Toenail Avulsion

Who needs a toenail avulsion procedure? 

Our aim at the University Foot & Ankle Institute is to preserve the patient's foot and use the least invasive treatment option possible. We may be considering toenail avulsion if less invasive treatment options have not resolved your problem.

During your consultation, one of our expert podiatrists will examine the condition of your toe and determine how much of the nail needs to be removed.

We can use partial or total nail avulsion to help resolve the following:

• Recurring onychocryptosis (ingrown toenails)
• Thickening nails
• Overgrown or irregularly growing nails (onychogryphosis)
• Onychomycosis (fungal infections)

Surgical nail avulsion can also serve as a diagnostic tool. Nail avulsion grants us access to the nail matrix, nail bed, and nail folds. After assessing the toenail and surrounding tissues, we can biopsy a nail sample. A nail biopsy helps in diagnosing anomalies, lesions, and tumors.

How is medical toenail avulsion performed? 

There are two types of nail avulsion — surgical or chemical — and both are performed with a local anesthetic. The procedure may also be combined with chemical matricectomy — the ablation of part of the nail bed through chemical cauterization. 

Chemical matricectomy offers a permanent solution to ingrowing toenails. Your doctor will apply a chemical (phenol or sodium hydroxide) to the nail bed. If the key parts of the nail bed are damaged, the nail will not regrow in the problem area.

In most other cases, we will perform toenail avulsion without matricectomy. For example, nail biopsies are generally done without matricectomy, ensuring the nail will grow back after the procedure.

How is chemical nail avulsion performed? 

Chemical nail avulsion is a more advanced treatment for fungal nail infections. A urea ointment is applied to the nail's surface, covered, and left for 7-10 days. This softens the nail and allows the diseased and damaged parts to be painlessly removed. 

Cloth tape will be placed around the outside border of the nail before applying the chemical ointment to protect the surrounding soft tissue. Once the nail is removed, the infection can be treated directly with antifungal creams or medications. A new nail will grow in, although it may take up to 18 months for full regrowth.

How is surgical nail removal performed? 

When it comes to surgical nail excision, your nail has two key edges: the distal (free) edge and the proximal edge (the cuticle). These relate to the two main types of nail avulsion surgery.

The proximal technique releases the nail plate from the proximal nail fold, and then the entire nail is removed. However, the distal approach — detaching the nail at the free end — is the most frequently used of the two approaches. 

A wedge excision can remove just a portion of the nail. It is commonly performed on ingrown toenails as it excises the part of the nail growing into the skin as well as the corner nail where growth stems from. 

Surgical nail avulsion is a quick outpatient procedure. A digital block for local anesthesia is used for patient comfort and most individuals will not need to be sedated. Sometimes, a tourniquet may be used for a few minutes to help control bleeding during the procedure. 

What is the toenail avulsion healing process? 

After the procedure, the doctor will apply antibiotic ointment and a sterile bandage. It is important to keep the area clean and protected to prevent infection.

Replace the bandage as directed by your healthcare provider. After removing the bandage, carefully clean the area with warm water or a prescribed antiseptic solution, then apply a new bandage. The best and easiest wound covering is Vaseline and a non-stick bandage.

Make sure the bandage stays clean and dry. Do not go swimming or submerge your toe until cleared by your doctor.

In some cases, you may be given prescription antifungals, antibiotics, or pain medications. Make sure to follow the doctor's directions carefully! In most cases, acetaminophen will be sufficient for pain management. A follow-up appointment can help check for subungual granulation tissue, an indicator that the wound is healing and no reinfection has occurred. 

A partial nail avulsion takes about six weeks to heal. In comparison, total regrowth after a complete nail avulsion can take at least eight weeks, generally requiring 12-18 months for toes to completely heal. 

Why choose University Foot and Ankle for your toenail solutions

UFAI is nationally recognized for advanced wound care treatment — specializing in wounds of the feet. Our podiatry team has decades of combined experience managing the special circumstances surrounding all types of toenail problems and injuries. For a consultation, please call (877) 736-6001 or make an appointment online now. 

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.

 

 

 

 

Toenail avulsion FAQ's

 

How long does it take for an avulsion to heal? 

Partial toenail avulsion can take as little as six weeks to heal. Total avulsions take at least eight weeks. If the avulsion was the result of surgery, healing may be faster compared to avulsion from trauma, which can take up to two years to heal completely. 

 

How painful is toenail surgery?

You should not feel any pain during the surgical procedure thanks to local anesthetic. After the procedure, pain is often minimal and lasts only a couple of days. Often, it is manageable with over-the-counter pain medications like acetaminophen or ibuprofen. 

 

What not to do after toenail removal? 

After toenail avulsion, you should avoid getting the area wet unless instructed by your doctor's cleaning recommendations. Swimming, strenuous physical activity, and tight-fitting footwear should also be avoided.

 

Sources 

Sears JK. The use of a combination nail elevator and hemostat clamp. New instruments for nail avulsion. J Dermatol Surg Oncol. 1992 Mar. 18(3):223-5. https://pubmed.ncbi.nlm.nih.gov/1541756/

Shaikh FM, Jafri M, Giri SK, Keane R. Efficacy of wedge resection with phenolization in the treatment of ingrowing toenails. J Am Podiatr Med Assoc 2008;98:118-22. https://pubmed.ncbi.nlm.nih.gov/18347120/