Toenail Removal Surgery

Dr. Leo Krawetz of Healthy Feet Podiatry in Tampa and Brooksville removes an entire toenail permanently.

This is Dr. Leo Krawetz of Healthy Feet Podiatry.

Today, I have a patient who’s diabetic and has an ingrown nail that also has fungus in it.  Last week, she injured her nail.  It bled under the nail and the nail came loose, but since the nail is permanently damaged, I’m gonna remove the whole toenail today.  So, I’ve numbed her up.  I put a shot here and here of 1% lidocaine and I’m gonna actually now remove the nail in total.  So, I’m freeing the nail up from the cuticle area, which is also called the eponychium and after I free it up, I’m gonna take the whole nail off.  It looks like it would be difficult to get the nail off, but in actuality it’s pretty easy.  At the end of the toe, the nail is actually loose.  You can see that this is coming loose already.  So, I’m gonna put my hemostats behind the nail and then I can spread the hemostats and pull the entire nail off.  Bababooey, there’s the nail.  And now, I’m gonna clean out all this extra skin that’s around the nail and I’m gonna use a tissue nipper for that.  You’ll get this cleaned up.  This is all dried blood and callused skin, and this is a result from the contusion.  Also, will result from the way this patient walks; her toe hits under the shoe when she’s walking and you can see how thick this callus is at the end of the toe.  The callus will probably reform over the next few weeks.  I’ll have to remove it again, but then it shouldn’t come back as there won’t be any more pressure from the nail.  You can see this is very, very thick.  The skin will heal from the inside out after this is completed and it will actually look like a less-deformed toe as long as there’s no pressure on the end of the toe and like I said before, most of the pressure was coming from the nail that was overgrowing and digging into the skin. And we’re almost done with the skin here and it’s much cleaner as you can see underneath.  It’s a nice clean wound and in a minute here, I’m gonna put a chemical called sodium hydroxide at the base of the nail, so it will never grow back again.  The nail is permanently damaged, so just removing the nail and letting it grow out again will not allow the nail to grow normally.  It will never grow normally again because it was damaged under the cuticle, which is back here and it will always produce a thicker than normal nail.  Now, I’m gonna put some sodium hydroxide on the nail matrix.  The nail matrix is what makes the nail grow and that is the area right here and you can see the sodium hydroxide causes a chemical burn to the nail bed and as it burns it, it turns it to whitish-grayish color.  It’s also killing all the nail‑producing cells.  We’ll do 3 sticks of the sodium hydroxide between 10 and 20 seconds each and that’s enough to permanently kill the nail matrix.  It will also cauterize some of the little nerve endings that are there, so it won’t be painful afterwards.  And this is just some vinegar to neutralize the chemical.  And at this point, I’ll put a dressing on here.  The patient will take the dressing off tomorrow, apply some type of antibiotic ointment, and then the patient will return in a couple of weeks and we will clean any of the dead tissue off 2 or 3 more times and that should be it.  There’ll be normal skin right here in the nail bed and we’ll be able to just look like a thin nail is present, even though there is no nail, it’s just the skin.  And the patient will be very happy because no nail will grow back.  Thank you.