Total Nail Avulsion
Total nail avulsion, usually shortened to TNA, is the removal of the whole nail plate. It is used when the entire nail is the problem rather than one edge of it, and it is far less common than partial nail avulsion.
Like everything we do, it is carried out in a treatment chair under local anaesthetic and takes about 20 minutes.
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When it is the right procedure
- The nail is thickened to the point where it cannot be cut or worn comfortably in a shoe
- It is badly deformed, usually after an old injury
- It is repeatedly infected across its full width, not just one side
- It is painful under any pressure at all
- A severe fungal nail is causing symptoms and other approaches have failed
The decision you make beforehand
There are two versions of this procedure and the difference matters, so we talk it through properly before the day rather than on the chair.
With the matrix left intact
The nail is removed and allowed to regrow. You get a new nail, which takes time, and there is a chance it grows back with the same problem if the underlying cause has not changed.
With the matrix treated
The nail is removed and the matrix is treated so that it does not regrow. The nail bed heals over and takes on a firm, skin-like surface. This is permanent. It is the right choice when the nail itself has been the source of years of trouble, and the wrong choice if you would be unhappy without a nail there.
Neither is better in the abstract. It depends on the toe and on you, which is why it is a conversation and not a default.
Afterwards
The toe is dressed and you go home the same way you came. Expect tenderness for a day or two once the anaesthetic wears off, and some discharge from the nail bed while it heals over the following weeks. Wear a roomy shoe or an open sandal for the first while.
If the nail is left to regrow, a toenail takes a long time, commonly twelve to eighteen months to grow out fully. A fingernail is much quicker, typically four to six months. We will tell you what to expect for your nail.
Common questions
Will my toe look strange without a nail?
Less than people expect. The nail bed heals over and firms up, and in a shoe or a sandal most people would not pick it out. We would rather you saw a realistic picture of it beforehand than found out afterwards, so ask us at the consultation.
Can I change my mind about the matrix afterwards?
Not in the direction you would want. Treating the matrix is permanent. That is exactly why we make the decision together in advance rather than on the day.
Is this what happens if I leave an ingrown toenail too long?
Usually not. Most ingrown toenails, even neglected ones, are still a partial avulsion. Total avulsion is about the condition of the whole nail, not about how long you waited.
Does it hurt more than a partial avulsion?
The procedure itself feels much the same, because the toe is fully numb either way. There is more nail bed exposed afterwards, so the healing phase is a little longer.