How to Remove Dead Toenails

Dead toenails can be quite inconvenient and painful, making you reluctant to wear sandals or expose your toes. These nails can die for various reasons, such as injury (e.g., when the toes are repeatedly pressed against the front of running shoes) or fungal infections. Even if the toenail is completely dead and no longer growing, it can still be removed, and any underlying infection can be treated. Removing the toenail helps prevent infection and allows the nail to heal after the injury. With proper care, the nail should regrow in 6 to 12 months. To ensure you fully understand the condition of your toenail, it is advisable to consult a healthcare professional before proceeding with the removal.

Pay attention to the presence of blisters. A dead toenail often develops when a blister (blood blister) forms under the nail. This blister can cause the tissue beneath the nail to die, causing the nail to detach from the toe.

• If the toenail is dead for another reason, such as a fungal infection, there usually won't be a blister to drain. You can skip this step and proceed to the "Toenail Removal" section and follow the procedure for removal and post-removal care. If it's a fungal infection, you should see a doctor for a prescription antifungal cream.
• Do not attempt to drain a blister under the nail if you have diabetes, peripheral artery disease, or a compromised immune system. These conditions can slow the healing process and make it harder for the wound to heal properly due to a weakened immune system and inadequate blood circulation. In such cases, seek advice from a doctor.

Clean Your Toes. It's essential to thoroughly wash your toenails and toes with soap and water. Don't forget to wash your hands as well. Sanitizing your toes and hands is a critical step before puncturing a blister or removing a toenail. The presence of bacteria increases the risk of infection.

• Consider wiping the toenail and surrounding skin with iodine. Iodine has been shown to help eliminate infection-causing bacteria.

Sanitize and Heat the Tip of the Needle or Paperclip. Use Isopropyl alcohol to wipe and disinfect the sharp end of the needle or paperclip. Heat the pointed end of the needle or paperclip over a flame until it turns red.

• For optimal infection prevention, you should carry out the disinfection under the supervision of a healthcare professional. Performing medical procedures at home, even simple ones, increases the risk of infection or accidental injury. It's best to seek professional medical help to have your toenail removed rather than attempting it yourself at home.
• You can substitute a blunt-ended metal paperclip for the needle if you feel uneasy using the sharp end to puncture the blister. If you've never drained fluid from a blister before, it’s safer to use a paperclip. Make sure to have a disinfected needle ready in case you need to puncture the blister.
• Heat only the tip of the needle. The rest of the needle will remain warm, but only the pointed end should turn red. Be cautious not to burn your fingers while handling it.

Pierce the Toenail with the Needle. Place the heated needle tip over the toenail, directly above the blister. Hold it firmly and allow the high temperature to melt a hole through the nail.

• If you can reach the blister by inserting the needle beneath the toenail, you won't need to create a hole through the nail. Simply drain the blister fluid by pushing the heated needle through it.
• Since toenails don’t have nerves, inserting the hot needle through the nail won't cause pain. However, be careful not to press too hard to avoid burning the skin beneath.
• Depending on the thickness of the nail, you might need to reheat the needle multiple times and repeat the process of piercing the nail at the same spot.

Pierce the Blister. After creating a hole in the toenail, you can use the needle to pierce the blister and allow the fluid to drain out.

• To reduce discomfort or pain, let the needle cool down to a tolerable temperature before piercing the blister.
• If possible, aim to pierce the blister around the outer edges. Avoid touching the skin beneath the nail. Never use your fingers to touch the skin under the toenail to prevent infection.

Care for the Wound. Immediately after draining the blister, soak your toenail in warm, soapy water for 10 minutes. Continue soaking your toenail in soapy water 3 times a day, for 10 minutes each time, until the blister heals. After soaking, apply an antibiotic ointment or blister cream to the toe and cover it with a clean bandage. This step helps prevent infection.

• Depending on the size and severity of the blister, you may need to drain the fluid multiple times until it is completely gone. Try to drain any remaining fluid from the blister through the same hole in the toenail you created previously.

