Toenail Removal

A Patient’s Guide to Toenail Removal

While no person wants to have surgery for toenail removal, sometimes this is the only solution.  For instance, the common ingrown toenail will sometimes self-correct but when it becomes too painful or infected the only solution is to have the entire nail taken off.  Ingrown toenails are easy to prevent, which includes trimming nails straight across instead of curving and wearing properly fitted shoes.  However, one condition called hyperhidrosis could also be the culprit.

If an ingrown toenail becomes irritated, it would quickly become so painful that walking would be difficult and soon, it would begin oozing pus due to infection.  In this case, toenail removal becomes critical, which involves the nail plate being removed so a new, healthy nail would grow back.  As long as the procedure for toenail removal is done by a qualified doctor or surgeon, the patient would experience no pain during and very little after.

Once it has been determined that toenail removal is necessary, the patient would be asked to lie down on the operating table in the doctor’s clinic or at the hospital.  The knees would be bent so the foot would be flat on the table’s surface.  From there, the doctor would put on sterile gloves and sterilize the entire foot, followed by draping it with a sterile cloth.

With a syringe of Xylocaine, a numbing medication, the area around the nail bed would be injected so the toe and surrounding area of the foot becomes completely numb, known as a digital block.  Depending on the doctor performing the toe removal surgery, a sterile rubber band may also be tightened around the base of the toe, which greatly reduces or eliminates bleeding.

Next, toe removal surgery involves closed tip scissors being slid beneath the cuticle so the nail plant can be separated from the proximal nail fold.  At that point, approximately one-fourth of the nail plate is removed, which is typically the location where the nail curves downward at the corner.  Bandage scissors or a special nail splitter would then cut the free end of the nail back under the nail fold.  As a result, the lateral edge is now straight and smooth.

Working with a hemostat and a loose nail, the next step of toe removal surgery is for the doctor to take off as much of the nail plate possible.  The goal is to remove the plate in one piece, which is done by rotating it out and toward the lateral nail fold but also pulling straight out away from the toe.  Of course, sometimes, the nail plate will break so several fragments must be removed.

To destroy the nail forming matrix under plate area, electrocaury would be used.  This electrode is an important aspect of nail removal in that it keeps the proximal nail fold from being damaged.  In addition, the bloodless field is cauterized using the electrode.  Generally, the nail bed, as well as matrix would be treated in this manner twice.  After toe removal surgery, the site will begin to fill in, usually in two weeks.

During the healing phase, antibiotic gel or cream would be applied and the toe bandaged in gauze.  The patient would also not be able to wear a normal shoe so most will simply slip on house slippers.  Following the doctor’s instructions after toe removal surgery will ensure no infection develops and that a new, healthy nail plate and matrix grow back as expected.