Toenail Removal: When It’s Time To See Your Doctor

A doctor looking at a patients foot.

Sometimes the pain from an underlying infection of the toenail might seem inconsequential. But in some cases, home treatment does not work and will require toenail removal to help cease the pain. This post will help provide the information for the proper prevention of ingrown nails when it is time to seek help from a doctor for the medical condition, surgery for toenail removal, and much more. 

Nail Problems That Might Require Toenail Removal

Many conditions may or may not require toenail removal to help the patient. The following will discuss the most common nail problem issues and whether you will need surgery for toenail removal. Toenail removal is unnecessary for many nail problems because patients could use other alternatives to heal their nail problems. However, in some cases, such as ingrown toenails, the nail’s parts are removed to help the patient. 

Ingrown Toenail

One common condition that would require toenail removal for the patient is ingrown nails in the toe. Two out of ten patients who have foot problems that need attention from a doctor have an ingrown toenail. Ingrown toenails, or its medical terminology onychocryptosis, is a condition that happens when a nail, commonly found in the big toe, digs into the skin along the side of the toe. The Institute for Preventative Foot Health has reported that 18% of American adults have experienced this ingrown toenail condition.

Ingrown toenails occur so frequently in many American adults because the toenail is cut too short in the foot. When a person clips the toenail too brief and lets the toenail grow too long on the toe, it allows the toenail to grow back into the skin since the skin on the side of the toenail can cover the nail. It is more likely to grow inward or curve downward into the skin when you are not trimming the long toenails properly. 

Although in most cases, an ingrown toenail does not require toenail removal since it will grow out and heal on its own. There are many causes of ingrown toenails, and one of the reasons is that it is a hereditary condition that makes it likely for an offspring to tend to develop an ingrown toenail. The procedure for toenail removal is entirely painless since the surgeon will put the patient under the effects of an anesthetic. During the surgical toenail removal procedure, the surgeon would remove all or part of the nail. After the surgeon removes the toenail, it usually takes 6 months to two years for the toenail to grow back. The duration for the nail to grow back depends on how much of the toenail the surgeon removes. 

Elderly woman holding her foot in pain.

Subungual Hematoma

In some instances, an issue requiring toenail removal is a subungual hematoma or a nail trauma condition where blood collects underneath the toenails or nails because of a traumatic accident. For example, a traumatic accident could hit the nail accidentally with a hammer or stubbing a toe. In some cases, the injury may only hurt slightly. However, in other cases, when the blood pools collect under the toenail may cause severe pain to the patient. In addition, there will usually be noticeable color changes in the blood clot from red, brown, then black. Sometimes, in severe cases, the pressure from the blood underneath will cause the nail to lift off the finger. 

The usual procedure for severe subungual hematoma uses a trephination medical technique. Trephination involves using a sharp instrument to pierce through the traumatized nail, drain the blood underneath the toenail, and relieve the patient of severe pain—toenail removal for nail trauma that had experienced nail bed lacerations in the nail area. However, toenail removal is not a necessary treatment for most cases of toenail trauma because it makes no difference in the effects between toenail trephination instead of toenail removal. 

Toenail removal for toenail trauma is needed when the bleeding in the nail area does not stop and extends far more than half of the nail. Seeking a medical professional is also recommended when the pain becomes too severe for the patient. It is also best advised when there’s a significant injury to the injured part of the nail. In the case of substantial damage causing the subungual hematoma, the doctor will do an x-ray to see if there is a fracture.

Fungal Nail Infection

For example, fungal nail infection is another nail problem that might require toenail removal. The signs that you may have nail fungus are if the nail has become crumbly, contains yellow or brown discoloration, foul smell, or debris building under the toenail. When left untreated, toenail fungus will affect the other nails and become increasingly separated from the nail bed. 

