From the Guidelines
Toenail removal is a necessary medical procedure for treating conditions like ingrown toenails, fungal infections, or nail trauma, and it should be performed by a qualified physician to minimize morbidity, mortality, and improve quality of life. The procedure typically begins with local anesthesia to numb the toe, followed by the separation of the nail from the nail bed using specialized tools, and the removal of either part or all of the nail 1. For partial removal, only the affected portion is removed, while complete removal involves taking out the entire nail. After removal, a chemical like phenol may be applied to prevent regrowth if desired. The toe is then cleaned, antibiotic ointment applied, and the area bandaged.
Some key considerations for the procedure include:
- Preventive measures such as gentle skin care instructions, wearing comfortable shoes, and avoiding biting nails or cutting nails too short can help prevent paronychia, a common complication of toenail removal 1
- Topical treatments such as povidone iodine 2%, topical antibiotics, and corticosteroids can be used to treat paronychia, and oral antibiotics may be necessary in cases of infection 1
- In severe cases of paronychia, surgical intervention or partial nail avulsion may be required, and the procedure should be performed by a qualified physician to minimize complications 1
Post-procedure care is crucial to prevent infection and promote healing, and includes:
- Keeping the area clean and dry
- Taking pain medications like acetaminophen or ibuprofen as needed (typically 400-600mg every 6 hours for ibuprofen)
- Wearing open-toed shoes for several days
- Soaking the foot in warm water with Epsom salt for 15-20 minutes daily to help healing
- Monitoring for signs of infection, such as increased redness, swelling, or discharge, and seeking medical attention if necessary 1
It's essential to note that while toenail removal can be an effective treatment for various conditions, it's not without risks, and patients should be carefully evaluated and monitored to minimize morbidity, mortality, and improve quality of life 1.
From the Research
Toenail Removal Procedure
The toenail removal procedure, also known as nail avulsion, is a common treatment for various nail-related conditions. The following are some key points to consider:
- Nail avulsion can be either surgical or chemical, using 40% urea 2
- The procedure is often performed under local anesthesia with or without epenephrine (1:2,00,000 dilution) 2
- Indications for nail avulsion include onychocryptosis, warts, onychomycosis, chronic paronychia, nail tumors, matricectomy, and retronychia 2
Methods of Toenail Removal
There are different methods of toenail removal, including:
- Surgical nail avulsion: a procedure where the nail is removed surgically 2, 3
- Chemical nail avulsion: a procedure where the nail is removed using a chemical agent, such as 40% urea 2, 4
- Combination therapy: a treatment approach that involves a combination of surgical and topical therapy 5
Efficacy and Safety
The efficacy and safety of toenail removal procedures have been studied in various clinical trials:
- A study found that surgical nail avulsion followed by topical antifungal therapy was not a very encouraging modality for the treatment of onychomycosis 5
- Another study found that 40% urea ointment with plastic dressing was superior to bifonazole-urea ointment for complete removal of the infected target nail plate area 4
- A review of the literature found that oral antifungal therapies are effective, but significant adverse effects limit their use, and topical antifungal therapies have minimal adverse events, but are less effective due to poor nail penetration 6
Treatment of Onychomycosis
Onychomycosis is a common fungal infection of the nail that can be treated with various methods, including:
- Oral antifungal agents: such as terbinafine and itraconazole 6
- Topical antifungal agents: such as ketoconazole and oxiconazole 3, 5
- Surgical nail avulsion: a procedure where the nail is removed surgically 2, 3
- Chemical nail avulsion: a procedure where the nail is removed using a chemical agent, such as 40% urea 2, 4