Toenail removal, medically known as onychotomy or nail avulsion, is a common minor surgical procedure performed in an outpatient setting. It is used to treat persistent issues like severe ingrown nails, chronic fungal infections, or trauma. The procedure involves removing either a portion or the entire nail plate to alleviate discomfort and allow the underlying tissue to heal. The experience and subsequent recovery are highly manageable, especially with modern pain control techniques.
Managing Pain During the Procedure
The primary step in pain management is the application of a local anesthetic through a process called a digital block. This involves injecting a numbing agent, such as lidocaine, into the base of the toe. This effectively blocks the nerves that transmit pain signals from the toe to the brain, making the entire procedure painless.
The only discomfort experienced during the procedure is typically the initial injection of the anesthetic itself. This injection is felt as a sharp sting or pinch, often described as brief but intense pressure that lasts only a few seconds. The healthcare provider injects the anesthetic on both sides of the toe to ensure a full nerve block.
Once the local anesthetic has taken effect, usually within five to fifteen minutes, the toe will feel completely numb. During the actual removal process, you may still feel sensations of pressure, pulling, or tugging as the provider separates the nail from the nail bed. These are pressure sensations, not sharp pain, because the pain nerves are deactivated. If any sharp sensation is felt, the provider can administer additional anesthetic to ensure comfort.
Step-by-Step Guide to Toenail Removal
The procedure begins with the provider thoroughly cleaning and sterilizing the toe and surrounding skin with an antiseptic solution. After the digital block is confirmed to be effective, a thin rubber tourniquet may be placed at the base of the toe to temporarily restrict blood flow. This creates a drier surgical field and helps the chemical agent work more effectively if needed. The tourniquet is removed before the end of the procedure.
The specific steps depend on whether a partial or total nail avulsion is performed. A partial removal, often called a wedge resection, is common for ingrown toenails. This involves the provider using specialized instruments to lift and separate the problematic strip of nail from the underlying nail bed. The separated strip is then cut and gently pulled away from the nail root.
A total nail avulsion is reserved for cases of severe trauma or pervasive fungal infection and involves removing the entire nail plate. Following removal, the provider may apply a chemical, such as phenol or sodium hydroxide, to the exposed nail matrix, which is the tissue responsible for nail growth. This step, called a matrixectomy, destroys the nail-producing cells to prevent the removed portion of the nail from growing back. The chemical is neutralized, the area is rinsed, and a sterile dressing is applied.
Post-Procedure Care and Healing Timeline
The most noticeable pain often begins when the local anesthetic starts to wear off, typically within one to two hours after the procedure. This discomfort is usually a dull, throbbing ache. It is effectively managed with over-the-counter pain relievers, such as acetaminophen or ibuprofen, as directed by your provider. The first 24 to 48 hours are the period of greatest discomfort, which should then steadily decrease.
Immediate care focuses on keeping the initial bulky dressing dry, elevating the foot to minimize swelling, and resting for the remainder of the day. The dressing should remain in place for the first day. Your provider will give specific instructions on when to remove it and begin the soaking process. Regular soaking in warm water with Epsom salt, followed by the application of an antibiotic cream and a fresh bandage, is a common protocol to promote healing and prevent infection.
It is normal for the exposed nail bed to weep or ooze a small amount of yellowish or reddish fluid, which should not be confused with pus from an infection. Signs of a true infection, which require medical attention, include severe throbbing pain that worsens, spreading redness, significant swelling, or thick, foul-smelling discharge.
For a partial nail removal, healing typically takes about four to six weeks for the nail bed to fully skin over. A total nail removal can take longer, often requiring three to four months for the entire area to fully heal. Activity restrictions include avoiding swimming and strenuous exercise until the area has healed sufficiently.