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What is the Procedure?
The Howard–Dubois procedure can be used to elongate or extend the nail bed of a toe. This may help the improve the appearance and function of nails that are naturally short, narrowed, or damaged.Â
It involves releasing and reshaping the surrounding soft tissue to allow the nail to grow longer over time.
Why is It Done?
You may be offered this procedure if you have:
- Short or underdeveloped nails
- Nails that appear small or disproportionate
- Cosmetic concerns about nail appearance
- Nails that have been damaged by trauma or previous surgery
The goal is to increase the visible nail surface while maintaining a healthy nail.
What Happens During the Procedure?
- The toe is cleaned and numbed using local anaesthetic
- The Podiatrist carefully releases soft tissue around the nail bed
- The nail bed may be gently mobilized and extended
- Stitches may be used to secure the tissue in its new position
- The area is dressed to protect it during healing
The procedure usually takes 20–40 minutes per toe.
Will It Hurt?
- You will not feel pain during the procedure due to local anaesthetic
- Mild to moderate discomfort is normal afterward
- Over-the-counter pain relief (e.g., paracetamol) is usually sufficient
Recovery and Aftercare
- Keep the dressing clean and dry for the first week.
- Wear open loose, comfortable footwear. Ideally a medical shoe. Add link
- Elevate the foot when resting to reduce swelling
- Avoid putting pressure on the toe until healing is underway
Healing timeline:
- 2–3 weeks: initial wound healing
- 4–6 weeks: nail bed stabilization
- Several months: full nail growth showing the elongation
Risks and Complications
Possible complications include:
- Infection
- Bleeding or bruising
- Scarring
- Nail regrowth issues
- Partial or incomplete elongation (rare)
- Pain Syndrome (Chronic regional pain symptoms)
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Contact your clinician if you notice:
- Increased pain, redness, or swelling
- Pus or unusual discharge
- Fever
Benefits
- Longer, more proportionate nail
- Improved appearance and confidence
- Maintains healthy nail growth
When Can I Return to Normal Activities?
- Walking: usually within
- Work/school: depends on comfort, often a few days
- Sports or tight footwear: after 4–12 +weeks
Follow-up
- Remove stitches
- Monitor healing and nail growth
- Assess whether further intervention is needed