Besides toenail removal, there are many ways to treat fungal nail infection, including taking medicines and getting laser treatment. Oral medications are usually the first choice, and these drugs help the new nail grow free of fungal infection and help replace the infected areas. There is also antifungal nail polish that the patient can use to paint on the infected area and the skin around it. Then there is antifungal nail cream besides oral medication and antifungal nail polish, which you can choose to help with the fungal nail infection.

However, nail removal is the last resort in treating this case. Like surgery for ingrown nails, the doctor would give the patient some injection to prevent pain in the area before surgery. In toenail removal for fungal nail infections, the doctor would loosen the nail from the skin and then separate the toenail from the skin before proceeding. Next, the doctor would try to remove the nail parts that require removal. 

Common Causes of Ingrown Toenail

Various reasons cause ingrown toenails that might warrant the need for toenail removal from nail surgery. One of the causes is the edge of the toenail pressing into the skin and continuing to grow. Another reason that might cause ingrown nails is wearing shoes that don’t fit well with the foot, which will press the toenail into the skin. Tight shoes are a problem for ingrown toenails, which in some cases will require toenail removal because they push them together and create pressure on the toenails.

For people of advanced age, the common causes might be the degradation of their eyes and the inability to reach their toes easily, making it difficult to trim their nails as easily as before. Also, thick toenails are a problem since the growth rate of nails decreases with age. Which makes it harder to cut their nails than before.

For teens who are active in a sport like playing soccer, the cause for ingrown nails, which will warrant toenail removal, is repeated sports activities that might injure the nail. In this situation, the ingrown nails are from repeated activity that might cause the nail to peel or tear a small part of the nail. A torn nail will irritate the skin around itself, creating inflammation or an infection. Besides soccer, which makes it more likely to place continued pressure on the toenail, another sports activity might be running, creating tension between the toenail and the soft skin. 

Another reason teens have ingrown nails is when the toenail is too short or rounded at the edge and when their feet are sweaty from exercise. Sweat, in this case, causes the nail to become softer or brittle because of the moisture from the physical exertion. Teens who do sports will likely sweat more on their feet, causing the nail to soften. The addition of soft pins will make the nails split more easily when coupled with activities that might cause repetitive damage to the toenail, like running or soccer. Besides playing strenuous physical sports, another reason for softer nails is vitamin deficiency. 

Working in a job that causes damage to the toenail would also be a possible case of repeated activities that injure the toenail that will require toenail removal. It will require toenail removal not just because of the consistent pressure on the skin or because the shoe pinches the toes together. Sometimes without the proper gears that adequately protect the foot, like a steel-toed shoe, it will make it possible for heavy objects to fall on the soft nail of the foot.

Woman holding her foot in pain.

Symptoms of Ingrown Toenail

One of the initial symptoms of an ingrown nail that might require your conscious attention and consideration of toenail removal is when the skin becomes inflamed. You will be able to see that the skin around it has become swollen or red. When the skin becomes inflamed, there will also be pain from that area you feel due to blood supply streaming into that area of your foot. Another is that there might be a puss, yellowish drainage coming from the nail, and other signs of infections. Besides the more obvious symptoms, there’s also a condition called a granuloma, when new tissues start to grow over the toenail, from inflammation to the affected skin.

When the symptoms of the ingrown nail start appearing in the foot, it is best to visit a doctor to get medical attention for toenail removal for the pain the patient is experiencing. The ingrown toenail will not continue to dig deeper and further through the toe if it is left untreated or find ways to manage the ingrown nail. Also, without toenail removal, the pain in that sensitive area with redness or infection will cause extreme pain to the patient when there is a slight bump from the front of the tight shoe to the toe that had ingrown. 

Patients with diabetes or neuropathy observing the symptoms mentioned, like swelling or pain in the toe, should be cautious. Diabetes or neuropathy will make it difficult for the patient to sense pain from the injured area. In addition, patients will also have trouble fighting off infection due to their immune systems. Therefore, the patient will only feel pain when the injury has not become too painful to keep away from notice. The inflammation is also easier to spread in patients with a weakened immune system, which will allow the bacteria to affect the wound from the nail. Without toenail removal from the foot, the infection will spread along the toe and create cellulitis in the toe.

