A removed toenail will generally grow back, provided the underlying structures responsible for nail production remain healthy. While the loss of a toenail, whether from trauma or a medical procedure, might seem permanent, the body’s natural regenerative capacity is typically preserved. The key factor for successful regrowth is the condition of the specialized tissue that continuously generates the nail material.
How Toenails Regrow
The growth of the toenail relies entirely on a specialized structure called the nail matrix, often referred to as the nail root. This matrix is located beneath the skin at the base of the nail, near the cuticle. It functions as the “factory” for new nail cells. The only visible portion of the matrix in many people is the pale, half-moon shape known as the lunula.
The cells within the nail matrix constantly divide and produce keratin, a tough protein also found in hair and skin. As these new keratin cells are generated, they push the older, dead cells forward, forming the hard, visible nail plate. The nail plate then glides over the nail bed, the soft tissue underneath, until it reaches the tip of the toe.
The nail bed itself also contributes a small percentage of new cells, mostly helping the nail plate adhere to the toe as it grows. When a toenail is completely removed, the nail plate is gone, but the matrix remains intact and continues its function of producing new nail material.
The Expected Regrowth Timeline
The process of a toenail fully regrowing is significantly slower than that of a fingernail. The typical duration for a complete toenail replacement after removal is between 12 and 18 months. This long timeline is due to toenails growing at a much slower rate, averaging about 1.6 millimeters per month.
Initial signs of regrowth may become visible after two to three months, as a thin layer begins to form over the nail bed. By around six to nine months, the nail may be halfway grown, offering a better indication of its final appearance. The new nail may appear thinner or softer at first, a condition that usually resolves as the nail hardens and thickens with continued growth.
This lengthy period is partly attributed to the reduced blood flow to the toes compared to the fingers, as well as the constant pressure from footwear and walking. The full restoration of the nail plate is a gradual biological function, requiring the 12 to 18-month timeframe to completely cover the nail bed and reach the free edge.
Factors That Affect Normal Regrowth
While regrowth is generally expected, several factors can prevent or alter the process, leading to an abnormal or absent nail. The most common cause of permanent failure to regrow is severe damage to the nail matrix. If this specialized tissue is crushed or scarred due to significant trauma, it may be unable to produce healthy keratin cells, resulting in a misshapen, split, or permanently thickened nail.
Underlying medical conditions can also impact the quality and speed of regrowth. Chronic fungal infections can cause the nail to grow back thick, discolored, or brittle until the infection is fully addressed. Conditions that affect circulation, like diabetes, can slow the delivery of necessary nutrients to the toe, delaying the regrowth timeline.
In some medical procedures, such as those performed for chronic ingrown toenails, the matrix is intentionally destroyed using a chemical process called chemical ablation. If the matrix is not intentionally destroyed, its health is the primary determinant of a successful toenail recovery.