Fungal toenail infections (onychomycosis) are common and can lead to thickened, discoloured, or uncomfortable nails. While many people manage mild cases with topical or oral treatments, some infections become persistent or cause enough discomfort that additional options may be considered. One of these clinical options is Total Nail Avulsion (TNA).
This blog provides general information about fungal toenails and TNA. It is not a replacement for a clinical assessment. Only a regulated foot specialist, such as a Chiropodist, can determine whether this procedure is appropriate based on an individual’s condition.
What Is a Fungal Toenail Infection?
A fungal toenail infection occurs when dermatophytes or other fungi invade the nail. Over time, the nail may:
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Become thick or brittle
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Change colour (often yellow or brown)
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Develop debris under the nail
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Lift from the nail bed
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Cause discomfort in footwear
Because fungal nails often progress slowly, early signs can be easy to overlook.
When Is Total Nail Avulsion Considered?
Total Nail Avulsion is a clinical procedure where the toenail is removed under local anesthesia. It may be considered when:
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The nail is significantly thickened or distorted
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The infection does not respond to other treatments
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The nail is causing recurring discomfort
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The nail is interfering with daily activities or footwear
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Secondary issues (such as ingrown edges or pressure points) are present
A Chiropodist will always complete a thorough assessment before recommending any procedure.
What Happens During TNA?
If TNA is determined to be an appropriate option, the procedure generally includes:
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Assessment and preparation
The Chiropodist examines the nail, reviews medical history, and discusses expectations. -
Local anesthesia
The toe is numbed to help ensure comfort throughout the procedure. -
Careful removal of the nail
The nail plate is gently detached and removed. -
Post-procedure dressing
A sterile dressing is applied, and the Chiropodist provides instructions for at-home care.
Most people can return to regular activities shortly after, but activity levels may be temporarily adjusted depending on the individual.
What to Expect After Nail Removal
Healing times vary from person to person. Common experiences include mild tenderness, drainage, or redness in the early stages. Following the provided wound-care instructions is important for best recovery.
In many cases, the nail will regrow, although the appearance of the new nail cannot be predicted. For some individuals, long-term management of fungal infection may still be recommended, including topical or oral antifungal treatments, hygiene guidance, or regular foot care.
Is TNA a Cure for Fungal Toenails?
Total Nail Avulsion is not considered a cure for the underlying fungus. Instead, it removes the affected nail to reduce bulk, discomfort, or recurring issues and may help support management of the infection. Fungal organisms can remain in the surrounding skin or nail bed, so continued treatment is often advised depending on the clinical findings.
When to See a Chiropodist
If you notice changes in your toenails or have discomfort that affects your daily life, a Chiropodist can provide an assessment and outline the treatment options available to you. Every case is unique, and the goal is always to recommend appropriate, evidence-based care.