Toenail removal, whether partial (for an ingrown nail) or complete (for trauma or chronic infection), creates an open wound on the toe. The success of the procedure depends significantly on diligent and proper aftercare. Understanding the specific steps for wound management, pain control, and activity modification is paramount for a smooth recovery and healthy tissue healing.
Initial Care in the First 48 Hours
The first two days following toenail removal focus on controlling post-operative pain and minimizing swelling. The physician applies a thick, sterile dressing immediately after surgery, which must remain completely dry and intact for 24 to 48 hours unless otherwise instructed. Keeping the foot elevated above the level of the heart (e.g., propping it on pillows) reduces throbbing pain and limits swelling at the surgical site.
It is normal to notice slight blood or clear-to-pink fluid soaking through the outermost layer of the original dressing during this initial period. For managing pain, over-the-counter medications like acetaminophen or ibuprofen are recommended and should be taken as directed before the local anesthetic fully wears off. Walking should be minimized to brief trips to the restroom to avoid putting unnecessary pressure on the tender toe.
Daily Wound Cleaning and Dressing Routine
Once the initial 48-hour period has passed, a daily routine of cleaning and redressing the wound begins. The first step involves soaking the foot in a warm solution to gently loosen the old dressing and cleanse the wound bed. A mixture of warm water and Epsom salts (about two teaspoons per quart of water) is often recommended for five to ten minutes, once or twice a day.
After soaking, the toe must be carefully patted dry with a clean, soft towel, ensuring no moisture remains trapped in the wound or between the toes. Applying a thin layer of a topical antibiotic ointment or sterile petroleum jelly maintains a moist healing environment, preventing scab formation that can impede new skin growth. Finally, apply a fresh, non-stick sterile dressing to cover the area completely, providing a protective barrier.
The dressing should be changed daily, or more frequently if it becomes wet or soiled, to maintain a clean environment. Consistent hygiene is important, including thoroughly washing hands before and after handling the wound and dressing supplies. Allowing the toe to air out at night may be possible after the first three to four days if drainage has stopped, but a healthcare provider should confirm this step.
Identifying and Addressing Complications
While mild redness, slight swelling, and minor discomfort are expected during the initial healing phase, certain signs indicate the process is not progressing normally. Worsening pain, throbbing, or swelling that increases after the first two to three days suggests a potential complication. A significant indicator of bacterial infection is the presence of thick, opaque, yellow, or greenish discharge, often accompanied by a foul odor.
The redness may also spread past the immediate wound margins, and the area may feel increasingly warm to the touch. Systemic symptoms, such as a fever or chills, are serious signs that the infection has spread beyond the local area, requiring immediate medical attention. Any sudden and excessive bleeding that does not stop after applying firm pressure for 15 to 20 minutes also warrants an urgent call to a healthcare professional.
Resuming Activities and Long-Term Foot Care
The timeline for resuming normal activities varies, but excessive stress on the healing toe should be avoided for several weeks. Patients are advised to avoid high-impact activities like running or jumping for at least two to three weeks to prevent trauma to the sensitive nail bed. Water exposure, particularly in public sources like swimming pools or hot tubs, should be avoided for up to six weeks to minimize infection risk and allow the wound to fully close.
For the first week or two, wearing open-toed shoes or sandals is recommended to eliminate pressure on the surgical site. When transitioning back to closed-toe footwear, selecting shoes with a wide toe box is important to ensure the toe has sufficient room and is not compressed. Choosing well-fitting shoes and socks remains a permanent measure to avoid putting pressure on the toe and encourage long-term foot health.
If the entire nail was removed, a new toenail may take 12 to 18 months to fully regrow, though it may look different than the original. If the procedure involved a chemical matrixectomy to prevent regrowth, the nail will not return, and the nail bed will scar and eventually harden. To prevent future ingrown toenails, trim the nail straight across, avoiding cutting the corners too short or rounding the edges.