Toenail removal (nail avulsion)

What is toenail removal, and how does it work?

Toenail removal, known as nail avulsion, is a minor operation that removes part of a problem nail (a partial avulsion, which leaves a narrower nail) or the whole nail (a total avulsion, which leaves no nail)¹. It's used for nails that are ingrowing or deformed and haven't responded to non-surgical care¹.

The aim is to stop the treated part growing back. This is done by removing or destroying the nail matrix (the area the nail grows from), either surgically or with a chemical called phenol¹. When phenol is used there's no surgical cut: it's rubbed over the matrix to prevent regrowth¹.

What is it used for, and how well does it work?

Mostly for ingrown toenails, and that's where the research is strongest. Surgery is better than non-surgical care at stopping an ingrown toenail coming back². Adding phenol to the removal seems to lower the chance of regrowth further, though the research behind this is limited, so the size of the benefit isn't certain³. One patient leaflet puts regrowth at fewer than 5 in every 100 cases⁴.

For other problems, such as thickened nails, it isn't clear yet how well it works. How well you heal also matters: smoking and vaping slow healing and are linked with more complications¹.

Is it right for me?

It suits ingrown toenails that haven't improved with other care, once the problem has been properly checked: other bone and soft tissue problems can look like an ingrown nail⁵.

Phenol isn't used in pregnancy⁶. If you are or might be pregnant, or are breastfeeding, tell the clinic before treatment, because the chemicals may harm an unborn child⁷. Tell them about your medicines and any changes in your health too.

Complications are more likely if you're older, obese, smoke, or have diabetes, heart disease or lung disease⁸, but these aren't automatic reasons to say no. Smoking is the one you can change: stopping beforehand may reduce the risk⁸.

What happens during and after nail surgery?

Before the day, arrange how you'll get home, and ask whether someone should stay with you afterwards.

During the operation you're usually awake, with your toe numbed by local anaesthetic injections¹. A tourniquet (a rubber ring that temporarily stops blood flow) may be placed around the toe⁹. Part or all of the nail is removed, and phenol is often applied. In the surgical version, a small cut is made at the base of the nail and stitched¹. In some cases a general anaesthetic may be preferred, so ask about it¹. If you're under 18, it may only be possible to operate on one toenail at a time¹¹.

Aftercare differs between clinics, so ask for yours. Common advice is to rest with your foot raised for the first few days, keep the dressing dry, wear open-toe shoes, and avoid sport and strenuous exercise for 2 weeks¹⁸. Expect a follow-up visit to change the dressing, for example 10–14 days after the operation¹. Yellowish oozing is normal⁴. Aspirin can make the wound bleed, so ask a pharmacist or your clinic about other pain relief, such as paracetamol¹².

What are the risks and side effects?

The main risks are wound infection (which may need antibiotics) and the nail growing back⁴. There's generally very little bleeding, but there can be more with severe ingrown toenails¹². Phenol can damage the tissue around the nail, causing drainage problems and slower healing¹³.

An allergic reaction to the anaesthetic or phenol is rare⁴. A severe one is extremely rare, and staff are trained to treat it as a medical emergency¹¹. Exact complication rates aren't clear, so ask your clinic what to expect.

How does it compare with other options?

For an early, mild ingrown toenail, non-surgical care usually comes first, and surgery is kept for later stages¹⁴.

If a chemical is planned, the choice matters. Phenol and trichloroacetic acid both lowered regrowth compared with placebo, but sodium hydroxide didn't⁶. Phenol can cause toxic effects in the body as well as locally, whereas trichloroacetic acid isn't reported to⁶. Ask which one is planned for you.

If a nail keeps coming back, ask about a matrix treatment such as phenol rather than repeated plain nail removal, because surgery is more likely to need repeating after plain removal without phenol¹³.