Explaining Toenail Removal Surgery

Toenail removal may sound to many like an awful procedure. However, there are many instances in which toenail removal is medically required, and the procedure itself is relatively painless beyond a brief numbing injection. It is performed on a daily basis in podiatry offices and urgent care clinics for nails that have chronic disease. This article will discuss the reasons why this procedure is performed, and how it can be performed quickly and comfortably.

Toenail removal is performed for a variety of different conditions in medical care, and nearly always due to nails that are painful, severely malformed, or are significantly cosmetically displeasing. Nails often become diseased beyond the point of medical treatment to restore them back to their natural state. This can occur when nails become fungally infected, and medical treatment is either ineffective or the nail is too thick and painful from the infection process to bear. Nail fungus infections develop when fungus, a microscopic organism responsible for athlete’s foot, jock itch, and ringworm, moves from the skin around the nails and into the skin underneath the nails. This infection causes the nail to thicken, become discolored, crumbly, and misshapen. Nail fungus is difficult to treat without resorting to oral medications or very specialized topical medications. Some nails can become so diseased that they are painful in shoes or with pressure, and even medication cannot restore these nails to their normal state. In this situation, nail removal is often advised.

Nails also change over time, becoming thickened and misshapen as we age. Many older people simply have thick, uncomfortable nails due to changes in the nail root growth pattern from a lifetime of shoe pressure and minor toe injuries. This process is hastened along at a younger age when there is an injury that bruises the nail or causes it to loosen or fall off. The force produced by these injuries often results in permanent cell damage to the nail root tissue that makes the nail. When the nail finally begins to grow again, it can become thick, grow upward or outward, or become ingrown and c-shaped. Unfortunately, this change is permanent and can never be reversed. Sometimes these nails likewise become painful, and removal is often used to relieve the pain.

Many people have ingrown toenails, either from birth or from the process described above. Unless the adjacent skin becomes inflamed, ingrown toenails do not generally hurt. However, some people develop chronic nail inflammation, and require a procedure to remove the ingrown side of the nail. Usually this can be performed by simply removing one side of the nail, or both, while leaving the central part of the nail alone. In cases where the nail is so severely curved that it looks like an upside down “c”, there would remain little nail after removal of the ingrown borders. In this case, complete nail removal is usually recommended and performed.

Finally, some people simply do not like the look of one of their nails, and may not necessarily have pain associated with it. In this case, the nail may be slightly oddly shaped, or may be discolored from keratin debris under the nail. Although many podiatrists and other physicians who remove toenails generally shy away from pure cosmetic procedures, nail removal can still be performed under the right circumstances.

No matter what the above reasons excepting pure cosmetic motivation, nail removal often makes sense from a medical perspective. Toenails serve no anatomic purpose at this point in human development, and the tissue underneath is simply normal skin. One does not lose anything by having a toenail removed. It is preferable in these situations to remove the toenail permanently, as allowing it to grow back will result in the exact same problem.

The procedure to remove a toenail usually takes under ten minutes from start to finish. It is nearly always performed in an office or medical clinic, and only rarely are toenails removed in an operating room. A local anesthetic is injected into the toe at its base. This is the only part of the procedure that is uncomfortable, and the stinging from the medication lasts under 20 seconds. The toe is cleansed with an antiseptic solution, and the toenail is then gently removed once it is determined the toe is completely numb. The skin underneath the toenail is assessed for any damage caused by the nail disease. The nail root cells found just under the cuticle area are then usually destroyed with a acidic chemical (phenol), although some physicians may use sharp instruments or laser to destroy them. The entire process is over quickly, and the skin is covered with an ointment after the remaining chemical is diluted using rubbing alcohol. A dressing is then placed over the toe, and one is then discharged home without any significant restrictions. Home care involves daily soaking in warm soapy water for 15-20 minutes followed by dressing with ointment and a small bandage or band-aid. Some physicians use a specialized gel that can allow one to skip the soaking all together. This process continues for at least 2 weeks, and the toe skin under the nail generally heals and toughens up within 3-4 weeks. Pain after the procedure is usually limited to only a minor throbbing sensation felt for a couple days, and often is absent completely. Complications such as significant infection or significant pain are uncommon, and are generally related to poor self-care or a minor infection that can be treated with basic antibiotics. Once the skin heals, one will have to look carefully to notice that the nail is gone, and cosmetic-minded women can still paint the skin to match the polish on the other intact nails.

As one can see, the removal of a toenail that is diseased and painful is simple, removes the symptoms completely, and allows for one to be able to return to shoes in comfort. It sounds worse than it really is, and the relief gained far outweighs the discomfort many people have in thinking about the removal itself. It should be considered if one suffers from diseased toenails that are otherwise not effectively treatable.