Toenail Avulsion

Updated 12/14/2022
Toenail Exam

What is nail avulsion? 

Nail trauma and injuries are more common than we’d like them to be. While a stubbed toe or broken nail is annoying but minor, some toenail injuries can be more extreme.

 

Nail avulsion is the separation of the toenail from the nail bed. This can be caused by trauma or injury that tears off part or all of the nail or performed as a medical procedure.

 

Injuries to the foot — such as dropping a heavy object, stubbing your toe on a hard surface, or ongoing trauma from poorly-sized shoes — can cause the toenail to break and fall off. Your podiatrist can also perform a nail avulsion procedure to treat toenail fungus, infection, or injury.

 

Because of where our toe and fingernails are located, they are quite vulnerable to injury. We get plenty of complaints about crushed nails, lacerations, and accumulation of blood under the nails due to injury.

 

Who needs a toenail avulsion procedure? 

Our aim at University Foot and Ankle Institute is to preserve the patient’s foot and use the least-invasive treatment option possible. If less invasive treatment options have not resolved your problem, toenail avulsion may be the next step.

 

During your consultation, one of our expert podiatrists will examine the condition of your toe. Based on the extent of the damage or infection, the nail may be partially or fully removed.

 

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

  • recurring onychocryptosis (ingrown toenails)
  • thickening nails
  • overgrown or irregularly growing nails (onychogryphosis)
  • onychomycosis (fungal infections)

 

Surgical nail avulsion can also be a diagnostic tool. Nail avulsion grants us access to the nail matrix, nail bed, and nail folds. After an assessment of the toenail and surrounding tissues, we can also biopsy a sample of the nail. 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. The procedure may also be combined with chemical matricectomy — chemical destruction of part of the nail bed.

 

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

 

In most other cases, we will perform toenail avulsion (either surgical or chemical) without matricectomy. Without this additional treatment, the nail will grow back.

 

How is chemical nail avulsion performed? 

Chemical nail avulsion is a more advanced treatment for fungal nail infections. An 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 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.

 

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

 

Surgical nail avulsion is a quick outpatient procedure. We will use a digital block for local anesthesia for your comfort but you will generally not need to be sedated for the procedure.

 

If we need to prevent the nail from regrowing, we can also perform nail ablation. This component of nail surgery destroys the nail matrix and prevents a new nail from growing.

 

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 toe 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 your doctor’s directions carefully! In most cases, acetaminophen will be sufficient for pain management.

 

A partial nail avulsion takes about six weeks to heal, and you will see complete nail regrowth faster than with 

 

Turn to University Foot & Ankle Institute for your toenail removal 

UFAI is nationally recognized for advanced wound care treatment — specializing in wounds of the feet. Our podiatrists have decades of combined experience managing the special circumstances surrounding all types of foot problems and injuries.

 

As one of Southern California’s largest and oldest podiatric healthcare practices, our wound care center offers multi-disciplinary medical care. 

 

We are conveniently located throughout Southern California, and the Los Angeles area as our foot doctors are available at locations in or near: Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California. We accept over 1000 PPO health insurance plans, including Medicare.

 

If you want to learn more about how UFAI can help you, we encourage you to schedule a consultation with one of our foot and ankle specialists by calling (877) 736-6001 or making an appointment online.

 

Sources

Bostanci S, Kocyigit P, Parlak N, Gungor HK. Chemical matricectomy with sodium hydroxide: long-term follow-up results. Dermatol Surg 2014; 40:1221.

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.

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. 

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