Toenail removal is a minor in-office procedure that takes about 20 to 30 minutes, performed under local anesthesia while you’re fully awake. Doctors either remove part of the nail (partial avulsion) or the entire nail (total avulsion), depending on the severity of the problem. In many cases, they also destroy the nail root to prevent regrowth. Here’s what actually happens at each stage.
Why Doctors Remove Toenails
The most common reason is a recalcitrant ingrown toenail that hasn’t responded to conservative treatment like soaking, antibiotics, or cotton wedges. But ingrown nails aren’t the only indication. Doctors also recommend removal for severely thickened nails, ram’s horn nails (a curved overgrowth that can’t be trimmed normally), congenital nail deformities, chronic painful nails, and pincer nails, where the nail curves inward from both sides and pinches the tissue beneath it. For pincer nails, complete removal with destruction of the nail root is considered the only definitive fix.
Partial vs. Total Removal
A partial nail avulsion removes only the problematic strip of nail, usually along one edge. You’re left with a slightly narrower nail that still looks relatively normal. This is the most common approach for ingrown toenails, since only one border is typically causing trouble.
A total nail avulsion removes the entire nail plate. Afterward, you’re left with an indentation where the nail used to be. This is reserved for cases where the whole nail is damaged, deformed, or causing pain across its full width. Either procedure can be temporary (the nail grows back) or permanent, depending on whether the doctor also destroys the nail matrix, the tissue at the base that produces new nail.
How to Prepare
There’s no fasting required. You can eat normally and take all your usual medications. Shower the night before or the morning of your appointment. Wear loose-fitting clothing and, if the procedure is on your toe, bring open-toed shoes to wear afterward, since your toe will be bandaged and won’t fit into a regular shoe. Stock up on bandages and petroleum jelly before your appointment so they’re ready when you get home. Having acetaminophen or ice packs on hand is also a good idea for any soreness once the anesthesia wears off.
If you’re driving yourself, bring someone who can drive you home. Your toe will be numb, which can make operating a gas pedal uncomfortable or awkward.
Numbing the Toe
The first step is a digital nerve block, which numbs the entire toe. Each toe has four nerves running along its sides, two on the top and two on the bottom. The doctor injects a local anesthetic, typically lidocaine, into the web space on each side of the toe near its base. One injection targets the nerve on the top of the toe, and then the needle advances deeper to reach the nerve on the underside. This is repeated on the other side.
The injections are the most uncomfortable part of the entire procedure. They sting for a few seconds, but once the anesthetic takes effect, you won’t feel pain during the rest of the operation, only pressure and movement. Full numbness usually sets in within a few minutes. The doctor will check sensation on both the top and bottom of your toe before proceeding.
The Removal, Step by Step
Once the toe is numb, the doctor cleans it with an antiseptic solution and places a surgical drape over your foot with the affected toe exposed. Some doctors wrap a small rubber band around the base of the toe to reduce bleeding and keep the area clear.
The actual extraction follows a logical sequence. First, the doctor uses a flat instrument called a nail elevator, or the closed tips of small scissors, to separate the nail plate from the skin fold at its base. This frees the nail so it can be cut and removed without tearing surrounding tissue.
For a partial removal, the doctor then uses a nail splitter or bandage scissors to cut straight back from the free edge of the nail toward the base, isolating the strip that needs to come out. They clamp that strip with a hemostat (a locking surgical clamp), gripping as much of the nail as possible, and rotate it outward while pulling toward the tip of the toe. The goal is to remove the piece in one smooth motion.
For a total removal, the same freeing and clamping technique applies, but the entire nail plate is pulled away from the nail bed.
Destroying the Nail Root
If the doctor wants to prevent the nail (or a section of it) from growing back, they perform a matrixectomy, destroying the cells at the base of the nail that produce new growth. There are three main ways to do this.
Chemical Matrixectomy
This is the most common method. After the nail or nail strip is removed, the doctor applies a chemical directly to the exposed nail matrix. The two chemicals used are phenol and sodium hydroxide. Phenol is applied at a high concentration and essentially cauterizes the growth cells. Sodium hydroxide works similarly but through a different chemical reaction. Both achieve success rates around 95%, and studies show no meaningful difference in recurrence between them. With either chemical, roughly 7 to 8% of patients eventually need a second procedure, and about 9 to 11% develop a recurrent painful nail border. Sodium hydroxide tends to heal a bit faster and carries a lower risk of tissue damage compared to phenol.
The advantage of chemical matrixectomy is that there’s no surgical incision at the nail root. The chemical is simply rubbed over the matrix area, which keeps the procedure simpler and the recovery less involved.
Electrocautery
Some doctors use an electrosurgical device with a specialized electrode to burn and destroy the nail matrix. The electrode is coated with a non-stick material on one side to protect the surrounding skin while the other side delivers heat to the growth tissue. If there’s excess inflamed tissue (granulation tissue) along the nail border, the doctor can remove that at the same time using a ball-shaped electrode.
Laser Matrixectomy
A CO2 laser can destroy the nail matrix more precisely than chemicals, targeting the growth cells while causing less collateral damage to surrounding tissue. Recurrence rates with laser treatment are notably low, around 2 to 6%. The trade-off is that laser matrixectomy requires more specialized equipment and greater surgical skill. Healing times can also be longer, and cosmetic results don’t always satisfy patients.
What Recovery Looks Like
After the nail is removed, the doctor applies antibiotic ointment, wraps the toe in a bulky gauze dressing, and may give you a disposable surgical slipper to wear home. The whole appointment, from check-in to walking out, is usually under an hour.
For the first 24 to 48 hours, leave the original bandage in place and keep your foot elevated above heart level as much as possible to minimize swelling. Don’t soak the wound or go swimming. After that initial period, you can gently wash around the wound with clean water twice a day, apply petroleum jelly, and replace the bandage. Continue redressing every other day until the site has fully healed.
A partial removal typically heals in six to eight weeks. A total removal takes eight to ten weeks. During this time, the exposed nail bed gradually hardens and forms a protective layer. If the nail matrix was left intact, new nail growth will begin within a few weeks, though a full toenail takes several months to grow back completely.
Possible Complications
The most common issue is regrowth of the nail despite matrixectomy. Even with chemical destruction, the nail matrix can partially survive and produce a small, irregular spike of nail called a nail horn, or a thickened claw-like regrowth. One study found recurrence in about 34% of patients after partial matrixectomy, though that figure likely underestimates the true rate since it only counted patients who returned for follow-up. Patients who experienced recurrence had a 31% higher rate of complications overall, including infections, abscesses, and abnormal nail regrowth.
Infection is the other main risk, though it’s relatively uncommon when wound care instructions are followed. Signs to watch for include increasing redness spreading beyond the toe, pus, worsening pain after the first few days, or fever. Minor oozing and tenderness in the first week are normal and expected.
Simply Removing vs. Permanently Removing
Not every toenail removal involves destroying the root. Sometimes the doctor removes the nail temporarily to treat an underlying infection, drain an abscess beneath the nail, or biopsy the nail bed for a suspicious discoloration. In these cases, the matrix is left completely intact and the nail regrows on its own over the following months. Permanent destruction of the matrix is only performed when the nail itself is the recurring problem and regrowth would simply bring the issue back.