Surgical Procedures

At Feet First Clinic, our chiropodists perform the following surgical procedures:

1. Partial Nail Avulsion
2. Total Nail Avulsion
3. Wart Needling
4. Wart Excision

See the “Procedures” section below for further information.

All procedures are performed with medical grade steel instruments, which are sterilized for each client. At our foot clinic, we follow an intense sterilization process and safety protocols in compliance with Health Canada regulations to ensure our instruments are clean and contaminant-free.  See the Safety section below for more information.

Although not covered by OHIP, most extended benefits providers will cover surgical procedures performed by chiropodists in whole or in part.  See insurance for more information.

Partial Nail Avulsion (PNA)

This procedure involves the safe surgical removal of part of the toenail and any affected tissue.  The toe is first numbed with a local anesthetic.  The chiropodist will cut open and drain any areas of infection.  A narrow vertical strip is then removed on the affected side of the nail from the edge to base of the nail.  Antibiotics and a dressing are applied to the exposed nail bed to prevent infection. This procedure is most often performed on deeply ingrown toenails that do not respond to non-surgical treatment.  It can also be performed on thickened toenails, cracked toenails, infected toenails, fungal toenails or disfigured toenails that are causing ongoing pain and discomfort, and do not respond to non-surgical treatments.  

In the case of a chronic ingrown toenail, the chiropodist may then apply a chemical called phenol to prevent nail regrowth. This means your toenail will be more narrow than it was before, but it will prevent further issues. 

Total Nail Avulsion (TNA)

Sometimes, a partial nail avulsion may not fully address the underlying issue.  In these cases, the chiropodist may perform a total nail avulsion.  A total nail avulsion is similar to a partial nail avulsion; however, instead of just removing a narrow strip of the nail, the entire nail is removed from the nailbed.  A total nail avulsion is performed when the underlying problem reoccurs after a partial nail avulsion, or if an issue is affecting the entire toenail, as opposed to just a portion of it.  In some cases, a healthy problem-free toenail will grow back afterwards.  The regrowth process takes about 12 to 18 months.  However, in some cases where the issue is likely to reoccur, phenol may be applied to ensure a new toenail does not grow back.  This would prevent whatever issue was affecting the nail from reoccurring.

Total nail avulsion is most often performed for recurring deeply ingrown toenails; however it is also used to treat thickened toenails, cracked toenails, infected toenails, fungal toenails or disfigured toenails that are causing ongoing pain and discomfort, and do not respond to non-surgical treatments.

Wart Needling

Needling is a simple surgical procedure for wart removal.  A local anesthetic is first applied to numb the area.  The wart is then punctured with a sterile needle approximately 100 times.  The puncturing pushes the wart-causing virus (HPV) further into the body, which triggers an immune response.  This immune response helps your body recognize and fight off the virus, and in turn, the plantar warts.  If the procedure is successful, your body’s immune response will fight off any other warts and make them go away.  

Needling is often used for people with multiple warts or clusters (mosaic plantar warts), or for particularly stubborn cases of plantar warts that resist other less invasive treatments.  It is about 70% effective.

Wart Excision

Excision is used for plantar warts that resist other treatments.  The foot is first numbed with a local anesthetic.  Then, as the name implies, the wart is cut away (or “excised”) from the skin with a sterilized surgical instrument.  The base is also cauterized to ensure no living viral tissue is left behind.  There is a risk of scarring, so this method isn’t used unless other treatments have failed.

At the beginning of all appointments at Feet First Clinic, the chiropodist will thoroughly cleanse and disinfect your feet with an alcohol solution. This solution kills all bacteria and contaminants on the feet. Before any surgical procedure, the area of interest is cleansed with Betadine solution.

When performing the above procedures, the chiropodist will numb the affected area with a local anesthetic to ensure you won’t feel any pain.  

All procedures are performed with medical grade steel instruments, which are sterilized for each client.  At our foot clinic, we follow an intense sterilization process and safety protocols in compliance with Health Canada regulations to ensure our instruments are clean and contaminant-free.  The sterilization process effectively kills all microorganisms such as fungi, bacteria, viruses, and spores.  Our foot clinic uses a steam sterilization process for all our tools and instruments, which is the gold-standard for sterilization.  

Our care continues after the surgery as well: after your surgical appointment, we will provide you with instructions for at-home care, and schedule an appointment for post-operative follow-up.  At your follow-up appointment, the chiropodist will ensure everything is properly healed, that the underlying issue is addressed, and that there are no adverse effects. There is no additional cost for the post-operative follow-up appointment.

The surgical procedures performed by our foot specialists can treat the following conditions:

• Ingrown toenails
• Discoloured toenails
• Cracked toenails
• Plantar warts
• Infected toenails
• Fungal toenails

If you’re having an issue causing you concern, pain or discomfort, you can contact our office at 416-769-3338 to book an assessment with one of our chiropodists.  You can also use our online booking form.

At your assessment, the chiropodist will examine the affected area and determine the best course of treatment.  Typically, non-surgical, less invasive treatment will be attempted before exploring surgical options.

Should your condition require surgery, the chiropodist will walk you through the surgical procedure and a separate appointment for the surgery will be booked.  After the surgery, the chiropodist will go over post-operative care, and we will provide you with a handout to take home.

We then will book an appointment for follow-up to make sure you are doing well and that there are no further complications or issues.  The post-operative follow-up appointment is free of charge.  At your follow-up appointment, the chiropodist will assess the operated area to see if the issue is resolved, or requires further treatment.

OHIP does not cover surgical procedures performed by a chiropodist; however most private extended health benefits plans will cover them in full or in part.  Each insurance company has their own stipulations about what and how much they will cover. If you are unsure about your benefits and coverage for chiropodist services and procedures, check with your employer’s HR department or your insurance provider. Feet First Clinic can also help you get a policy breakdown on your behalf.

The post-operative follow-up appointment is free of charge.