How Do Doctors Remove Toenails Step By Step?

You might be facing a toenail removal and want to know exactly what happens. Doctors remove a toenail by first numbing the toe with a local anesthetic injection, then separating the nail from the skin and nail bed using a thin tool, and finally lifting or cutting the nail off. The entire procedure takes about 10 to 20 minutes. The nail can grow back over several months, or the doctor may permanently prevent regrowth if the problem is chronic.

What Exactly Happens During the Numbing Process?

The numbing is often the part people worry about most. The doctor injects a local anesthetic like lidocaine into the base of your toe. You will feel a burning or stinging sensation for about 10 to 15 seconds. After that, the entire toe goes completely numb within a minute or two.

Some doctors use a tourniquet or a small rubber band at the base of the toe. This keeps the anesthetic in the area and reduces bleeding during the procedure. The toe will feel thick and rubbery to you, but you will not feel any cutting or pulling. If you feel anything sharp during the removal, tell the doctor immediately. They can add more numbing medicine before continuing.

How Do Doctors Remove Toenails Step By Step: The Full Procedure

Once the toe is numb, the doctor cleans the entire area with an antiseptic like betadine. They then use a small, flat tool called an elevator to gently slide under the nail. This separates the nail from the skin and the nail bed underneath. You may feel pressure but not pain.

After the nail is fully separated, the doctor uses a hemostat — a clamping tool — to grip the nail firmly. They then roll or lift the nail straight out from the nail bed. If the nail is thick or brittle, the doctor may cut it down the middle first and remove each half separately. This is faster and causes less trauma to the surrounding skin.

If the goal is permanent removal, the doctor applies a chemical called phenol to the nail bed after the nail is out. Phenol kills the nail matrix cells so the nail cannot grow back. Research published in the Journal of the American Podiatric Medical Association shows that phenol treatment has a success rate of about 95 percent for preventing regrowth.

What Happens Right After the Toenail Is Removed?

Immediately after removal, the doctor applies pressure to the toe with gauze to stop any bleeding. This usually takes a few minutes. They then apply an antibiotic ointment and cover the toe with a sterile dressing. You will be able to walk out of the office, though you should wear open-toed shoes or sandals.

You will need to keep the dressing dry for the first 24 to 48 hours. After that, you can change the dressing daily. Soak the toe in warm water with Epsom salt for 10 to 15 minutes twice a day to keep the area clean and reduce swelling. The American Academy of Dermatology recommends doing this until the skin heals completely.

Pain after the procedure is usually mild to moderate. Over-the-counter ibuprofen or acetaminophen is typically enough. Most people return to normal activities within one to two days. Avoid running, jumping, or heavy exercise for at least one week.

What Are the Risks and Side Effects of Toenail Removal?

Infection is the most common risk. Signs include increased redness, warmth, pus, or pain that gets worse instead of better after three days. If you have diabetes or poor circulation, your risk of infection is higher. The CDC reports that foot infections in people with diabetes are a leading cause of lower-limb amputations, so careful wound care is critical.

Bleeding is usually minor and stops quickly. Some people experience a condition called paresthesia, where the toe feels numb or tingly for weeks or months. This is usually temporary and resolves on its own. In rare cases, the nail may grow back deformed or with a thickened ridge if the matrix was only partially removed.

If phenol is used for permanent removal, the toe may ooze a clear or slightly yellow fluid for several weeks. This is a normal reaction to the chemical. It is not an infection. Keep the area clean and dry, and call your doctor only if the drainage becomes thick, green, or foul-smelling.

When Is Toenail Removal Medically Necessary?

Doctors do not remove toenails for cosmetic reasons alone. The most common reason is a chronic ingrown toenail that keeps coming back despite home treatment. If the nail digs into the skin and causes repeated infections, removal is often the best long-term solution.

Another common reason is a fungal infection that has made the nail very thick, painful, or crumbly. Oral antifungal medications work for many people, but they take months and can stress the liver. For severe cases, removal provides immediate relief. Some studies suggest that combining nail removal with topical antifungal treatment improves cure rates compared to medication alone.

Trauma is another reason. If you drop something heavy on your toe and the nail is partially detached or bleeding under it, the doctor may remove it to prevent infection and allow a healthy nail to grow back. People with diabetes who develop a foot ulcer near a toenail may also need removal to prevent the infection from spreading to the bone.

Common Misconceptions About Toenail Removal

Many people believe the nail never grows back after removal. This is not true. If the doctor only removes the nail without treating the matrix, the nail will grow back fully in 6 to 12 months. Permanent removal only happens when phenol or another chemical is applied to the matrix.

Another widespread claim is that you should not walk after the procedure. This is false. You can walk immediately. The toe may be sore, but weight-bearing is safe. Some people also think soaking the toe in alcohol or hydrogen peroxide speeds healing. This is not supported by evidence. Warm water and mild soap are better. Hydrogen peroxide can damage healthy tissue and slow healing.

There is also a myth that toenail removal is extremely painful. The procedure itself is painless because of the numbing. The injection stings briefly. The recovery pain is usually less than the pain of a chronic ingrown toenail. Most people say the relief outweighs the temporary discomfort.

What to Avoid Before and After Toenail Removal

Before the procedure, do not take blood thinners like aspirin, ibuprofen, or warfarin unless your doctor tells you otherwise. These increase bleeding during and after the removal. If you take prescription blood thinners, your doctor will advise you on whether to stop them temporarily.

Do not try to remove the nail yourself at home. This is one of the most dangerous viral health trends online. Home removal can leave nail fragments behind, cause severe infection, and damage the nail bed permanently. A doctor has sterile tools, proper numbing, and the training to remove the nail completely and safely.

After the procedure, avoid tight shoes for at least two weeks. Pressure on the healing nail bed can cause pain and delay healing. Avoid swimming, hot tubs, or soaking in bathwater for at least 48 hours. Do not apply any creams or ointments that were not prescribed by your doctor. Stick to the antibiotic ointment they gave you.