  The only way I could get the bandages off in both situations was to soak my whole foot in a foot bath. It stung like crazy! But eventually, after about 10 minutes each time, the bandages released and popped off into the water. And that's when I realized I was able to tolerate the foot baths well enough to do them to clean my toe out. But not with epsom salt. I used colloidal silver in the water instead. 

So I thought through it. I decided to put antibiotic gel directly only the pad of the bandages, and I painted it with a sterile pad to coat the entire pad. That worked to prevent the pad from sticking to the wound. That is what I should have been doing the whole time, and I never should have attempted a smaller bandage. 

But then... about 2 weeks into this nightmare, I started to get a lot of pus. White, not yellow, but a lot. Everyone told me it was time to see a doctor - a different doctor. I mailed my podiatrist photos of my pus covered toe on a Thursday evening, thinking I would get a response the next day. At 11 am the next day the message showed it was read, but I never got a reply (at all - not even by today.).

So by Friday afternoon I decided to go to the walk-in clinic, and it was a very good thing I did! The doctor was an ER doctor and the nurse had podiatry experience. Both excellent! I told them how I was I treated - I mean, not treated. They couldn't say much, but they did tell me how to take care of myself correctly. The nurse swabbed my toe bed to do a culture - OUCH OUCH OUCH. Holy @#$%^. And then the doctor put me on antibiotics. She attempted to put me on an anti-inflammatory, but I was allergic to all of them. She wrote me a note to prevent me from going to work and told me to get off my feet no matter what! The nurse taught me how to bandage properly, and even gave me scissors to cut bandages exactly right. Then she told me where to go to buy a proper pair of shoes to recover in (I'll get into the shoe issue in the next part of my blog.)

That was exactly 1 week ago. I took my antibiotics, got my proper shoes, bandaged correctly, got off my feet as much as possible, let it breathe more, was able to clean it in foot baths, and elevated it more often. In the last 48 hours I have FINALLY started to heal. I was at a 8-10/10 level of pain managed only with ibprofen for 2.5 weeks. In the last 48 hours the pain level went down gradually, and I haven't taken pain killers in this time. I now am at a 2-3/10 level of pain when resting, and it goes up to a 5/10 when touched or walking too much. The tenderness on the nail bed is 50% reduced. 


PART II: Complications and Solutions

Shoes:
MAKE SURE YOU GET A POST-OP SHOE BEFORE THIS SURGERY. Don't rely on your doctor to give you mobility aids. And trust me, you will need it. Think through this: you have to put all your body weight on your foot to walk, which increases pressure on the wound, which is on the most sensitive part of your body. Consider using a cane too. You're not being a baby. Keep weight off that toe if you want to heal!

I couldn't find a post-op shoe in town. I spent a week looking and asking around, and it meant I was hobbling around on the side of my foot without a shoe, which lead to ankle pain. All I could find were expensive boots for ankle recovery. I tried all the shoes I own. The ONLY shoe that I could make work was a Teva sandal, and it wasn't comfortable at all, but it was all I had. I went to work wearing that sandal and it was borderline not acceptable for all the walking I had to do. 

The nurse at the walk-in clinic sent me to The Uniform Center on 3rd street in Bismarck. Their new shoe store, Happy Soles, was phenomenal. The lady who helped me has been through the surgery too, and her daughter has POTS. She understood!! She was able to fit me in an open-toed slipper that's been saving me. It has a thick sole that isn't flexible, so it's keeping me stable, and I don't feel the ground. It has Velcro straps on top so that I don't have to slide in and out. I strap it on. It was a game changer for my recovery!!! The velcro is very impotent: I couldn't slide into slippers because of the size of the bandage and the pressure. I needed straps that come fully open so I could simply step onto the sole and then strap in. 

POTS: 
Okay - this really really really complicated issues. I wasn't prepared for the biggest issue at all: blood pooling in my feet.