Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
| Procedure Type | Nail Removed | Matrix Destroyed? | Nail Regrows? | Indication | Recurrence |
|---|---|---|---|---|---|
| Temporary Avulsion (full or partial) | Full plate or border | No | Yes — 6–12 months | Subungual hematoma drainage; nail bed access; acute trauma | Underlying condition can recur |
| Partial Permanent Matrixectomy (Phenol) | Border (1–3mm) | Yes — chemical | No (that border) | Recurrent ingrown toenail | 5–10% |
| Partial Permanent Matrixectomy (NaOH) | Border (1–3mm) | Yes — chemical | No (that border) | Recurrent ingrown; faster healing than phenol | 5–10% |
| Total Permanent Matrixectomy | Full nail plate | Yes — full matrix | No | Onychomycosis refractory; severe pincer nail; trauma with irreparable matrix | <5% |
| Winograd Procedure (surgical) | Nail border + nail fold tissue | Yes — excisional | No (that border) | Failed phenol; hypertrophic nail fold | <5% |
| Phase | Timeline | What Happens | Care Instructions |
|---|---|---|---|
| Procedure day | Day 0 | Digital block; avulsion; dressing; walk out | Keep dry 24h; elevate; OTC pain reliever PRN |
| Early healing | Days 1–7 | Wound weeps; mild soreness; initial granulation | Daily wound soak (Epsom salt or saline); non-adherent dressing; avoid pools |
| Intermediate healing | Weeks 2–4 | Granulation tissue matures; wound contracts | Continue daily dressings; wear open-toe or wide shoe |
| Full healing (temporary avulsion) | 4–6 weeks | Nail bed epithelialized; new nail emerging | Protect new nail; avoid trauma; normal shoes by 4–6 weeks |
| Full nail regrowth (temporary) | 6–12 months | Full nail plate replacement | Moisturize; no tight shoes during regrowth |
| Full healing (permanent matrixectomy) | 3–6 weeks | Wound closed; no nail plate present | Normal toe appearance; cosmetically acceptable without nail |
Quick answer:A toenail avulsion is a common in-office procedure in which a podiatrist removes part or all of a problem nail — for a severe ingrown, fungal, or injured nail — under local anesthetic. It is quick and low-risk, and the nail edge can be treated to keep the problem from returning. Call (810) 206-1402.
Watch: Tea Tree Oil Toenail Fungus Home Treatment [Doctor Cure!] — MichiganFootDoctors YouTube
Toenail avulsion — removing part or all of a toenail — sounds more dramatic than it actually is. It is one of the most commonly performed in-office podiatric procedures, typically done in less than 15 minutes under local anesthesia with minimal post-procedure discomfort. Here is everything you need to know.
The most important clinical decision with Toenail Avulsion Removal What To Expect isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
When Nail Removal Is Indicated
Partial nail avulsion: the most common indication is a recurrent or severely ingrown toenail that fails to respond to conservative treatment. The offending nail border is removed and the underlying nail matrix is permanently destroyed (matrixectomy) to prevent that portion of the nail from growing back. Total nail avulsion: indicated for severe fungal nail infection, significant nail trauma, nail bed tumor, or complete nail detachment.
The Procedure: What Happens
Local anesthetic is injected at the base of the toe (digital block). The toe becomes completely numb within 3-5 minutes. The nail or nail border is separated from the nail bed and removed. If permanent prevention is desired, phenol (a chemical matrixectomy agent) is applied to the nail matrix for 30 seconds to destroy the nail-growing cells. The procedure takes 10-15 minutes total.
Permanent vs. Temporary Removal
Temporary avulsion (nail removed, matrix left intact): the nail grows back in 6-12 months. Used for trauma, hematoma drainage, or accessing the nail bed for treatment. Permanent avulsion (matrixectomy with phenol): the nail border or entire nail is permanently prevented from growing. Appropriate for recurrent ingrown toenails to eliminate the problem permanently.
Recovery
After the procedure, a bulky dressing is applied. The toe may throb mildly as the anesthesia wears off — over-the-counter pain medication is sufficient. Daily foot soaks and dressing changes are typically recommended for 2-3 weeks. Most patients return to normal activities within 1-3 days. The toe must be kept clean and dry to prevent infection.
Success Rate
Partial avulsion with phenol matrixectomy has a success rate of approximately 95% for permanent ingrown toenail resolution. Total nail phenol matrixectomy has similar rates. The most common complication is a small nail spicule (regrowth at the matrix edge) requiring re-treatment.
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✅ Pros / Benefits
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Dr. Tom Biernacki’s Recommendation
Nail avulsion is one of the most gratifying procedures I do because patients with chronic painful ingrown toenails walk out of the office the same day with immediate relief. The anesthesia is the only uncomfortable part, and after that the procedure is painless. I always discuss whether the patient wants permanent prevention or temporary removal — most choose permanent. — Dr. Tom Biernacki
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
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Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Township
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If home treatment isn’t providing relief for your toenail condition, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
American Academy of Dermatology: Nail Conditions
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If the reason for the avulsion is an ingrown nail, our complete guide to ingrown toenail removal in Michigan covers the whole procedure, what it costs with and without insurance, and how quickly you can be seen.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.