What is the treatment for a fallen great toenail?

Management of a Fallen Great Toenail

If your great toenail has fallen off, keep the nail bed clean and protected, watch for signs of infection, and allow the new nail to grow naturally over the next 6-12 months—no specific medical treatment is typically required unless infection develops. 1

Immediate Care and Monitoring

When a toenail falls off (onycholysis), the exposed nail bed requires basic wound care:

• Clean the nail bed and apply topical antiseptics such as povidone-iodine 2% to prevent infection 1
• Protect the exposed area with a clean bandage to prevent trauma and contamination 1
• Monitor for signs of infection including increased redness, swelling, warmth, pus, or worsening pain 1

When to Seek Medical Attention

You should see a healthcare provider if:

• Signs of infection develop, requiring bacterial/viral/fungal cultures and possible oral antibiotics with anti-staphylococcus aureus coverage 1
• Severe pain or suspected subungual abscess is present, which may require drainage 1
• The nail bed appears significantly damaged or there is persistent bleeding 1

Nail Regrowth Expectations

• Toenails typically take 10-18 months to fully regrow after complete loss 2
• Keep nails trimmed straight across as the new nail grows to prevent ingrown nail complications 1
• The new nail may initially appear abnormal but often improves as it continues to grow 1

Preventive Measures During Regrowth

• Wear comfortable, properly-fitted shoes with adequate toe room to avoid trauma to the regrowing nail 1
• Avoid walking barefoot indoors or outdoors to protect the vulnerable nail bed 1
• Apply topical emollients to the nail bed and surrounding skin to maintain moisture 1
• Keep the area clean and dry, especially between toes 1

Common Pitfalls to Avoid

• Do not attempt to reattach the fallen nail—this can trap bacteria and cause infection 1
• Avoid tight footwear or excessive pressure on the affected toe during the regrowth period 1
• Do not ignore signs of infection, as untreated infections can damage the nail matrix and affect future nail growth 1
• Avoid cutting the cuticle or nail folds aggressively, as this can lead to paronychia (nail fold infection) 1

If Fungal Infection Was the Cause

If the nail fell off due to onychomycosis (fungal infection), treatment is necessary to prevent recurrence:

• Laboratory confirmation through KOH preparation or fungal culture should be obtained before starting treatment 3
• Oral terbinafine 250 mg daily for 12-16 weeks is the first-line treatment for toenail fungal infections 3, 2
• Baseline liver function tests should be checked before starting terbinafine 3, 2
• Treatment should begin after the nail has fallen off to maximize effectiveness, as the medication works best when the infected nail material is removed 3

Long-term Nail Care

Once the nail has regrown:

• Maintain proper nail hygiene by keeping nails clean, dry, and trimmed straight across 1
• Use moisturizing creams on the nail and surrounding skin to prevent brittleness 1
• Wear properly fitted shoes to prevent future trauma 1
• Address any underlying conditions such as hyperhidrosis (excessive sweating) that may have contributed to nail loss 4