A Step-by-Step Guide to Partial Nail Avulsion
Ingrown Toenail Surgery | Perth Nail Surgery Clinic
Are you suffering from a painful ingrown toenail and wondering what happens during ingrown toenail surgery? If your toenail is digging into the surrounding skin, causing redness, swelling, bleeding or infection, a partial nail avulsion may be an effective treatment option.
The thought of having toenail surgery can be daunting, particularly if you have never had a procedure performed on your toe before. However, partial nail avulsion is a commonly performed minor surgical procedure carried out under local anaesthetic, meaning the toe is numbed before treatment begins.
At Perth Nail Surgery Clinic, we specialise in ingrown toenail treatment and surgical management, helping patients find relief from painful, recurring and infected ingrown toenails.
In this guide, we explain exactly what happens during partial nail avulsion, whether it hurts, how long the procedure takes and what to expect during recovery.
What is a partial nail avulsion?
A partial nail avulsion (PNA) is a minor surgical procedure used to treat an ingrown toenail by removing the offending section of nail that is penetrating the surrounding skin.
Rather than removing the entire toenail, only the problematic nail edge is removed. This allows the remaining healthy portion of the nail to stay intact.
The procedure is particularly useful for patients experiencing:
Painful ingrown toenails.
Redness and swelling around the nail fold.
Recurrent nail edge irritation.
Infected ingrown toenails.
Bleeding or excessive granulation tissue.
Difficulty wearing shoes due to nail pain.
Depending on the severity of the condition and whether recurrence is a concern, partial nail avulsion can be performed with or without a chemical matrixectomy. A chemical matrixectomy treats the part of the nail matrix responsible for producing the removed nail section, helping prevent that edge from growing back.
What happens during ingrown toenail surgery?
Partial nail avulsion is performed in several carefully controlled steps. The procedure is generally straightforward and most patients can return home shortly afterwards.
Step 1: Assessment of the ingrown toenail
Before surgery, your podiatrist will examine the affected toe and assess the severity of the ingrown toenail.
This includes checking for:
The location and extent of nail penetration.
Redness, swelling and inflammation.
Infection or discharge.
Hypergranulation tissue (excessive red fleshy tissue).
Previous ingrown toenail treatments or surgery.
Your podiatrist will discuss the recommended treatment, explain the procedure and answer any questions before proceeding.
Step 2: Local anaesthetic injection
The next step is administering local anaesthetic to numb the affected toe.
A small injection is given around the base of the toe, commonly using a digital nerve block technique. This temporarily blocks sensation so that the procedure can be performed comfortably.
You may feel a brief stinging or burning sensation during the injection, followed by numbness as the anaesthetic takes effect.
Your podiatrist will check that the toe is adequately numb before beginning surgery.
Step 3: Removal of the ingrown nail edge
Once the toe is numb, the affected area is cleaned and prepared for surgery.
Your podiatrist carefully separates the offending nail edge from the surrounding skin and removes the problematic section of toenail using specialised surgical instruments.
Only the ingrown portion is removed, leaving the remaining healthy nail intact.
If excessive granulation tissue is present, it may also require appropriate treatment to reduce inflammation and allow the nail fold to heal.
The removal of the offending nail edge eliminates the source of pressure and irritation that has been causing pain and inflammation.
Step 4: Chemical treatment (if permanent nail removal is required)
If you experience recurrent ingrown toenails, your podiatrist may recommend a permanent partial nail avulsion using a chemical matrixectomy.
This involves applying a chemical agent, commonly phenol, to the exposed nail matrix. The nail matrix is the area responsible for producing new toenail growth.
Treating this area prevents the removed section of nail from growing back, reducing the likelihood of another ingrown toenail developing along the same nail border.
It is important to understand the difference:
Temporary partial nail avulsion: The offending nail edge is removed, but the nail matrix is left intact. The nail can grow back.
Permanent partial nail avulsion: The offending nail edge is removed and the corresponding nail matrix is treated to prevent regrowth.
Your podiatrist will discuss which option is most appropriate for your condition.
Step 5: Dressing the toe
Once the procedure is complete, the toe is cleaned and a sterile dressing is applied to protect the surgical site.
You will receive instructions on how to care for your toe at home, including when to change the dressing, how to keep the area clean and what to expect during healing.
Most patients can go home shortly after the procedure.
Does ingrown toenail surgery hurt?
One of the most common concerns patients have is whether ingrown toenail surgery is painful.
The procedure itself should not be painful once the local anaesthetic has taken effect. You may feel some pressure or movement during the removal of the nail edge, but you should not experience sharp pain.
The local anaesthetic injection can cause a brief stinging sensation.
After the anaesthetic wears off, some tenderness, throbbing or discomfort is normal. This is generally manageable with appropriate pain relief and following your podiatrist's aftercare instructions.
How long does ingrown toenail surgery take?
A partial nail avulsion is generally a relatively quick procedure.
The actual surgical treatment often takes approximately 15–30 minutes, depending on the complexity of the ingrown toenail, whether granulation tissue requires treatment and whether a permanent matrixectomy is performed.
However, we book a 1 hour appointment to provide additional time for your initial assessment, local anaesthetic, preparation and post-operative instructions.
What is recovery like after partial nail avulsion?
Recovery depends on whether you have undergone temporary or permanent partial nail avulsion.
Following surgery, it is normal to experience:
Mild tenderness around the affected nail.
Minor bleeding or wound discharge.
Some swelling or redness.
Temporary sensitivity when wearing shoes.
If a chemical matrixectomy has been performed, some ongoing wound drainage can occur while the treated nail border heals.
Tips for a smooth recovery
Keep the dressing clean and follow your podiatrist's instructions.
Elevate your foot when possible, particularly during the first 24 hours.
Wear open-toed or roomy footwear to avoid pressure on the toe.
Avoid activities that cause excessive pressure or friction.
Attend any recommended follow-up appointments.
Do not pick at the healing nail fold or attempt to remove remaining nail fragments yourself.
Healing times vary. A simple partial nail avulsion may heal within a few weeks, while permanent nail procedures involving chemical matrixectomy can take several weeks or longer, depending on the extent of inflammation and tissue involvement.
If you experience increasing pain, spreading redness, worsening swelling, pus or fever, seek medical assessment.
Will my toenail look different after surgery?
With a partial nail avulsion, only the affected nail border is removed, so the remaining nail is preserved.
If permanent nail surgery is performed, the treated side of the nail will remain narrower because that section is no longer intended to grow back.
The final appearance depends on the width of the removed nail section and the surgical technique used.
Is partial nail avulsion a permanent solution?
This depends on the type of procedure performed.
A temporary partial nail avulsion removes the offending nail edge but allows it to grow back. Therefore, the ingrown toenail may recur.
For patients who experience repeated ingrown toenails, permanent partial nail avulsion with chemical matrixectomy may provide a longer-term solution by preventing the problematic nail edge from regrowing.
Our ingrown toenail podiatrists can assess your nail and recommend the most appropriate treatment.