Toenail Removal: What the Procedure Involves and What to Expect

Quick answer:During a toenail removal, a podiatrist numbs the toe, then removes part or all of the nail in a few minutes — you feel pressure, not pain. For recurring nails the root is treated so that portion will not regrow. Expect mild soreness, daily soaks, and normal shoes within a week or two. Call (810) 206-1402.

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.

Toenail removal is one of the most commonly performed minor procedures in podiatric medicine — and one of the most anxiety-inducing for patients who’ve never had it done. The reality: it is a brief, well-tolerated in-office procedure with minimal recovery. Here is exactly what to expect.

When Is Toenail Removal Needed?

• Ingrown toenail (partial nail avulsion) — removing only the offending nail border that is growing into the skin, combined with phenol matrixectomy to prevent regrowth of that specific border
• Chronic toenail fungus (total nail avulsion) — in severe cases where the nail is completely destroyed and causing pain, total removal followed by antifungal treatment allows healthy nail to regrow
• Subungual hematoma — large, painful blood collections under the nail may require nail removal for drainage and inspection of the nail bed
• Nail bed tumor or biopsy — removal of the nail to access the nail bed for biopsy (subungual melanoma evaluation) or minor tumor excision
• Nail deformity — severely thickened, curved, or deformed nails causing chronic pain and wound formation, particularly in elderly patients

The Procedure: Step by Step

Local Anesthesia (Digital Block)

The procedure begins with a digital nerve block — local anesthetic (lidocaine or bupivacaine) is injected at the base of the toe on both sides. Most patients report the injection itself as a brief sharp sting, after which the toe becomes completely numb within 3–5 minutes. No pain is felt during the actual nail removal once the block is in effect.

Nail Avulsion

For partial nail avulsion: a nail elevator is used to separate the nail from the nail bed along the affected border. A nail splitter cuts the border of the nail straight back to the matrix (root). The strip of nail is removed with a firm pull — no pain, but pressure is felt.

For total nail avulsion: the entire nail plate is separated from the nail bed and matrix and removed in one piece or in sections.

Matrixectomy (If Preventing Regrowth)

For permanent ingrown nail correction: phenol (carbolic acid) is applied to the nail matrix for 30 seconds, neutralized, and repeated. The phenol chemically destroys the matrix cells responsible for growing the nail border, preventing regrowth of the avulsed portion. This is what makes the procedure permanent — without matrixectomy, the nail simply regrows in 3–6 months.

Wound Dressing

The nail bed is dressed with antibiotic ointment and a non-adherent dressing. The patient leaves with instructions for daily home dressing changes.

Recovery

For partial nail avulsion with phenol matrixectomy:

• Day 0–3: Some soreness when the block wears off (OTC pain relief adequate); keep the dressing clean and dry
• Days 3–14: Daily dressing changes with antibiotic ointment; minor drainage is normal for up to 2 weeks
• Weeks 2–6: Nail bed gradually closes; most patients return to normal shoes within 2–3 weeks
• Months 2–3: Nail bed fully healed; permanent absence of the removed border (matrixectomy) or beginning of nail regrowth (simple avulsion)

Frequently Asked Questions

How long does it take a toenail to grow back?

6-12 months for a full big toenail. Smaller toenails 4-6 months. Speed varies with age, circulation, and nutrition.

Will this affect other nails?

Trauma affects only the injured nail. Fungal infection can spread without treatment. Systemic causes affect multiple nails simultaneously.

Should I cover the nail or leave it open?

Cover with a breathable bandage during work or activity. Leave open at night for healing. Keep dry and clean.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your foot and ankle conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.