Doctors have characterized different stages of severity to the ingrown nail as it requires surgery for toenail removal. The first stage is when the skin becomes inflamed because the ingrown nail has grown into the soft tissues of the toe. The second stage is when the patient sees infections and granuloma, the appearance of tiny granules that produce around the toe. Lastly, the third stage is where the patient will feel extreme pain from that area of the toe, intense infection with oozing pus or drainage, and the appearance of a granuloma that has grown over the nail. 

Woman holding her foot in pain.

Preventing Ingrown Toenails

You can take many steps to help prevent or avoid ingrown toenails at home. Sometimes, ingrown toenail treatment at home may resolve the condition causing the person pain. When ingrown toenails begin to cause much discomfort, seeing a medical specialist is necessary for toenail removal. Preventing the growth of ingrown toenails is essential, and there are a lot of steps to take in terms of prevention. An obvious tip is to wear shoes that give ample room for your toes, which means don’t select pointed or too tight shoes on the toes.

In addition, it is an excellent consideration for anyone active in sports to wear breathable shoes that allow air and water vapor to escape from inside the shoe. Wearing breathable shoes will help with sweaty feet, preventing ingrown toenails from the nail from softening due to the moisture of the sweat and biting into the soft tissue around the toe. When the nail becomes too brittle, it is easy to chip and injure the delicate skin around it, causing an ingrown toenail that will require toenail removal.

Another step you can use to prevent ingrown toenails and avoid needing toenail removal is to trim the toenails properly. First, you can do this by not rounding the toenails around the edges. Also, let them be in the proper length so that corner where the nails are can rest on the skin at the side. You can also file the toenail to be more rounded and don’t poke the skin around itself. Lastly, if you notice any symptoms of the ingrown nail, it is essential to contact a doctor to consider nail surgery for toenail removal to cease the pain felt in the foot.

Ingrown Toenail Treatment From a Doctor

When you go to a doctor to seek medical advice for the nail, they would first perform a diagnosis. During the diagnosis, the doctor will be checking the toe where the nail has grown into the skin to see if it will require toenail removal and might also give you antibiotics. Then, the doctors would recommend toenail removal to remove a part of the entire ingrown nail and advise the patient to see a podiatrist. 

As part of the surgery when the doctor is doing the toenail removal as part of the surgery, the doctor would first numb the toe where the ingrown nail is. The second step of toenail removal is to lift the toenail along the edge where the nail grows into the skin’s soft spot. Then, in the next stage of the toenail removal surgery, the doctor would destroy all or part of the nail. 

The last step of the toenail removal surgery is eliminating the nail root. Destroying the nail root is crucial because it prevents the ingrown nail’s continued growth a couple of months after the toenail removal surgery. Nail ablation is the medical term for removing the nail root during the toenail removal process. The most common way to do this is by using electrocautery ablation to destroy the nail-forming matrix tissue. The other method of nail ablation besides electrocautery ablation is through a liquid solution applied to the exposed part of the nail bed or matrix tissue. The technique of nail ablation will keep the nail from growing into the skin again, but not all people who perform the toenail removal surgery will require nail ablation. 

After the surgery for toenail removal, the doctor will most commonly give the patient any medicine they need to help cope with the pain. Some common medications that doctors give to patients after the surgery may include Ibuprofen or Tylenol to help the patient cope with pain. It is best to keep the wound clean and dry during this time, so there will not be any contamination. Another recommendation is to avoid wearing any tight-fitting shoes. It is best to wear shoes with a lot of open space for the toes for the specified time appointed by the doctor. Also, avoid activities that might cause nail problems like running or sports like soccer. Finally, it is essential to call your doctor if you notice that your toe is not healing after the toenail removal procedure. 

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