Toenail avulsion is the removal of the entire or a portion of the toenail plate. This common procedure is performed in a doctor’s office or clinic setting by a podiatrist or healthcare provider. It is an effective treatment when conservative methods have failed to resolve painful or infected nail conditions. The goal is to remove the problematic nail section so the underlying nail bed can heal properly.
Medical Reasons for Toenail Avulsion
Toenail avulsion is necessary for conditions causing persistent pain, infection, or abnormal nail growth. One frequent indication is a chronic ingrown toenail, medically known as onychocryptosis, especially when the nail edge has repeatedly pierced the skin, causing inflammation or infection. This painful condition can become severe if left untreated.
Another common reason is severe or chronic onychomycosis, a fungal infection that has not responded to oral or topical antifungal medications. The removal of the damaged nail allows for better access to the nail bed for treatment and promotes the growth of a healthy nail. Toenail avulsion is also performed following acute trauma that results in a subungual hematoma (blood under the nail), particularly if the pressure is causing significant pain. Chronic nail disorders that cause the nail to become thickened or distorted, such as psoriasis, may also require avulsion to relieve discomfort and improve function.
The Avulsion Procedure
The procedure begins with administering a local anesthetic via a digital block, where an injection is given at the base of the toe to numb the area. Once the toe is numb, a tourniquet is often applied around the base to temporarily limit blood flow, providing a clearer surgical field. This preparation ensures the patient feels no pain during the procedure.
The surgeon uses a specialized instrument, such as a nail elevator, to separate the nail plate from the underlying nail bed and the surrounding skin folds. For a partial avulsion, only the problematic section of the nail is cut free and removed. In a total avulsion, the entire nail plate is removed. The procedure takes less than twenty minutes, and the patient should feel only pressure or movement, but no pain, once the anesthesia has taken effect.
Post-Procedure Care and Recovery
Immediate post-procedure care focuses on protecting the surgical site and managing discomfort. Mild pain and throbbing are common once the local anesthesia wears off after several hours, usually managed with over-the-counter pain relievers. Patients must keep the foot elevated for the first day to minimize swelling and keep the dressing dry and intact for at least 24 hours.
After the initial dressing period, patients begin a routine of gentle soaking, two to three times a day to keep the area clean and to ease the removal of the old dressing. Following each soak, the toe should be gently patted dry, and a topical antibiotic ointment and a fresh, non-stick sterile dressing should be applied. This process is continued until the nail bed surface hardens and is no longer weeping, which usually takes two to four weeks.
Patients must monitor the site for signs of infection, such as increasing redness, swelling, or drainage. While the nail bed heals quickly, the full regrowth of a new toenail is a long process, taking approximately 12 to 18 months. During this period, the new nail may temporarily appear different in texture or shape until it fully matures.
Permanent Removal Options
For individuals who experience chronic, recurring issues like severe ingrown toenails, a simple avulsion may not be a sufficient long-term solution. In these cases, a matrixectomy is often performed in conjunction with the nail avulsion. The matrixectomy is the permanent destruction of the nail-producing tissue, known as the nail matrix, located at the base of the nail bed.
This is most commonly achieved by applying a chemical agent, such as phenol, to the exposed nail matrix after the nail portion is removed. The phenol chemically cauterizes the matrix tissue, preventing the nail from growing back in that area. This results in a slightly narrower, but permanent, correction that eliminates the recurrence of the ingrown section. While a total nail avulsion can prevent the entire nail from regrowing, a partial nail avulsion with chemical matrixectomy is the more common approach, as it preserves the majority of the healthy nail.