You might need toenail removal for a variety of reasons. It is a small operation, but it is perfectly normal to feel worried about it. Nail surgery can sound daunting, particularly if you are unsure whether part or all of your toenail will be removed, whether it will grow back, or what the procedure actually involves.
Toenail removal, also known as nail avulsion, is a minor surgical procedure usually performed under local anaesthetic. It can be used to treat persistent nail problems that are causing pain, infection or ongoing discomfort when other treatment is unlikely to solve the problem.
Importantly, toenail removal does not always mean losing your entire nail. Depending on the reason for surgery, a podiatrist may remove only the troublesome section or the whole nail, and can sometimes treat the area to prevent the problem section from growing back.
Why Might You Need Toenail Removal?
One of the most common reasons for nail surgery is an ingrowing toenail. This occurs when the edge of the nail presses or grows into the surrounding skin, causing pain and swelling and, in some cases, repeated infections. Where the problem keeps returning, removing the affected section of nail can relieve the pressure and prevent the same edge continuing to grow into the skin.
Very thick or badly distorted toenails can also become painful. Onychogryphosis, sometimes known as a ram’s horn nail, causes the nail to become excessively thickened and curved. This can create pressure against footwear and the surrounding tissues, making shoes uncomfortable and sometimes making walking painful.
Fungal infection can also leave a toenail thickened, brittle, discoloured or badly deformed. Nail surgery is not automatically required for a fungal nail infection, but removal may sometimes be considered when a severely affected nail is causing persistent problems.
A toenail can also be damaged through a heavy impact, sporting injury, repeated pressure from footwear or accidental stubbing. Nail trauma can cause a toenail to split, lift away from the nail bed, partially detach or grow back in a distorted shape. Not every injured nail needs to be removed, but a badly damaged nail that continues to cause pain or other problems should be assessed by a podiatrist.
Whatever the cause, nail surgery should be used to solve a specific problem rather than simply remove a troublesome-looking nail. Your podiatrist will assess the nail first and determine whether surgery is appropriate or whether the problem can be managed in another way.
What Does Toenail Removal Surgery Involve?
Before nail surgery, your podiatrist will assess the affected nail and discuss your symptoms and medical history. If surgery is considered the most appropriate treatment, they will explain what they recommend, what the procedure involves and any relevant risks before you decide whether to proceed.
The type of toenail removal required depends on the problem being treated.
A partial nail avulsion involves removing only the troublesome section of nail. This is often appropriate when the problem affects one edge of the toenail, allowing the healthy portion to remain in place.
A total nail avulsion involves removing the entire nail plate and may be used when the whole nail is badly damaged, distorted or otherwise causing problems.
Both procedures are normally carried out under local anaesthetic. The anaesthetic is injected into the toe and given time to work before the nail is removed. Once the toe is numb, the podiatrist can remove the affected section of nail without you feeling pain from the procedure itself.
In some cases, the aim is not only to remove the problematic nail but to prevent that section from growing back. A chemical called phenol can be applied to the nail-producing area after removal to greatly reduce the likelihood of regrowth.
This means that toenail removal can be either temporary or permanent depending on what is required. If only one side of the nail is permanently treated, the remaining nail stays in place but will be narrower. Where the entire nail is removed and the whole relevant growth area is treated, the intention is for the nail not to grow back.
Once the procedure is complete, the toe is dressed to keep the area protected while healing begins.
What Can You Expect From Nail Surgery?
The local anaesthetic injection can be uncomfortable for a short time, but the toe should be completely numb before the nail itself is removed.
The actual removal is generally quick. Most of the appointment is taken up by assessment, preparation, allowing the anaesthetic to work and dressing the toe afterwards rather than the removal itself.
As the anaesthetic wears off later, it is normal to experience some soreness or discomfort. Your podiatrist will explain how to look after the toe and manage any discomfort following your particular procedure.
Because the dressing around the toe can be fairly bulky, it is worth wearing or bringing very loose-fitting or open footwear. You can normally walk following nail surgery, although you should plan to rest afterwards and avoid unnecessary activity while the initial wound settles.
You should also arrange appropriate transport home rather than planning to drive immediately after surgery while your toe is still numb.
Nail surgery is a routine minor procedure, but no surgery is completely without risk. Possible complications include infection, bleeding, delayed healing, a reaction to the local anaesthetic or phenol, and regrowth of a section of nail that was intended to be permanently removed. Your individual health and medical history can also influence how well and how quickly the area heals, which is why these are considered before treatment.
What Happens After Toenail Removal?
Once the nail or affected section has been removed, the tissue underneath needs time to heal. The toe will initially be protected by a dressing and may feel sore once the anaesthetic has worn off.
Some swelling and weeping from the wound can be part of the normal healing process. Following the wound-care and dressing instructions provided by your podiatrist helps protect the area and reduces the risk of complications.
The exact recovery after nail removal surgery depends on how much of the nail has been removed, whether phenol has been used and your individual rate of healing. A partial removal may therefore follow a different recovery pattern from removal of the whole nail.
It is also important to distinguish between the surgical wound healing and the toenail growing back. If the nail has been allowed to regrow, replacing the nail takes considerably longer than healing the initial wound because toenails grow slowly.
If the nail-producing area has been permanently treated, the removed section should not return. With a partial removal, this usually leaves a narrower nail. Following permanent removal of the entire nail, there will no longer be a natural nail plate covering the nail bed.
Toenail Reconstruction After Surgery or Damage
For some people, the appearance of the toenail becomes a concern following significant damage or removal.
Where there is enough suitable nail or nail surface remaining, toenail reconstruction can be used to improve the appearance of damaged, distorted or partially missing nails. A specialist flexible gel is used to recreate a more natural-looking nail rather than applying a standard cosmetic false nail.
Reconstruction is not suitable in every situation, particularly where there is no suitable surface for the material to bond to, so the nail needs to be assessed before treatment.
Toenail Removal And Nail Surgery At Northwich Foot Clinic
At Northwich Foot Clinic, our podiatrists can assess painful, damaged and problematic toenails and determine whether nail surgery is the most appropriate treatment.
Where toenail removal is needed, the clinic’s nail surgery package includes the procedure under local anaesthetic, the dressings required during healing and a free follow-up check.
If you are experiencing persistent problems with a toenail and want to find out whether toenail removal or nail surgery could help, book an appointment.
