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Toenail Removal – Before, During, and After Surgery

Dr. Donald Pelto

Reviewed by
Dr. Donald Pelto

Surgical toenail removal (also known as avulsion of the nail plate) is a common method of treatment for a variety of conditions, including “ram’s horn nails” (onychogryphosis) and an ingrown toenail.

Toenail removal may be partial or complete, and in some cases a doctor may recommend permanent toenail removal. This involves the destruction of the nail matrix, the layer of cells at the root of the nail that produces keratin, the material the nail is composed of.

To put it more simply, the matrix creates the nail and causes it to grow. Permanent toenail removal may be recommended for both children and adults who suffer from chronic infected ingrown toenails.

The toenail removal procedure is simple and usually takes no more than twenty minutes—the surgeon injects a local anesthetic into the toe and then removes (or avulses) the nail.

While this may be disturbing for the reader to contemplate, the operation is generally quite painless. After the nail plate has been removed, it may in some cases be necessary to destroy the nail matrix.

This is necessary in cases in which the patient’s condition is so severe (or has gone so long without treatment) that the orientation of the nail matrix has been permanently altered by scarring, making it impossible for the nail to ever grow properly again.

If the toenail is allowed to grow from a matrix that has been damaged in this way, it may not adhere properly to the nail bed. Destruction of the nail matrix can be performed chemically or surgically.

Chemical cauterization of the nail matrix with a chemical called phenol is most common. Although phenol is about 90 percent effective at destroying the nail matrix, there are some cases in which the nail does in fact grow back.

If chemical cauterization is not effective, surgical matrixectomy (removal of the nail matrix) is indicated. This involves surgically creating a flap of the skin at the base of the nail, retracting it back and surgically removing the nail matrix.

Reasons for Toenail Removal

In addition to being useful for the treatment of conditions such as ingrown toenails, warts, nail tumors, or fungal infections like onychomycosis or paronychia , nail avulsion is sometimes useful for diagnostic purposes—a doctor may want to explore the nail bed, the matrix, and the nail folds before deciding whether to conduct a biopsy on the nail bed.

The Nail Avulsion Procedure: What to Expect

Your toenail removal operation will most likely not take very long. To begin, the surgeon will have you lie on your back, either with your knee flexed and your foot flat on the table, or with the knee extended so that the foot hangs off the edge of the table.

Partial nail avulsion: This is usually indicated for ingrown toenails. A local anesthetic is injected into the toe, and the surgeon cuts away the ingrown portion of the nail with surgical scissors, being careful not to injure the nail bed (the skin underneath the nail plate).

It may take three to four months for the excised portion of the nail to grow back, unless a permanent removal or cauterization of the nail matrix was performed.

Complete nail avulsion: This procedure involves complete removal the entire nail with as little trauma as possible. Again, while this may be unsettling for the reader to contemplate, it is almost painless.

Matrixectomy: If your doctor believes the destruction of the nail matrix is necessary after removing the toenail, he or she will perform a partial or full matrixectomy (or matricectomy), which is permanent toenail removal by applying a chemical agent (most commonly phenol or sodium hydroxide) to the matrix.

In some cases the nail matrix is destroyed with electrocautery ablation, using electricity to burn it away. Laser procedures can also be used for this purpose, but the necessary equipment is prohibitively expensive for most practices, and in the majority of cases unnecessary.

What Are The Complications of Toenail Removal?

Complications of toenail removal are not common, but may include partial regrowth of the nail in cases of incomplete matrixectomy. Postoperative infection of the nail bed is also a possibility. Most commonly, patients will have some drainage and tenderness for a week or two following the procedure.

Recovery From Toenail Removal Surgery

After your toenail is removed, you will most likely wear a bandage or a Band-Aid for two weeks, during which time your mobility may be somewhat limited. You will be advised to keep your foot elevated as much as possible, but most patients are able to walk easily after toenail removal.

The first night there may be some throbbing, but ibuprofen or acetaminophen should be sufficient to keep the pain under control. Within a few days, you will be nearly back to normal, and within about two weeks you should be able to resume all your normal activities.

After the procedure, typically the bandage is kept on for 24 hours. After 24 hours, you may remove your bandage and soak the affected toe in lukewarm water and Epsom salt for 20 minutes once or twice a day.

Following soaking, cover the procedure site with a topical antibacterial and a Band-Aid. Your doctor will want to see you within a week or two in order to make sure no infection is present and to clean out the procedure site.

Medical References:

    The American Orthopaedic Foot and Ankle Society http://orthoinfo.aaos.org/topic.cfm?topic=A00154 National Institutes of Health http://www.ncbi.nlm.nih.gov/pubmed/22565429 The Student Doctor Network http://forums.studentdoctor.net/threads/surgical-matricectomy-post-procedure-pain.310006/ The American Academy of Family Physicians http://www.aafp.org/afp/2002/0615/p2547.html The Straight Dope http://boards.straightdope.com/sdmb/showthread.php?t=601985

This page was last updated on October 2nd, 2015



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