Toenail removal is a minor procedure often performed in an outpatient setting to alleviate pain and treat persistent nail conditions. This intervention is generally recommended when less invasive, conservative treatments have failed to resolve the issue. The procedure is typically carried out by a medical professional, such as a podiatrist or dermatologist. The goal is to remove the problematic portion or the entirety of the nail plate to allow the underlying tissue to heal properly.
Common Situations Requiring Removal
A doctor recommends toenail removal when a nail issue causes chronic pain, repeated infection, or significant deformity that impairs daily life. One of the most frequent reasons is chronic ingrown toenails, where the edge of the nail grows into the surrounding skin, leading to inflammation and sometimes pus formation. When this condition reaches moderate or severe stages, it often requires a surgical solution.
Severe fungal infections that prove resistant to oral and topical antifungal medications may also necessitate removal to allow direct application of medicine to the nail bed. Furthermore, significant trauma to the toe can result in a fractured nail bed or a large collection of blood beneath the nail plate (subungual hematoma). Removing the nail in these trauma cases allows the physician to assess the damage and release the pressure. Other indications include chronically thickened or deformed nails that cause pain or difficulty with footwear.
Surgical and Chemical Removal Methods
The technique used for removal depends on whether the goal is temporary relief or a permanent solution to prevent regrowth.
Partial Nail Avulsion
A Partial Nail Avulsion involves removing only the section of the nail that is causing the problem, such as the sharp side-wedge of an ingrown nail. This procedure leaves the majority of the nail intact. The nail matrix, the tissue responsible for nail growth, is often left alone, allowing the nail to regrow normally.
Complete Nail Avulsion
For widespread infection, severe trauma, or extensive deformity, a Complete Nail Avulsion may be performed, which involves removing the entire nail plate. Since the nail matrix remains intact, the nail is expected to regrow, though a toenail can take up to 8 to 12 months to fully regenerate.
Matrixectomy
A permanent solution, known as a Matrixectomy, is performed following either a partial or complete avulsion to prevent the problematic section or the entire nail from growing back. Matrixectomy involves destroying the germinal tissue of the nail matrix using chemical or surgical methods. The most common chemical agent used is Phenol, an 88% concentration solution applied to the nail matrix. Alternatives include Trichloroacetic Acid (TCA) and Sodium Hydroxide. Surgical matrixectomy involves physically cutting away the nail matrix tissue, a technique often reserved for cases where chemical destruction is not suitable.
The Patient Experience During the Procedure
The toenail removal procedure is performed under local anesthesia to ensure the patient feels no pain during the actual removal. The process begins with the administration of a local anesthetic, typically Lidocaine, injected near the base of the toe. While the injection itself can cause a brief stinging or burning sensation, this discomfort is short-lived, lasting only a few seconds.
Once the local anesthetic has fully numbed the toe, the procedure can begin. A tourniquet, a tight rubber band, is often applied to the base of the toe to prevent bleeding and keep the area clear for the surgeon. During the removal, the patient may feel pressure or a pulling sensation, but no sharp pain.
The procedure is generally quick, often completed in about 15 to 30 minutes from start to finish, depending on the complexity of the case. After the nail or nail section is removed and any chemical agent is applied, the tourniquet is taken off, and a large, bulky dressing is immediately applied to the site. The toe remains numb for an hour or two after the procedure, allowing the patient to leave shortly after the dressing is secured.
Post-Procedure Care and Healing
Proper post-procedure care is essential for preventing infection and promoting successful tissue healing. Patients are advised to keep the initial bulky dressing dry and elevated for the first 24 to 48 hours to minimize bleeding and swelling. After this period, the dressing must be changed regularly, typically once or twice daily, or as directed by the podiatrist.
Part of the daily care regimen involves soaking the foot in a solution of warm water and salt, such as Epsom salt or table salt, which helps to clean the wound and ease the removal of the old dressing. After soaking, the toe should be gently patted dry, and a fresh, sterile, non-adherent dressing should be applied. Over-the-counter pain relievers, such as acetaminophen, are usually sufficient to manage any discomfort once the local anesthetic wears off.
Activity restrictions are necessary to protect the healing toe; patients should avoid strenuous activity, swimming, and tight footwear until cleared by their doctor. Healing time varies based on the extent of the procedure; a partial nail removal often takes about two to four weeks. If the entire nail was removed or a chemical matrixectomy was performed, healing may require six to twelve weeks. Patients must contact their doctor if they notice signs of complications, such as excessive bleeding, spreading redness, or persistent throbbing pain.