If I tear my toe nail should I have the entire nail removed?

This is for my good friend who I saw recently in the ER with this exact problem.

Discussing trauma to our toe nails and fingernails can often make us a bit queasy. While the nail itself is made of protein and has no nerve fibers the bed just underneath is very sensitive as it has a large number of nerve fibers. This is well known to anyone who has torn their nail or bitten them off too close to the bed.

The nail grows from the proximal end of the bed. That is from where our cuticle is, outward. They grow at a rate of about 1 inch a year.

Being on our outermost extremities these appendages are prone to trauma as my friend found out recently. Once the nail is torn there are two basic options to treating the damaged nail and often it can depend on the extent of damage done to the nail.

If the nail is torn to the base or completely off, quite often the doctor will simply remove what’s left of the nail or leave it off respectively. If the tear is partial the nail can be left alone or removed. This usually depends on whether the remaining nail is going to be more of a nuisance if left on, i.e. catch on clothing, objects etc. Either treatment is fine and quite often is doctor dependent. The bottom line is in most cases a new nail will grow back in either case. Even if the damaged nail is left in place but ends up falling off later a new nail almost always grows underneath. Often I will explain all of this to the patient and let them decide what they prefer to do.

I did have one patient a few years back who had several episodes of an ingrown toenail on his big toe. He came to me asking that I pull the entire nail out of the bed and completely off. After an intense and goose-bump-producing sucking sound, the whole nail came out. To his dismay it grew back months later. However, he seemed happy for the relief it offered him from an ingrown nail in the meantime.

Keep those nails trimmed!
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David M. Berry, M.D.