Clean the area around the toe. Before you remove any part of the toenail, make sure to wash the toe with warm soapy water. Dry the area thoroughly before proceeding. Cleansing the entire foot, toe, and nail before removing the toenail helps prevent infections. Additionally, it is important to wash your hands well to minimize the chance of transferring bacteria.

Trim as much of the toenail as you can. Cut the toenail above the dead skin to prevent dirt and bacteria from getting trapped underneath the dead nail. Removing the toenail will also help the skin beneath heal faster.

• To reduce the risk of infection, disinfect the nail clippers with Isopropyl alcohol before use. A sharp clipper is preferable to a dull one, as a dull clipper can cause the nail to crack during the removal process.

Examine the toenail before trimming. If the nail has begun to die, you will be able to gently pull the dead part of the nail from the skin without discomfort. The portion of the nail that can be removed easily without pain is the part you should cut.

Wrap the toenail. After removing the top part of the toenail, use non-stick gauze to securely wrap the area around the nail. The newly exposed skin will be soft and tender, so wrapping the toenail will help alleviate discomfort. You should also apply an antibacterial ointment to promote healing and reduce the risk of infection.

Wait before removing the remaining toenail. While every case is different, it is generally recommended to wait a few days (ideally 2-5 days) before removing the remaining portion of the toenail. The toenail will gradually die and be much less painful to remove after waiting a few days.

• While waiting for the toenail's base to die and be ready for removal, keep the toenail as clean as possible. This means gently washing the nail with soap and water, applying antibiotic ointment, and loosely wrapping the toe with gauze.

Remove the remaining toenail. Once the remaining toenail has fully died, you can grab it and gently pull it from left to right. As you pull, you will feel when the nail is ready to come off. Stop pulling if you feel any pain.

• If the nail is still attached to the corner of the cuticle, you may notice some bleeding, but the pain from the bleeding should not be severe.

Keep the toe clean and wrapped. After completely removing the toenail and exposing the flesh beneath, clean the toe gently with warm water and mild soap. Additionally, apply antibacterial ointment and loosely wrap the toe with gauze. Remember, this is an open wound, so handle it carefully until the new skin forms.

Give the skin time to "breathe". While it is important to keep the toe clean and protected, you should also allow the new skin to be exposed to air in order to heal. While resting and watching TV, you can remove the gauze to let the toenail breathe. However, when walking outside, especially if wearing open-toed shoes, make sure to wrap the toe again.

• Change the dressing whenever you clean the wound. Additionally, replace the gauze if it becomes dirty or wet.

Treat the exposed skin area. Apply antibiotic cream or ointment to the wound at least once a day to prevent infection and continue until new skin forms. Over-the-counter creams are usually sufficient, but you may need a prescription cream if an infection develops.

Rest the foot. Give your foot as much rest as possible during the first few days after toenail removal, especially since it will be quite painful. Once the pain and swelling subside, you can gradually return to normal activities, including exercise. However, do not push yourself to do anything that causes pain in the foot.

• If possible, elevate your foot when sitting or lying down. Raising your foot above heart level helps reduce swelling and pain.
• While your toenail is growing back, avoid wearing tight shoes that squeeze the nail. It’s best to wear closed-toe shoes to protect the nail bed during the healing process, especially when engaging in outdoor physical activities.

Know when to see a doctor. Severe pain may be a sign of infection. Other infection symptoms include swelling, warmth around the nail, pus drainage, redness spreading from the wound, and fever. Don’t wait until the infection becomes severe; seek medical attention as soon as you notice any concerning signs.

• Do not attempt to remove a toenail that has not fully died. If toenail removal is necessary, consult a doctor about having it removed surgically or non-surgically by a medical professional.
• Do not drain fluid from blisters or remove toenails if you have diabetes, peripheral artery disease, or any conditions that negatively affect the immune system.

• Warm water
• Soap
• Clean towel
• Sharp pins and/or blunt paper clips
• Cotton pads
• Isopropyl alcohol
• Matches (or similar flame source)
• Non-stick gauze
• Nail clippers
• Antibiotic ointment