Nail Avulsion
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Nail avulsion is a minor operation that removes part of a problem nail, leaving a narrower nail, or the whole nail. It is mostly used for ingrown or thickened toenails that haven't improved with other care. Your toe is numbed first, and a chemical called phenol is often used to stop the treated part growing back. Surgery stops ingrown toenails coming back better than non-surgical care. Most people have one operation per toe and a check-up about 10 to 14 days later.
What is it?
Nail avulsion is a minor operation to remove a problem toenail. In a partial avulsion, only the troublesome edge or part of the nail is removed, so you are left with a narrower nail. In a total avulsion, the whole nail is removed and you are left with no nail, just an indentation.
The nail grows from a small area of tissue at its base called the nail matrix. To stop the treated part growing back, the matrix is either cut out or treated with a chemical called phenol. Phenol is rubbed onto the exposed nail bed and destroys the cells that make new nail.
You may hear different names for this, such as nail surgery, nail removal or phenolisation (using phenol).
What is it used for?
The most common reason is an ingrown toenail. This is a painful problem where the edge of the nail digs into the skin beside it, and it often causes infections. Taking away the part of the nail that digs in should settle the pain and the infection.
Surgery is worth considering when an ingrown toenail causes a lot of pain or infection, or when the skin beside the nail keeps getting inflamed. It is also used for ingrown or deformed nails that haven't improved with non-surgical care. Thickened nails are another reason it may be suggested.
The strongest research is for ingrown toenails. For a nail problem called retronychia, removing the nail resolved about 71.2 per cent of cases. For other uses, such as thickened or involuted (curled in) nails, it isn't clear yet how well it works compared with other treatments.
Is it right for me?
Surgery is usually for ingrown toenails that are painful, infected, or keep coming back. In the early stages, care that doesn't involve surgery often works, so your podiatrist may suggest that first. Surgery is more likely to be needed when the problem is more advanced or hasn't settled.
Before any operation, your podiatrist will check that it really is an ingrown toenail. Other problems with the bone or soft tissue can look similar, so a proper assessment matters.
Who shouldn't have phenol
Phenol should not be used in pregnancy, because the chemicals may harm an unborn child. Tell the clinic if you are pregnant, think you might be, or are breastfeeding. They can talk through your options with you before the day.
Other things that matter
Some risks are higher if you are older, are very overweight, smoke, or have diabetes, heart disease or lung disease. None of these automatically rules you out, but your podiatrist should know about them, and about your medicines.
If you have diabetes or poor circulation, you are more likely to get an infection and heal slowly. If you also have an ingrown toenail, see your podiatrist or GP today rather than treating it yourself. Whether and how nail surgery is done for you is a decision for the practitioner treating you.
If you are under 18, it may only be possible to operate on one toenail at a time. This is because there is a safe limit on the amount of local anaesthetic (the medicine that numbs the toe) you can have in 24 hours.
What happens?
Most people have this done awake, with local anaesthetic injected at the base of the toe or on each side of it. Sometimes a general anaesthetic is preferred, and you can talk this through with your surgeon. A tourniquet (a tight rubber band) is often placed around the toe to limit bleeding while the work is done.
The exact method depends on your toe. There are three common options:
- Part of the nail is cut out together with the matching part of the nail matrix.
- Part of the nail is removed and phenol is applied to the nail bed underneath.
- The whole nail is removed and phenol is applied to the whole nail bed.
With phenol, there is no cut in the skin. A small cotton wisp dipped in phenol is rubbed into the nail matrix for about 2 to 3 minutes. If the matrix is removed surgically instead, the nail and matrix come out through a small cut at the base of the nail. The cut is then stitched and dressed.
This is usually one operation per toe. It is done by a trained clinician and is not something to try at home.
How well does it work?
Surgery is better than non-surgical care at stopping an ingrown toenail coming back. Adding phenol seems to cut the chance of regrowth further. For example, after a partial avulsion with removal of the matrix, the nail came back in about 14 per cent of people when phenol was used, compared with 41 per cent when it wasn't. Exactly how big the extra benefit of phenol is isn't certain.
