What Is Nail Avulsion?
Nail avulsion is the partial or total nail removal from its bed. This can be due to trauma, infection, or chronic nail conditions such as fungal infections or ingrown toenails. Occasionally, it occurs intentionally, like during surgery, or because of a traumatic accident. If not managed properly, an avulsion of the nail plate can lead to prolonged discomfort, infection and poor nail growth.
The nail bed, a very sensitive structure beneath the nail plate, is crucial in the nail’s regeneration. A nail bed avulsion requires careful management to minimise scarring and ensure the nail grows back in the correct position. When trauma is severe, a podiatrist can provide tailored management to help heal and reduce nail avulsion pain.
Causes and Risk Factors of Nail Bed Injury
A nail avulsion injury can be related to any of the following:
- Nail Bed Injury: Trauma to the toes can cause various types of injuries, such as subungual hematoma, nail bed laceration, or nail bed avulsion.
- Nail Bed Laceration: Direct trauma to the toe tip can cause lacerations, often with a subungual hematoma.
- Ingrown Toenails: Severe cases of ingrown toenails may require partial or total nail removal to relieve pain and prevent infection.
- Fungal Infections: Long-standing fungal infections can weaken the nail, making it more prone to detachment.
- Psoriasis and Other Skin Conditions: Certain skin conditions can affect nail integrity, leading to avulsion.
Regardless of the cause, while minor nail avulsion can heal on its own, severe cases need medical attention to prevent secondary infection and proper regrowth.
Anatomy and Function of the Nail
The nail is a complex structure composed of several layers, each of which plays a role in nail health and growth. The nail plate is the hard keratinised layer on the surface that protects the sensitive structures beneath.
Beneath the nail plate is the nail bed, a highly vascular area that supports the nail and contributes to its overall health.
The nail matrix is located at the base of the nail, and under the proximal nail fold is the growth centre where new nail cells are produced. The proximal nail fold and the surrounding nail folds act as a barrier to protect the nail matrix from infection and injury.
Nail Bed Avulsion Management
When the nail plate is removed or severely damaged, the underlying nail bed is exposed and is vulnerable to infection and further trauma. Proper care is crucial for optimal healing.
In severe cases with significant damage to the nail bed or partial detachment of the nail, assistance from a podiatrist is advisable to promote healing and to prevent complications.
Immediate Care
Clean the area and apply a sterile dressing to prevent contamination if a nail avulsion injury occurs. Over-the-counter pain relief can help manage nail avulsion pain, but professional evaluation is necessary to determine if further intervention is required.
Podiatric Intervention and Surgery for Partial Nail Avulsion
For severe or chronic cases, nail avulsion surgery may be necessary. This is performed under local anaesthesia, where the damaged portion of the nail is safely removed to ensure that the underlying nail bed is protected.
Partial nail avulsion is a procedure where only a portion of the nail is removed to address specific issues with minimal damage to surrounding tissues. Total nail avulsion is a procedure where the entire toenail is removed due to severe trauma or nail pathologies.
If there is an infection, antibiotics may be prescribed. Some cases, such as recurrent ingrown toenails, may require chemical matrixectomy, where part of the nail matrix is treated with a chemical agent to prevent regrowth. This will reduce discomfort and minimise future nail-related issues.
Managing Nail Avulsion Pain and Recovery
Nail avulsion recovery varies depending on the extent of the injury and the patient’s overall foot health. Healing will take several weeks, with full nail regrowth taking months. Patients should elevate the foot for the first few days to reduce swelling and discomfort. Over-the-counter anti-inflammatory medication may also help with pain.
During recovery, keep the affected toe dry and clean. Apply prescribed antibiotic ointments to prevent infection. Avoid wearing tight footwear that can cause friction on the healing nail bed. Monitor for signs of infection, such as increased redness, warmth or pus formation. Also, look for ingrown nails and seek intervention if they occur to prevent complications.
A podiatrist may also recommend custom footwear adjustments or orthoses to offload pressure from the affected area, especially for those prone to repeated nail trauma. At The Foot Practice, our 1,000-point sensor gait analysis can detect your pressure points when you walk or run to provide you with the best advice on footwear.
A new nail will grow with proper management, and the nail bed will heal. However, it may take several months for the nail to grow fully. In cases of severe nail bed avulsion where the nail matrix is damaged, regrowth may be irregular and ongoing podiatric care may be needed to manage the appearance and function of the new nail.
Why Podiatry Is Important for Nail Avulsions
Podiatrists play a key role in the management of nail avulsions. Their expertise will minimise complications, manage pain, and keep the nail bed healthy for regrowth. Podiatrists will provide specialised solutions for those who experience recurrent nail avulsions to minimise the risk of future injuries while maintaining overall foot health.
Podiatric care includes:
- Accurate diagnosis and management for traumatic or medical nail avulsions.
- Expertise to prevent complications and recurrence of nail conditions.
- Customised management plans to enhance healing and promote proper nail regeneration.
- Preventative care advice, including proper footwear, hygiene practices, and orthoses for long-term foot health.
Seek Professional Help for Nail Avulsions
While a nail avulsion may seem minor, improper care can lead to prolonged discomfort, infection and long-term nail deformities. Seeking professional podiatric care will ensure correct management, reduce pain and promote proper nail regrowth.
If you have experienced a nail avulsion injury, consult with our podiatrists at The Foot Practice. Our expert guidance will help smooth your nail avulsion recovery, return your foot to normal function, and prevent future complications.
