Caleb Foster
Nails are formed in the nail matrix, which is the only part of the nail that is alive. The nail matrix is located under the base of the nail, and injuries to this area can cause onycholysis, or nail separation. In the case of onycholysis, the nail will eventually grow out, but the detached part cannot be reattached. While it is rare, nail matrices can be permanently damaged, preventing the nail from growing back. Surgical procedures are available to partially or completely remove nails, and these procedures are often carried out to treat ingrown toenails or relieve pain.
| Characteristics | Values |
|---|---|
| Nail removal procedure | Onychectomy |
| Reasons for nail removal | Abnormal ingrown toenail or fingernail, fungal infections, bacterial infections, nail matrix melanoma |
| Nail removal process | Local anaesthesia is administered to numb the toe and toenail area. A tourniquet is applied to stop bleeding, and the nail is gently lifted and removed. A chemical called Phenol is applied to prevent regrowth. |
| Post-operative care | Keep the foot raised to reduce bleeding. Take painkillers for post-operative pain. |
| Nail regrowth | Nails usually grow back with proper medical care. Fingernails can take up to 6-9 months to regrow, while toenails can take 12-18 months. |
| Preventative measures | Keep nails trimmed short, avoid biting nails, wear proper footwear, avoid chemicals that irritate nails |
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What You'll Learn
Surgical nail removal
The recovery process for surgical nail removal typically takes four to six weeks if part of the nail is removed and 10 to 12 weeks if the whole nail is removed. During this time, it is important to keep the dressing clean and dry and change the bandages regularly. Patients are advised to keep their foot raised as much as possible for the first 24 hours to reduce bleeding and avoid driving until the numbness wears off. Most people can return to work or school the day after the surgery if they can keep their foot raised.
While surgical nail removal is generally safe, there are some risks and complications to consider. Removing the entire nail may increase the risk of the new nail growing back misshapen or deformed, which can lead to future ingrown toenails. There is also a small chance of an allergic reaction to the surgical equipment, and the local anaesthesia may take longer than usual to wear off. In rare cases, the toe may remain permanently numb. It is important for patients to discuss their treatment options with a skilled podiatrist or orthopedic surgeon to ensure excellent medical care and reduce the risk of complications.
Overall, surgical nail removal can be an effective solution for chronic ingrown toenails or nail infections that have not responded to other treatments. While it carries some risks, proper medical care and home management can increase the likelihood of a full recovery and the regrowth of a healthy nail.
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Nail regrowth
Nails have a good regeneration capacity, but they grow slowly. The rate of regrowth depends on various factors, including the status of the nail bed, the cause of nail removal, age, and overall health.
If the nail bed is left intact after a nail removal procedure, regrowth usually begins after the wound has healed. This initial regrowth is often visible within 6 to 8 weeks, with full regrowth occurring within 12 to 18 months. However, it's important to note that toenails grow more slowly than fingernails. While fingernails may take 4 to 6 months to completely regrow, toenails can take twice as long, ranging from 10 to 18 months. Younger individuals tend to experience faster nail growth, while aging and certain diseases may decrease blood flow to the hands and feet, slowing down the process.
In some cases, chemical destruction of the nail bed may be performed to prevent the nail from regrowing, particularly in instances of chronic ingrown toenails. When the nail bed is chemically treated, there is a possibility that the nail may not return at all. Additionally, the severity of injury to the nail bed can influence the recovery time, with more severe trauma prolonging the regrowth process.
Proper aftercare is crucial for healthy nail regrowth and preventing complications. It is essential to keep the affected area clean and dry, change dressings as directed, and avoid soaking until advised otherwise by a medical professional. Wearing protective and appropriately fitted footwear is also recommended to avoid pressure on the healing nail bed. Monitoring for signs of infection, such as redness, swelling, discharge, or persistent pain, is important, and any concerns should be addressed by a healthcare provider.
It is worth noting that nail avulsion, the surgical removal of the nail, is a common procedure performed for both diagnostic and therapeutic reasons. It grants access to the nail bed and the deeper germinal matrix for biopsies or treatments. While nail avulsion can be intentional, it can also occur unintentionally due to injuries or trauma. In such cases, the degree and type of damage can significantly influence how the nail regrows.
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Nail matrix damage
The nail matrix is the part of the body responsible for producing new nails. It is located under and underneath the base of the nail, and the only visible part of the nail matrix is the lunula, or the white crescent shape at the base of the nail.
