What Does a Toe Look Like After a Fungal Nail is Removed? - Jeffrie C. Leibovitz, DPM

What Does a Toe Look Like After a Fungal Nail is Removed?

I get this question asked a lot.

Fungal Nails are Abnormal

Remember, we are NOT dealing with a normal nail. A fungal nail is thick, dark, and crumbling, and is not normal. It is common to see people hiding a thick mycotic nail that has fungus with polish. Unfortunately, this is not fooling anyone. It is like a bad hairpiece – people will try not to stare but they cannot help it. Perpetual use of polish is the leading cause of nail changes in women. For men, trauma is the primary reason for thick, discolored, and brittle nails.

A normal toenail does not need to be removed.

This is much more than just an ingrown nail. Long-term toenail fungus can make the nail grow into a circle. It is amazing how the skin that borders the nail will tolerate abuse… until it doesn’t.

Toenail Appearance is Everything

Let’s get back to the original million-dollar question, what will the toe look like after the fungal nail is removed? There will typically be an outline of the nail on the nail bed. It will look like a “Ghost” nail.  People can use polish over this area. Spoiler alert: the polish does not last as l long on the skin as it does on nails. I have not had any of my patients try a gel covering. Let me know if that works.

Sometimes the end of the toe may look swollen. This is a bit of an optical illusion. The nail bed is lower than the end of the toe. This step-up makes the end tuft of the toe look raised up.

But a picture is worth more than words.

These are close-up images. From 6 feet away it is hard to tell if the nail is absent. It is pretty easy to tell which nails are not normal and are fungal nails.

End results can depend on how long and how aggressively the toenail fungus has hijacked the nail. Chronic fungal nails (more than 5 years) can change the nail bed and leave an irregular bumpy surface on the nail bed.

Fungal nails with one toenail removed

More Questions about Toenail Removal

What if I drop something on my toe that does not have a nail?

Well, it will hurt with or without a nail. If there is a nail, bleeding could occur under the nail, which is what black nails are. This is a sub ungula hematoma (aka blood clot under the nail). This type of injury can become painful as pressure builds up.

If there is no nail, it will also hurt. The sad true is that you do not get much protection just from a toenail. So make sure to not drop stuff on your toe!

What are Nails Good for? (Absolutely Nothing. Huh! Say it Again!)

Well, our hunting and gathering days are over. Not too many of us use coins as currency anymore. Fingernails definitely are handy to help pick up pennies! However, they can still help with handling tiny things.

Present-day nails can serve as a tapestry for individual expression. There are some nail artisans that can paint a work of art on a little toenail. Whatever your desire, you can use your nails to express it!

Fake News for Nail Removal

A lot of people believe that if the fungal nail is removed and allowed to grow back it will be normal. This treatment is a common recommendation from primary care doctors who do not see a lot of this problem. Unfortunately, the nail will grow back the same as before the procedure. No change … and no gain. There is little sense in having the procedure over and over when it can be a “One and Done” affair.  

Whenever a nail is temporally removed, there will be some damage to the growth center. When the nail eventually grows back there can be a split, thickening, or irregular pattern in the nail. The chances of having a normal nail after elective or traumatic nail removal is slim.

Will The Nail Grow Back?

We see a lot of nail problems. Rarely do I remove the nail and allowed it to grow back. TO REPEAT – I usually only remove the nail with the intention it will NOT grow back. But there is a 2-5% chance the nail or part of the nail will return. Unfortunately, no surgical procedure is 100%. I do not think you will get these odds in Vegas or on any betting app.

Thick fungal nails with one toenail removed

What Else Can be Done about Fungal Nails?

There are some people that should not have a permanent nail avulsion due to a complicated medical history. And there are some people that do not want to have this procedure. Debridement may be the best treatment option. This involves reducing the size of the nail. We have some special instruments for this.  The nail will eventually grow thick again as a fungal nail will grow thick before it gets long. This type of maintenance can range from 2-6 months.

Warning: Fungal nails are extremely brittle and hard. DO NOT use tin snip, garden tools, or power equipment to cut these. Sounds like I am kidding but people actually use these with disastrous results. Self-treatment is an even greater danger if there is diminished blood flow or loss of protective sensation. A little slip and a person may have a piggy that will not make it home.

I do not recommend using an artificial nail to replace a removed fungal nail. Glue on the skin can be problematic. It produces a very strong attachment. There is no longer a safety or crumple zone between the nail and the skin. If a normal nail gets damaged it separates from the skin, but a glued-on artificial nail will take the skin with it. There is only about 2-3 mm of tissue above the toe bone (phalanx). 

The Early Bird can get Rid of Fungal Nails

When a fungal nail gets to be this deformed, it is at the end game. Early detection and early treatment of fungal nails can prevent nail removal. As with most health conditions and problems, the earlier the treatment starts, the quicker and easier the treatment is.

If you are in the beginning stages of fungal nails we have treatment options that can get a normal nail back.

If you have any other nail problems we also have treatment options to get your toenails back into perfect shape! Give our office a call at (317) 545-0505, or use our super easy and convenient online contact form to have our awesome staff contact you for an appointment!