Toenail removal, medically known as nail avulsion, involves separating the nail plate from the underlying nail bed. This process is sometimes necessary for damaged nails or as a therapeutic measure to treat underlying conditions. While minor injuries may allow for careful management of a partially detached nail at home, complete removal is a specialized surgical procedure. Attempting to forcibly remove an attached toenail without medical supervision carries significant risks, including severe infection, excessive bleeding, and permanent damage to the nail matrix. Professional medical intervention is required for any procedure involving cutting or detaching a healthy, attached portion of the nail plate.
Identifying When Removal is Needed
Toenail removal is indicated by underlying pathology or severe trauma affecting the nail unit. A common traumatic indication is a large subungual hematoma—a collection of blood trapped beneath the nail plate causing intense throbbing pain. If the hematoma covers more than 25% of the nail surface or causes significant pressure, a doctor may drain the blood or remove the nail to assess the nail bed for lacerations.
Chronic onychomycosis, a fungal infection that causes the nail to thicken and crumble, is another frequent reason. If topical treatments fail, the nail may be removed to allow antifungal medications to reach the infected tissue more effectively. Recurrent and painful ingrown toenails (onychocryptosis) are also a primary indication for professional removal, often involving only the offending edge. Immediate medical attention is necessary if the toe shows signs of severe infection (spreading redness, pus discharge, or fever), especially in individuals with compromised circulation or diabetes.
Safe Handling of Damaged or Partially Detached Nails
When a toenail is partially detached due to minor injury, the primary goal of home care is to prevent infection and further damage before consulting a healthcare provider. Only the portion of the nail that is completely loose or fully separated should be managed at home; never apply force to an attached section. Begin by cleaning the entire area with mild soap and water to remove debris.
Any tools used, such as small scissors or tweezers, must be sterilized, ideally by soaking them in rubbing alcohol or boiling them. Carefully trim the loose edges of the nail plate to prevent them from catching, which could cause further trauma. Cut along the line of detachment and avoid digging into the soft tissue.
Once the loose fragment is removed, gently cleanse the exposed nail bed. Apply a thin layer of over-the-counter topical antibiotic ointment. The exposed tissue must then be covered with a non-stick sterile dressing and secured with medical tape to provide a protective barrier. This dressing should be changed daily, or whenever it becomes wet or soiled, until a medical professional can assess the injury.
Medical Procedures for Complete Toenail Removal
When a physician determines that complete toenail removal is necessary, the procedure is performed under sterile conditions following the administration of a local anesthetic, typically injected at the base of the toe. The anesthetic ensures the patient experiences no pain during the procedure. The two primary professional approaches are simple nail avulsion and matrixectomy, chosen based on the underlying condition and desired outcome.
Simple Nail Avulsion
A simple nail avulsion involves physically separating the entire nail plate from the nail bed and nail folds using specialized instruments. This temporary method is used to treat conditions like a severe hematoma or acute infection, allowing the nail matrix to remain intact so a new, healthy nail can regrow. The procedure provides immediate relief and allows the doctor to inspect the nail bed for damage to the underlying bone or soft tissue.
Matrixectomy
For chronic, recurring issues like severe onychocryptosis or persistent fungal infections, a permanent solution called a matrixectomy may be performed. This procedure removes the nail plate and destroys the nail matrix—the specialized tissue responsible for producing nail cells. The matrix can be destroyed surgically by excising the tissue or chemically by applying a caustic agent, such as phenol, to prevent future nail growth. Matrixectomy is reserved for patients who have failed conservative treatments and require definitive cessation of nail growth.
Post-Removal Care and Regrowth
Management of the exposed nail bed following removal is essential for optimal healing and complication prevention. Immediately following the procedure, the toe should be kept elevated above heart level for the first 24 to 48 hours to minimize swelling and post-operative bleeding. The physician will apply a bulky, sterile dressing that must be kept dry and in place for the prescribed initial period, usually 24 hours.
After the initial dressing change, the wound requires daily cleaning and the application of a fresh, non-adherent dressing until the nail bed skin hardens (typically two to three weeks). Over-the-counter pain relievers, such as acetaminophen or ibuprofen, are usually sufficient to manage discomfort. Wear open-toed or loose-fitting shoes during recovery to avoid pressure on the sensitive tissue.
If the matrix is preserved (simple avulsion), the nail bed will heal completely, and a new toenail will begin to grow back. Full regrowth is a slow process, often taking between ten and eighteen months. Monitoring the site for increased pain, persistent redness, warmth, or pus is necessary, as these are signs of a potential infection requiring immediate medical follow-up.