Toenail removal, or excision, is recommended when one of two conditions repeatedly occur and all other simple treatment options have been exhausted. The two conditions that warrant toenail removal are ingrown toenails and thickened toenails. Both of these conditions typically only affect the big toe, and the treatment for both essentially is the same.
An ingrown toenail occurs when the ends of the nail are rounded more than usual. This extra curving allows the nail to grow into the side or the sides of the toe. Once the nail has punctured the skin, infection is likely to occur and continue on and off. A thickened nail grows from the nail bed and normally only occurs when there is damage to the bed of the nail. This damage to the nail bed can occur from a long-term infection with athlete's foot or sometimes from a tumor or growth beneath the surface of the skin.
The procedure for removal of the nail is slightly different depending on the situation. For an ingrown toenail, the first step is to apply a tourniquet to the toe. Just below the tourniquet, a needle with a numbing agent is inserted repeatedly as the agent is administered; this is called a ringblock. Once the numbing agent has taken effect and you no longer have any feeling in the top of your toe, the doctor removes the tourniquet. The doctor then cuts out the portion of the toenail that was growing into the side of the toe, all the way down to the nail bed. Depending on whether ingrown toenails have been a reoccurring problem, the doctor also might decide to burn the nail bed with a chemical to keep the nail from growing and prompting another visit to the doctor.
The procedure to remove the nail when infection is caused by a thickened nail is slightly different. The same procedure is used to numb the toe first. Once you are comfortable and no longer have any feeling in the top of your toe, the doctor will remove the tourniquet. The doctor then will proceed with the surgical removal of the complete toenail rather that just taking a small section of the toenail. The nail bed is then burned to prevent the nail from growing again.
Care of the Excised Toenail
After the toenail has been removed, it is essential to provide proper care at home. The removal of the nail itself is a quick outpatient procedure. Once at home, you will be instructed to stay off of your feet as much as possible while keeping your leg elevated. On the second day after the procedure, you can remove the dressing that was put on after the procedure was completed. Some pain may accompany the removal of the dressing. If pain medication was prescribed, take the medication approximately a half hour before attempting to remove the dressing. If no pain medication was prescribed, an aspirin or other over-the-counter pain medication will suffice. Once the dressing is removed, soak the foot in warm water and soap for about 20 minutes. Once the soaking is complete, remove the foot from the water, dry it off well with a towel, and recover the site with a Band-Aid large enough to cover the area. The process of soaking the foot and covering with the Band-Aid should be repeated twice a day over the next 10 to 14 days until the follow-up appointment with your physician. It is essential that the wound never be left uncovered to reduce the risk of infection. You also must remember to wear cotton socks at all times when not soaking the foot.
Sometimes things happen that would warrant a visit to the doctor before your scheduled follow-up appointment. For example, you always need to watch out for signs of infection. Symptoms of infection include increased swelling, redness, bleeding, drainage and pain. Infection definitely is present when accompanied by a fever. If you experience any signs of infection, it is imperative that you follow up with the doctor right away and not wait until the 10 to 14 day follow-up visit. Infections can turn severe quickly if signs and symptoms are ignored.
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