Toenail Removal by a Podiatrist: Procedure, Indications, and Recovery

Podiatrists (DPM) are the surgical specialists for toenail avulsion and matrixectomy procedures.

Common Indications

• Ingrown toenail (onychocryptosis) — recurrent or infected
• Fungal nails (onychomycosis) refractory to medical therapy
• Trauma: subungual hematoma >50%, nail plate disruption
• Dystrophic/thickened nails causing pain/shoe conflict
• Tumor/cyst excision requiring nail access

Procedure Overview

1. Anesthesia: Digital block (lidocaine ± epinephrine) — near-painless.
2. Avulsion: Partial (affected border) or total nail plate removal.
3. Matrixectomy (optional): Chemical (phenol 88%, sodium hydroxide) or surgical (excision, laser, electrocautery) to prevent regrowth.
4. Dressing: Non-adherent, bulky pressure dressing.

Recovery

• Mild-moderate pain 2–3 days (acetaminophen/ibuprofen)
• Dressing changes daily × 1–2 weeks
• Open-toe shoes, elevation, limited activity 48 hrs
• Complete healing: 2–4 weeks (skin); 6–12 months if nail regrows

Complications (Rare)

• Infection, phenol burn, recurrence, prolonged drainage, nail spicule

Office-based, high success rate, minimal downtime. Conservative measures (proper trimming, footwear, topical antifungals) tried first when appropriate.