If the nail matrix is damaged, it can affect how your nails look and grow. Nails may become thicker or crumbly, and may have large or small dents, horizontal ridges or lines, splits or cracks, spots or streaks of colour, or other texture changes. In some cases, nail matrix damage can lead to onycholysis, or nail separation, where the nail pulls up from the nail bed. This can be caused by injuries, fungal infections, or reactions to chemicals in nail products.
Treatment for nail matrix damage depends on the cause. In many cases, with proper medical care, healthy nails can grow back even if the nail falls off. It is rare for the nail matrix to be permanently damaged, but if this does occur, protection of the finger or toe during physical activity may be recommended.
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Onycholysis (nail separation)
Onycholysis is a common nail disorder where the nail plate separates from the nail bed. It typically affects a single nail, but it can also affect multiple nails. This condition usually lasts for several months or over a year. It is most frequently observed in adult women.
Onycholysis is caused by trauma or injury to the nail or the nail matrix (the area where nails start to grow). This trauma could be caused by bumping or hitting nails, wearing tight-fitting shoes, or even keeping nails immersed in water for too long. Regular manicures and pedicures can also cause onycholysis due to the force applied during trimming, buffing, and polishing. Additionally, fungal infections can lead to onycholysis, resulting in thick, yellow nails with white spots and streaks.
Other causes of onycholysis include reactions to chemicals in nail products like nail polish, nail gloss, nail hardeners, and fake nails. Certain medications, such as chemotherapy drugs, tetracycline, nonsteroidal anti-inflammatory drugs (NSAIDs), and oral retinoids, can also induce onycholysis. Nail psoriasis, which affects nail structure, is another potential cause. In some cases, onycholysis may be a symptom of an underlying condition like a thyroid disorder, vitamin deficiency, or yeast infection.
The symptoms of onycholysis include nails peeling away from the nail bed, thickened nail beds, and an abnormal border between the pink and white areas of the nail. The border may appear wavy, and the white areas may vary in thickness. Nails may also exhibit discoloration, dents, pits, crumbling, and hemorrhages. Onycholysis is usually painless, but it can be painful if acute or inflammatory.
Treatment for onycholysis focuses on addressing the underlying cause. If the condition is caused by an injury, the nail will eventually grow out, and the affected nail can be carefully clipped or cut away as it grows. Antifungal medications may be necessary if a fungal infection is present. Keeping nails trimmed and avoiding activities that may harm them can help manage the condition and prevent further trauma.
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Fungal infections
Fungal nail infections are characterised by nails that are brittle, discoloured, and thicker than usual. They usually start at the edge of the nail and are typically caused by the same fungus that causes athlete's foot. This fungus thrives in warm, dark, and moist places, such as sweaty feet inside trainers.
Fungal nail infections are unlikely to get better without treatment, and treatments can take a long time. A pharmacist may recommend an antifungal nail medicine that you brush onto the nail and need to use regularly for several months. If pharmacy treatments don't work, your GP may prescribe antifungal tablets, which need to be taken for up to six months. These tablets are not suitable for those with liver or kidney disease, or for pregnant or breastfeeding individuals. In rare cases, badly infected nails may need to be removed under local anaesthetic. Toenail removal is generally a last resort, as the nail can grow back thickened or misshapen, and the fungus can re-infect the nail.
After nail removal, topical medications can be applied to the exposed nail bed as the nail grows back, which may improve the efficacy of the treatment. Nails usually regrow in 6 months or longer for fingernails, and 12 to 18 months for toenails. Laser treatment can also be used to improve the look of the nail after the infection has cleared, although insurance typically does not cover this treatment.
To diagnose a fungal nail infection, a doctor may take a sample of the nail for testing. They may also perform a blood test to check that your liver is functioning properly before and during treatment.
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Frequently asked questions
Nail surgery is a procedure to remove part or all of a nail due to various causes, including ingrown toenails, injuries, and infections.
Nail surgery is usually performed under local anaesthesia. A tourniquet is applied to stop any bleeding, and the nail is gently lifted off the nail bed and removed. A chemical may then be applied to prevent the nail from growing back.
Risks of nail surgery include pain and bleeding after the procedure. Benefits include relieving pain, returning to normal activities, and preventing the problem from reoccurring.
It is recommended to eat something before your appointment and bring any necessary medications. You should also remove any nail varnish, acrylic nails, and jewellery from your fingers and toes.
You should keep your foot raised for the first 24 hours after surgery and follow instructions for pain management. You must not drive until the numbness in your toe has worn off. The dressing will be removed at a check-up appointment, and your nail should grow back over time.
