Toenail avulsion refers to the complete or partial removal of a toenail. This can occur accidentally due to trauma or be performed intentionally as a medical procedure.
Causes and Indications
Toenail avulsion can result from accidental injuries or be a necessary medical intervention. Acute trauma, such as dropping a heavy object on the toe or forcefully stubbing it, commonly leads to accidental avulsion. Chronic trauma, often from ill-fitting shoes, can also damage the nail over time, making it prone to detachment or thickening.
Medical professionals may recommend toenail avulsion for conditions unresponsive to other treatments. Severe fungal infections (onychomycosis) can cause pain, thickening, and disfigurement, making avulsion an option. Ingrown toenails (onychocryptosis), where the nail grows into the surrounding skin, often cause pain, swelling, and infection, necessitating partial or total nail removal to alleviate symptoms and prevent recurrence.
Another indication is a subungual hematoma, a collection of blood trapped under the nail. Tumors or growths under the nail may also require avulsion for diagnosis or removal. Chronic nail disorders like psoriasis, leading to abnormal nail growth or thickening, can sometimes be managed with avulsion.
The Procedure
A toenail avulsion typically begins with preparation of the affected toe. The area is cleaned. Local anesthesia is then administered, often through a digital block, involving injecting a numbing agent, such as lidocaine, into the base of the toe.
Once the toe is numb, a tourniquet may be applied to the base of the toe to ensure a bloodless field. Using specialized instruments, the surgeon detaches the nail from the nail bed. In a partial avulsion, only the problematic section of the nail, such as an ingrown edge, is removed. For a total avulsion, the entire nail plate is removed.
Following nail removal, the underlying nail bed is inspected and treated as needed. This might involve draining a subungual hematoma, removing granulation tissue, or addressing other abnormalities. For recurrent ingrown toenails or severe fungal infections, a chemical agent like phenol may be applied to the nail matrix to prevent regrowth. An antibiotic ointment may be applied, and a sterile dressing is placed over the nail bed.
Recovery and Aftercare
Following a toenail avulsion, aftercare focuses on protecting the wound and managing discomfort. A sterile dressing is applied, and patients are instructed to keep the toe clean and dry. Elevating the foot above heart level helps reduce swelling and pain. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can manage post-procedure discomfort as the local anesthesia wears off.
The recovery timeline varies; partial nail avulsions heal in about six weeks, while total avulsions can take eight weeks or longer. Full regrowth of a toenail, if the matrix is preserved, can take 6 to 18 months. Aftercare instructions include regular dressing changes and gently washing the area with soap and water.
Patients should monitor the site for signs of infection, such as increased pain, swelling, warmth, redness, pus, or red streaks. Activity restrictions apply; strenuous activities, swimming, and tight shoes should be avoided until the wound is fully healed. Open-toed shoes or footwear with ample room are recommended to prevent pressure on the healing toe. Follow-up appointments with the healthcare provider are important to monitor healing progress and address concerns. If the nail matrix was significantly damaged, the nail may not regrow perfectly or at all.