Expert: Shawn Bakowski, R.N. - 6/22/2006

Question
Hi, a friend of mine recently dropped a rock on his toe, and most of the toenail has subsequently detached from the bed. The toenail is still a little attached at the top of the nail in one spot but has completely come out of the nail bed at the base. The nail is whole and totally unbroken. Should he remove the nail so a new one can grow back asap, or will it fall off on its own? Will a new nail even grow back if the entire nail has been removed?  

Answer
Hi Geoff,

Your friend must be little uncomfortable to but it mildly.  It is hard to advise if you should remove the nail or not.  I can say once the nail is broken it will not mend back together.  There is a point where the nail (usually when it grows past the toes) losses the nerve cells.  This is why when you trim your fingernails or toenails, you don’t experience any discomfort.  So, I would not suggest that you cause your friend any unnecessary pain by cutting the nail while the nerves are still active.  However, if it is in a position where he may snag it on something, he can make matters worse.  So, you have to trust your best judgment.  Another option, & this is what I would recommend, is to call his Dr. or local urgent care center for instructions on how to proceed.  They will be able to inject a local anesthetic in the area and do what is every necessary with little or no discomfort.  

It will likely fall off on its own very soon.  Couple days I would guess, but don’t hold me to that because everyone is different.  For now, you must be sure the wound is clean, use a mixture of Hydrogen Peroxide (H2O2) and water (1/2 & ½) or you can use Betadine solution (Iodine).  This will help to prevent infection.  The feet are not the cleanest part of your body, so he/you will have to do this 1-2 times a day, and whenever the dressing gets wet.  After cleaning, you want to put on a bulky dressing but before that, you should apply a generous amount of Neosporin or Vitamin A&D Ointment.  This will also help with infection, but more importantly, it will help to prevent the dressing from sticking when you take it off.  If you forget & the dressing is stuck to the wound, use sterile or very clean water & slowly and carefully apply drops of the water to the dressing and remove carefully.  You don’t want to harm the healing tissue.

At the very base of the nail, you should she a very small nail barely protruding from the nail bed.  If this is the case, a new nail will likely grow in its place. However, this may take a long time, maybe even months. If not, it shouldn’t be a great concern.  His toes will adapt and the tissue on the nail bed will get stronger.  I think my mother is missing 4 or 5 of her toenails and it has never been an issue.  Sorry I could not give you a more definitive answer, but like I said, it is difficult to say without seeing it.  Along with the pain, your greatest concern should be to insure that the area does not get infected.  Signs & symptoms of infection are: Increased redness & swelling, fever, pus or unusual drainage from the wound, streaking red lines from the wound, and unexplained increase of pain.  If this think there is even a chance that it gets infected, please seek care from a medical practitioner as soon as possible.  It does not take long for an infection there to get out of hand and spread to the surrounding tissue.  This is because, the further the wound is from the heart, the harder it is to get blood to it (this is why when you hear of someone with uncontrolled Diabetes they have trouble with wounds and circulation in there feet and lower extremities, sometimes leading to removal of the area (toe, foot or limb).  If your friend has diabetes by chance, he should seek care for this regardless.  Good Luck.

Thanks for writing,

Shawn Bakowski