How do I care for a fallen toenail?

Care for a Fallen Toenail

Keep the exposed nail bed clean and protected, apply topical antiseptics, and monitor closely for signs of infection while allowing natural regrowth over several months. 1

Immediate Care of the Exposed Nail Bed

• Clean the area thoroughly and apply topical antiseptics such as povidone iodine 2% twice daily to prevent bacterial colonization of the exposed tissue 2
• Culture the nail bed if there are any signs of infection (redness, warmth, purulent drainage) to guide antibiotic selection if needed 1
• Protect the exposed nail bed with a clean, non-adherent dressing changed daily to prevent trauma and contamination 1

Infection Prevention and Monitoring

• Watch for signs of infection including increased pain, erythema, warmth, swelling, or purulent drainage 1, 2
• If infection develops, start oral antibiotics with anti-Staphylococcus aureus and gram-positive coverage (such as amoxicillin-clavulanate) 1, 2
• The exposed nail bed is particularly vulnerable to colonization by environmental organisms including Candida and Pseudomonas, which thrive in moist environments 3

Daily Hygiene and Protection

• Keep the area dry between cleanings, as moisture promotes bacterial and fungal colonization 3
• Avoid walking barefoot indoors or outdoors to prevent trauma and contamination 1
• Wear well-fitting shoes with adequate toe room and cotton socks to protect the exposed nail bed from pressure and friction 1, 2
• Change socks daily to maintain cleanliness 1

Promoting Nail Regrowth

• Apply topical emollients to the periungual folds and nail matrix to support healthy regrowth 1
• Do not manipulate or pick at the healing nail bed or emerging nail plate 1
• Understand that complete nail regrowth takes 6-12 months for toenails, so patience is essential 1

Common Pitfalls to Avoid

• Never apply artificial nails or nail polish to the exposed nail bed or partially regrown nail, as this traps moisture and increases infection risk 1
• Avoid prolonged soaking in water, which creates an environment favorable for bacterial and fungal growth 1, 3
• Do not use chemical agents or plasters on the healing tissue 1
• Avoid tight or constricting footwear that could traumatize the healing nail bed 1

When to Seek Medical Attention

• Contact a healthcare provider immediately if signs of infection develop (cellulitis, purulent drainage, significant pain) 1, 2
• Seek evaluation if the nail bed appears abnormal, develops excessive granulation tissue, or if regrowth appears dystrophic 1
• Consider podiatry referral if there are underlying foot deformities or biomechanical issues that may have contributed to nail loss 1

Long-term Nail Care After Regrowth

• Cut nails straight across (never rounded at corners) to prevent ingrown nails and future trauma 1, 2
• Maintain regular foot inspections to identify early problems 1
• Use lubricating creams on dry skin around the nail, but not between the toes 1