Nail Surgery Information Sheet

What is nail surgery?

Nail surgery is a minor procedure performed under local anaesthetic. It may involve removing one or both sides of a toenail, known as a partial nail avulsion, or removing the entire nail, known as a total nail avulsion.

Nail surgery may be recommended for an ingrowing, painful, recurrently infected, severely curved, thickened, fungal or damaged nail.

Will my nail be permanently or temporarily removed?

Your clinician will discuss whether the nail should be removed permanently using phenol or removed without phenol to allow possible regrowth.

Permanent nail treatment with phenol.

When permanent removal is intended, liquid phenol is carefully applied to the selected nail-producing tissue after part or all of the nail has been removed. Phenol causes controlled chemical destruction of this tissue, reducing the likelihood that the treated nail or nail section will grow back.

This approach is commonly used for recurrent ingrowing, painful or significantly deformed nails. Although phenol substantially reduces the likelihood of regrowth, a small section of nail or nail spicule can occasionally grow back. The final appearance of the nail and toe cannot be guaranteed.

Temporary nail removal without phenol.

When nail regrowth is desired, part or all of the nail is removed without applying phenol. This may be appropriate for fungal, thickened, loose, traumatised or cosmetically damaged nails.

Removal may reduce pain or pressure, allow examination and care of the nail bed, and improve access for topical treatment. Nail removal does not, by itself, guarantee that fungal infection will be eliminated.

The new nail may grow slowly, incompletely, thickened, discoloured or misshapen, and fungal changes may persist or return.

What happens during the procedure?

Before treatment, your clinician will confirm your health information, medicines, allergies, circulation, sensation, proposed operation and consent.

Local anaesthetic is injected at the base of the toe to numb the treatment area. The injection may sting briefly. You will remain awake and may feel pressure or movement, but you should not feel sharp pain. The clinician will confirm that the toe is adequately numb before proceeding.

A small tourniquet is temporarily placed around the toe to control bleeding. The agreed section or entire nail is removed. If permanent treatment has been agreed, phenol is applied to the selected nail-producing tissue. The tourniquet is then removed and a sterile postoperative dressing is applied.

Tell your clinician immediately if you experience pain or unexpected discomfort during the procedure.

What are the expected benefits?

Nail surgery aims to remove the problematic nail or nail section and reduce pain, pressure, inflammation or recurrent infection.

Where phenol is used, treatment aims to provide a long-term solution by preventing regrowth of the selected nail tissue. Where phenol is not used, treatment may relieve symptoms, remove damaged nail and support further management while allowing the possibility of regrowth.

A successful clinical or cosmetic outcome cannot be guaranteed.

What are the possible risks?

Expected effects include temporary discomfort from the local-anaesthetic injection, numbness, postoperative soreness, bleeding, swelling and wound drainage.

Possible complications include infection, delayed healing, persistent drainage, postoperative pain, bruising, scarring, altered skin colour, cosmetic change and sensitivity around the treated area. Further dressings, medication, referral, additional treatment or repeat surgery may occasionally be required.

Nail regrowth or a small nail spicule may occur following phenol treatment. Following removal without phenol, the nail may regrow slowly, incompletely, thickened, discoloured, misshapen or ingrowing, or it may not regrow.

Phenol creates a controlled chemical wound. Redness, inflammation and clear or light-yellow non-offensive drainage can occur during normal healing. Less commonly, phenol may affect surrounding skin and cause excessive inflammation, blistering, tissue damage or prolonged healing.

Local-anaesthetic complications are uncommon but can include prolonged numbness, nerve irritation or injury, fainting, allergic reaction or systemic toxicity. Tourniquet complications are uncommon but can include bruising, pressure injury or temporary altered sensation.

Rare complications include severe infection, infection involving deeper tissue or bone, persistent nerve symptoms, significant tissue damage and complex regional pain syndrome. An unexpected reaction or complication may also occur.

How long does healing take?

Healing varies according to the procedure, use of phenol, general health, circulation and aftercare.

A partial nail avulsion commonly heals in approximately four to eight weeks. Total nail avulsion, particularly with phenol, may take approximately eight to twelve weeks and occasionally longer.

Healing may be delayed by diabetes, reduced circulation or sensation, impaired immunity, inflammatory conditions, smoking, certain medicines, infection, repeated pressure or trauma, or dressings becoming wet or contaminated.

How long does nail regrowth take without phenol?

Toenails grow slowly. Visible regrowth may take several months, and a great toenail may take approximately 12–18 months to grow fully. Growth may take longer depending on age, health, circulation and the condition of the nail-producing tissue.

Normal, complete or cosmetically acceptable regrowth cannot be guaranteed.

Will removing a fungal nail cure the infection?

Nail removal may form part of a combined fungal-nail treatment plan but is not a guaranteed cure. Fungal organisms may remain in the nail bed, surrounding skin, footwear or other nails.

Further management may include confirmation of fungal infection, topical or oral antifungal treatment where appropriate, treatment of athlete’s foot, footwear hygiene and monitoring of new nail growth.

What are the alternatives?

Depending on the problem, reasonable alternatives may include monitoring without active treatment, footwear modification, conservative nail cutting or reduction, removal of the problematic edge without phenol, nail bracing where appropriate, treatment of infection, topical or oral antifungal treatment, or referral for another opinion or procedure.

Conservative treatment may provide temporary relief but may not prevent recurrence. Choosing no treatment is also an option, although pain, inflammation, infection or nail damage may persist or worsen.

How should I prepare?

Eat and drink normally unless specifically instructed otherwise. Take your usual prescribed medicines unless the clinician who prescribed them has advised differently. Do not stop anticoagulant, antiplatelet or other prescribed medication without appropriate medical advice.

Tell the clinic about any change in your health, medication or allergies. It is particularly important to report diabetes, reduced circulation or sensation, bleeding or clotting disorders, conditions or medicines affecting immunity or healing, pregnancy or possible pregnancy, current infection, antibiotic treatment, and any previous reaction to local anaesthetic or phenol.

Remove nail varnish, gel polish and artificial nail products before attending. Bring an open-toed sandal or very roomy footwear that can accommodate a bulky dressing. Arrange transport home and do not plan to drive immediately after the procedure.

What happens after surgery?

Rest with the foot elevated for the remainder of the day. Keep the original dressing clean, dry and in place. Your first wound and dressing review will normally take place within 24–48 hours.

Following the first review, you will be shown how to cleanse and redress the wound using the products supplied or recommended by the clinic. Further reviews are normally arranged at approximately one week and, depending on healing, at approximately two to four weeks.

Your clinician will advise when you can return to normal footwear, work, driving, exercise and sport. Healing and activity advice will be individualised according to your procedure and progress.

Consent and questions

Consent is an ongoing process rather than simply a signed form. Before proceeding, your clinician will confirm the exact toe and nail section being treated, whether the procedure is partial or total, and whether phenol will be used.

You will have an opportunity to discuss your individual risks, alternatives and treatment goals. You may ask for the procedure to be paused or withdraw your consent at any time.