Management of Partially Avulsed Great Toenail from Trauma
The remaining attached portion of the nail should be removed, and the exposed nail bed should be kept clean with daily antiseptic care, protected with non-adherent dressing, and monitored closely for infection. 1
Immediate Nail Removal
Complete removal of the partially avulsed nail is indicated when the nail plate is nearly detached and causing pain or risk of further trauma. 1 The loose nail acts as a foreign body that can trap debris, promote bacterial colonization, and prevent proper healing of the underlying nail bed. 1
Removal Technique
- Remove the remaining lateral attachment under digital nerve block if needed for patient comfort 2
- The nail bed should be cleaned and cultured at the time of removal if any signs of infection are present 1
- Ensure complete removal to avoid retained nail fragments that could cause complications 2
Nail Bed Care Protocol
First Week Post-Removal
- Apply topical antiseptics such as 2% povidone-iodine daily to prevent infection 1
- Alternatively, perform daily dilute vinegar soaks (50:50 dilution) for 10-15 minutes twice daily 1
- Cover the exposed nail bed with non-adherent dressing to protect the healing tissue 3
- Wear comfortable, well-fitting shoes that avoid pressure on the surgical site 3
- Use cotton socks to reduce friction and moisture accumulation 3
Infection Surveillance
Reassess at 2 weeks for signs of infection including erythema, discharge, increased pain, and swelling. 1, 3 This is a critical timepoint as the exposed nail bed is vulnerable to bacterial colonization.
- Obtain bacterial, viral, or fungal cultures if infection is suspected 1, 3
- If infection develops, begin oral antibiotics with anti-staphylococcus aureus and gram-positive coverage 1
- Continue monitoring until the nail bed has re-epithelialized and new nail growth begins 1
Common Pitfalls to Avoid
Do not leave the partially attached nail in place hoping it will reattach. 1 Once significant onycholysis develops, it is fundamental to promote proper healing as early as possible, otherwise chronic changes may become permanent with nail bed keratinization. 1
- Avoid premature return to tight footwear which can cause repeated trauma 3
- Do not allow prolonged soaking in water or exposure to irritants during the healing phase 1
- Avoid manipulation of the healing nail bed or cuticle area 3
Long-Term Preventive Care
Once healing is complete:
- Apply topical emollients daily to cuticles and periungual tissues to maintain nail health 3
- Trim nails straight across, not too short, to prevent future complications 3
- Avoid nail biting, cuticle manipulation, and using nails as tools 3
- Continue wearing well-fitting shoes and cotton socks long-term 3
- Avoid repeated friction, trauma, and excessive pressure on the toe 3
Expected Timeline
The nail bed typically takes several weeks to heal and re-epithelialize. 4 New nail growth from the matrix will take months to fully replace the removed nail, as toenails grow slowly. 1