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Table of Contents

Magill’s Medical Guide, 9th Edition

Nail removal

by Jeffrey R. Bytomski, , DO

Category: Procedure

Anatomy or system affected: Feet, hands, nails

Specialties and related fields: Emergency medicine, family medicine, internal medicine, pediatrics, podiatry, sports medicine

Definition: The partial or total removal of either fingernails or toenails.

INDICATIONS AND PROCEDURES

Nail removal is one of the most common office procedures seen in primary care. Nail disorders leading to removal occur most often in toenails, but they can also occur in fingernails. Common reasons for removal are infection, ingrown nails, or trauma. Patients usually experience pain and inability to function in their normal activities. Rarely are there any systemic signs or symptoms, such as fever, chills, or nausea, unless the cause is a serious infection.

The patient’s foot or hand is first cleansed and draped. Sterile techniques are used throughout the procedure. Patients undergoing partial or total nail removal require adequate anesthesia, which is usually done through a digital block. This procedure is performed at the base of the digit with lidocaine or a similar anesthetic to numb the entire finger or toe. The provider should wait five minutes for the anesthesia to become effective. A tourniquet may be applied to min-imize bleeding and enhance anesthesia. An instrument is then used to separate the nail from the nail bed with the least trauma possible. In a complete removal, the nail is gently pulled away from the nail bed. In a partial removal, scissors are used to cut the desired amount of nail away from the intact nail. Some providers will also chemically destroy the nail matrix in the area of the partial removal to prevent recurrent ingrown nails, if clinically indicated.

Compression for a few minutes may be needed to slow any bleeding from the nail removal. Topical antibiotic ointment may be applied with gauze and a compression dressing. When a toenail is removed, patients may walk immediately after the procedure and resume any activity as tolerated. Local wound care instructions are given, and if the procedure is performed secondary to an infected digit, oral antibiotics may be ordered. The procedure usually takes approximately fifteen minutes to complete.

USES AND COMPLICATIONS

Partial nail removal or trimming may also be performed in diabetic patients or those unable to perform routine nail care. Fungal infections cannot be cured with nail removal alone, though in severe or painful cases, the procedure may be performed in conjunction with the administration of antifungal agents.

Nail removal has few complications if performed properly. Pain is one of the most common complications of the procedure, especially if the digit was already infected. Bacterial infection may also occur after the procedure without proper wound care management. Bleeding may occur, as epinephrine is not used in digital blocks. Adequate compression or cautery usually stops any continued bleeding after the procedure. Patients must also be warned that the nail may not grow back with the same shape prior to removal. Nails should be cut straight across without curvature to prevent any ingrown nail recurrence.

See also Bacterial infections; Diabetes mellitus; Feet; Lower extremities; Nails; Podiatry; Upper extremities; Wounds.

For Further Information:

1 

Clark, Robert E., and Whitney D. Tope. “Nail Surgery.” In Cutaneous Surgery, edited by Roland G. Wheeland. Philadelphia: W. B. Saunders, 1994.

2 

“Nail Diseases.” MedlinePlus, April 11, 2013.

3 

Woods, Michael, et al. “Ingrown Toenail Removal.” Health Library, May 2, 2013.

4 

Zuber, Thomas J. “Ingrown Toenail Removal.” American Family Physician 65, no. 12 (June 15, 2002): 2547-2554.

Citation Types

Type
Format
MLA 9th
Bytomski, Jeffrey R. "Nail Removal." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_0926.
APA 7th
Bytomski, J. R. (2022). Nail removal. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Bytomski, Jeffrey R. "Nail Removal." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed September 16, 2025. online.salempress.com.