Other chemicals have been tried. Trichloroacetic acid also lowered regrowth, and it doesn't cause toxic effects through the body. Sodium hydroxide did not lower regrowth.
Figures for how often the nail comes back vary. One patient leaflet says regrowth happens in fewer than 5 in every 100 cases. Some services say the operation is about 98 per cent effective, but that is the service's own statement, so treat it as a rough guide.
Smoking slows healing and is linked to more complications. If you smoke, stopping before surgery may lower your risk.
Risks and side effects
Most people do well, but there are some risks to know about:
- Infection: the wound can get infected and may need antibiotics.
- Regrowth: the nail, or part of it, can grow back. This is what phenol is used to prevent.
- Bleeding: there is generally very little, but more can happen with a severe ingrown toenail.
- Allergic reaction: a reaction to the local anaesthetic or phenol is rare, fewer than 1 person in every 10,000. A severe allergic reaction (anaphylaxis) is extremely rare. Staff are trained to treat it as an emergency.
- Phenol effects: phenol can damage the skin around the nail bed. This can mean the toe drains fluid for a while and heals more slowly. It can also cause toxic effects in the body, which is why it isn't used in pregnancy.
If your toe drains or seems slow to heal, ask your podiatrist what to expect.
Afterwards
After-care advice differs a little between clinics, so follow the plan you are given. Common advice includes:
- You can usually walk straight away, but wear open-toe or soft shoes for the first days.
- Rest with your foot raised for 1 to 2 days, and keep it up as much as you can for a few days.
- Keep the dressing dry.
- Avoid sport and strenuous exercise for 2 weeks.
- Use the painkillers your clinic recommends. Avoid aspirin, because it can make the wound bleed.
You will usually have a check-up about 10 to 14 days later. The dressing is changed then, and stitches are taken out if you had a cut.
Some yellowish oozing is normal. Avoid smoking and vaping while you heal, as they slow healing down.
When to see a podiatrist
Book an appointment if
Your ingrown toenail hasn't settled after 2 weeks of home care, it keeps coming back or getting infected, or it is painful enough to affect walking or work. Also book if a nail change doesn't look like a typical ingrown nail or isn't settling, so it can be checked before any procedure. If you are pregnant, may be pregnant or are breastfeeding, tell the clinic before you have surgery.
Seek prompt assessment if
you have a foot wound or infection and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine. This could be sepsis: call your local emergency number. Also call your local emergency number if, after an anaesthetic or other medicine, you have trouble breathing, swelling of your face, lips, tongue or throat, or you feel faint or dizzy. See your GP or another doctor today if your toe or foot is swollen with pus, warm, more painful, or has redness spreading into the foot or leg, or you feel unwell with a fever. This matters most if you have diabetes or a weakened immune system, and you shouldn't wait to see if it settles. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. If you have diabetes or poor circulation and an ingrown toenail, see your podiatrist or GP today rather than treating it yourself. After surgery, contact your podiatry team, day surgery unit or GP promptly if you have sudden increased pain, redness, heat, swelling, or smelly or increased leakage or bleeding, because you may need antibiotics. Out of hours, use an on-call GP or a health advice phone line, if there is one where you live.
Frequently asked questions
Does having a toenail removed hurt?
The toe is numbed with local anaesthetic before the operation, so you shouldn't feel pain during it. Afterwards, use the pain relief your clinic recommends. If your pain suddenly gets worse in the days after surgery, that can be a sign of infection, so contact your clinic.
Should someone come with me on the day?
It's a good idea to plan ahead. Arrange how you will get home, and ask the clinic whether someone should stay with you afterwards. Having your foot raised and rested at home for the first day or two will be easier with a little help.
What should I ask my podiatrist before surgery?
Ask whether a partial or total avulsion is planned, and whether phenol will be used. Ask what the numbing injections will feel like, what the aftercare involves, and when your follow-up visit will be. Tell them about any medicines, smoking, diabetes or circulation problems.