Toenail removal is a common medical procedure, often raising questions about discomfort. Many individuals considering this treatment are concerned about the level of pain involved. This article explains the process and outlines how pain is managed for a more comfortable experience.
Reasons for Removal
Toenail removal is necessary for several medical conditions. Ingrown toenails (onychocryptosis) are a frequent reason, occurring when the nail’s edge grows into the skin, causing pain, redness, and swelling. Untreated, these can lead to serious infections. Trauma, such as from an injury or dropping an object, can also damage the nail beyond repair, requiring removal for proper healing and infection prevention.
Fungal infections (onychomycosis) are another common cause, especially when topical or oral treatments prove ineffective. These infections discolor, thicken, and crumble the nail. Conditions like onychogryphosis, where the nail becomes excessively thick and curved, often due to fungal infections or past injuries, can also necessitate removal to alleviate pressure and discomfort.
The Removal Process
Toenail removal, often performed by a podiatrist, is a minor surgical procedure. It begins with thoroughly cleaning the affected toe to minimize infection risk. A local anesthetic is then administered, usually through injections at the base of the toe, to completely numb the area. This numbing ensures that while a patient remains awake, they will not feel pain during the procedure itself.
Once the toe is adequately numb, a tourniquet may be applied to temporarily restrict blood flow, providing a clearer surgical field. The podiatrist then carefully removes the problematic portion of the nail, or the entire nail, depending on the condition. A chemical solution, such as phenol, is often applied to the nail matrix (the tissue from which the nail grows) to prevent the nail from regrowing, which is particularly common for recurrent ingrown toenails. A protective dressing is applied once the procedure is complete.
Pain Management During and After
Pain management during toenail removal primarily relies on local anesthesia. The initial injection to numb the toe is often described as the most uncomfortable part, sometimes causing a mild burning sensation for a few seconds. Once the anesthetic takes full effect, the toe becomes completely numb, ensuring the patient experiences no pain throughout the actual removal procedure. Patients may still feel pressure or movement, but not sharp pain.
After the procedure, once the local anesthetic begins to wear off, mild to moderate discomfort is common. This pain usually starts to ease within 24 hours. Over-the-counter pain relievers such as acetaminophen or ibuprofen are generally effective for managing this post-operative discomfort. Elevating the foot above heart level for the first 24 to 48 hours can help reduce throbbing pain and swelling. Applying ice packs, wrapped in a towel, for 15-20 minutes every 2-3 hours during the first day can also help alleviate discomfort and reduce swelling.
Recovery and Healing
Recovery following toenail removal involves careful wound care and activity modification to promote healing. After the procedure, the toe will be covered with a dressing that needs to be kept clean and dry. Healthcare providers typically advise changing the dressing once or twice daily, often after soaking the foot in warm, soapy water to ease removal and cleanse the area. Keeping the wound covered, especially for the first week, is important for preventing infection.
Initial healing for a partial nail removal usually takes about 4 to 6 weeks, while a total nail removal may take 8 to 10 weeks. During this time, it is normal to observe some weeping or light yellowish discharge from the wound, which does not necessarily indicate infection. Signs of infection to monitor for include increased redness, swelling, throbbing pain, warmth, pus drainage, or a foul odor. Avoiding strenuous activities and wearing open-toed or loose footwear for at least two weeks can prevent irritation and support the healing process. While a new toenail can take 12 to 18 months to fully regrow, some regrowth may be visible within a few months, depending on whether the nail matrix was treated to prevent regrowth.