Nail Surgery Healing following Partial Nail Avulsion

Sue Ferguson
Chiropodist and Podiatrist in Tenterden, Kent

Registered with the Health and Care Professions Council
Registration No. CH16194

Nail Surgery Healing

Partial Nail Avulsion and Healing

Healing and recovery following a Partial Nail Avulsion (PNA) for an ingrowing toenail takes about 3-6 weeks or longer.

The toenail however will take about 6 months to 1 year to look completely normal again. This is because complete growth of the toenail from the base to the top of the toenail has to happen. Eventually the toenail will look the same as before the procedure but much narrower which means it will no longer dig in and cause pain and infection.

Case Study

The following documents a partial nail avulsion to the medial side of the right hallux toenail (1st toenail) in November 2008 to permanently cure an ingrowing toenail by removing a small section of the toenail. The toenail was frequently infected and was painful and uncomfortable most of the time.

Partial Nail Avulsion - procedure

local anaesthetic to the base of the right big toenail to numb the toe to make the procedure painless
removal of a small piece of nail (in this case about 4-5mm) from the side of the nail
phenolisation of the relevant part of the nail bed for 1 minute x 2 applications with EZ swabs. Phenol is a strong chemical which is applied to destroy the relevant part of the nail bed to stop the side of the toenail regrowing.

Why was this Procedure Undertaken?

Before the Partial Nail Avulsion the toenail was constantly digging into the skin at the side of the nail and causing the patient pain and discomfort. Several episodes of infection had occurred.

Conservative treatment had been tried for many months which included elevating the side of nail, slightly cutting down the side of the nail to remove a small part of the nail, packing with cotton wool and tinc benz.

The toenail had become a constant source of discomfort.

Healing Photos
Recovery from Toenail Surgery

The following photos below show recovery of the toenail and the surrounding skin following the nail surgery. Healing times vary according to the severity of the ingrowing toenail and the individual patient. Healing typically takes 3-6 weeks or longer.

Without the use of the phenol healing would be much quicker but the side of the toenail would regrow.

The nail often only looks perfectly straight at the side after about 6 months to 1 year when the toenail has grown from the base up to the top of the toe.

Partial Nail Avulsion Healing Day 2	Partial Nail Avulsion Healing Day 3
Partial Nail Avulsion Healing Day 4. Early stages of inflammatory response - a normal occurrence	Partial Nail Avulsion Healing Day 5. The wound starts to look red, a direct result of the phenol. Production of exudate.
Partial Nail Avulsion Healing Day 6	Partial Nail Avulsion Healing Day 7
Partial Nail Avulsion Healing Day 8. Typical healing crisis. The area will normally look at its worse around this time. More exudate evident.	Partial Nail Avulsion Healing Day 9. Patient reports the toe "sore today"
Partial Nail Avulsion Healing Day 10 Huge improvement on previous day	Partial Nail Avulsion Healing Day 11
Partial Nail Avulsion Healing Day 12	Partial Nail Avulsion Healing Day 18
Partial Nail Avulsion - 3 months after surgery. The toenail has flaked at the side which can happen. As the nail grows from the base the side of the nail will eventually become straight.	Partial Nail Avulsion - 4 months after surgery. The toenail is slowly growing up.
Partial Nail Avulsion - 8 months after surgery. You can see that the side of the nail is much straighter now. Still a little way to go.	Partial Nail Avulsion - 9 months after surgery.