What is Toenail Removal?

Your toenail can cause trouble in two main ways. First, it can make the skin fold at the side and become very swollen and red (ingrowing toenail). Second, it can become very thick, curved and painful. Both these conditions can be treated by an operation.

Effects of Toenail Removal

With this procedure, the entire nail or only the portion of the nail growing into the skin may be removed. It is most often performed for the following reasons:

  • To relieve pain
  • To relieve swelling (inflammation or infection)
  • To remove a deformed nail
  • To correct abnormal nail growth

Candidates for Toenail Removal

Toenails may need to be removed because of injury or nail infection. The nail may also need to be removed if it is not growing correctly. This may be called an ingrown toenail. This usually happens when the toenail grows into the tissue or skin of the toe.

Your Consultation

Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests, to make sure that you are well prepared and that you can have the operation as safely as possible.

The Toenail Removal Procedure

The toe is made numb with an injection of local anaesthetic into its base. Then, for an ingrowing toenail, a sliver of the nail and of the nail bed is cut out on each side that is tender and swollen. The nail is then always a little narrower. The skin fold settles down. For a thick curved nail, the whole nail and all the nail bed are cut out so that instead of a nail there is just skin.

Recovery

There is no feeling in the toe for an hour or so. After this you may need painkillers such as paracetamol, to control any pain. This gradually improves after a day or so. You should be able to eat and drink normally. The wound has a dressing which should not be removed for one week. You will need shoes with a large area for your toes to accommodate the bandages, or shoes with no toes. Keep the dressing dry and as clean as possible. There may be stitches in the skin. Wash around the dressing to avoid wetting it. Some hospitals arrange a check-up about two weeks after you leave hospital. You should be able to return to a light job within 24 hours and a heavy job within three weeks.

Risks

Complications are rare and seldom serious. If you think that all is not well, ask the nurses or doctors. Bleeding in the first 12 hours may be troublesome. Apply pressure with a bandage on the toe wound and contact your doctor straight away. Pain in the toe that cannot be controlled with simple painkillers, or pain that is bad enough to keep you awake, means you should contact a doctor. The wound is tender and delicate for a week or so after the dressings are taken off. This rapidly gets better. There is also a very small chance of infection, which can be controlled by taking antibiotics for a few days. The chance of the nail trouble coming back is about 1 in 20.

FAQs

What happens during the toenail removal procedure?

For the operation, you will be lying on an operating table. The anaesthetic injection will be given into your toe. This is uncomfortable, but the feeling soon wears off. Your toe will be cleaned with antiseptic, and sterile towels will be draped around it. A tight band will be clipped around your toe to prevent bleeding. The operation is performed. This takes about 15 minutes per toe. The toe is covered with a dressing and a bandage to apply gentle pressure on the wound and to prevent any bleeding.

Are there any alternatives to toenail removal?

If you leave things as they are the trouble with your toenail will stay about the same. Antibiotics can be helpful, especially when the area that is swollen and painful is infected. However, if you don’t have any other treatment, the infection might very well come back. Taking off the nail and letting it re-grow does not give good results. Killing the nail bed with Phenol is sometimes used. Taking away the whole nail bed is needed only if the whole nail is diseased.

Is the procedure painful?

Most patients report no pain during the procedure once the anesthetic has been given. But injection of the local anesthetic can be painful; this discomfort can be reduced by careful administration by your doctor. [Anesthetic injection into toes or fingers are usually quite painful due to the tight skin and many nerve endings. Spraying with a topical anesthetic spray first before the injection may help or perhaps some anesthetic preparations may be less irritating than others—so the doctor can reduce the discomfort somewhat.

How can I avoid future ingrown nails?

Do the following to prevent having ingrown nails:

  • Do not wear high heels or shoes that fit poorly
  • Trim your toenails straight across and do not pick or tear at them
  • If you have diabetes, consider letting a podiatrist or other health professional trim your nails