Today I received a great question from a patient. with toenail fungus on the big toenail. He wanted to know whether or not it would be prudent to remove the entire toenail plate. The thinking behind this question is that if the toenail itself is infected with fungus, then removing the entire nail plate could effectively cure the infection.
A podiatrist could certainly remove the entire nail plate.
Removal of a fungal infected toenail has advantages and disadvantages. Removing the entire nail plate removes a great deal of the infection. After all, most of the fungus is in and on the toenail itself.
When the plate is removed, most of the fungus is removed. There can still be some fungus in the nailbed, underneath the toenail. This must also be treated in order to have a successful care of toenail fungus.
Studies have shown that removing the nail plate, as a stand-alone treatment, has about a 50% success rate. Those are not great odds.
But there is a bigger risk with removing a fungal toenail. It takes many months for the toenail to grow back. During the time you are waiting for the nail to grow back the skin folds tha make up the nail grooves at the side of the toe can contract. If the skin contracts or shrinks, there may be less space available at the end of the toe for the toenail plate. If the toenail grooves are restricted, this can lead to an increased risk of ingrown toenails in the future.
A better option may be to actually aggressively debride the fungal toenail prior to laser treatment. In that case, the podiatrist would simply trim back and grind down/file away the vast majority of the nail, but retain enough of the nail plate to keep the skin folds intact without contracting. This should increase the chances of success, without adding the increased risk of deformity of the toe that could lead to ingrown toenails.
In either case, it is important to make sure that all of the other sources of fungus (including shoes, socks and any fungal infection in the skin) are treated simultaneously. If not, your chances of success may be lower.
A podiatrist could certainly remove the entire nail plate.
Removal of a fungal infected toenail has advantages and disadvantages. Removing the entire nail plate removes a great deal of the infection. After all, most of the fungus is in and on the toenail itself.
When the plate is removed, most of the fungus is removed. There can still be some fungus in the nailbed, underneath the toenail. This must also be treated in order to have a successful care of toenail fungus.
Studies have shown that removing the nail plate, as a stand-alone treatment, has about a 50% success rate. Those are not great odds.
But there is a bigger risk with removing a fungal toenail. It takes many months for the toenail to grow back. During the time you are waiting for the nail to grow back the skin folds tha make up the nail grooves at the side of the toe can contract. If the skin contracts or shrinks, there may be less space available at the end of the toe for the toenail plate. If the toenail grooves are restricted, this can lead to an increased risk of ingrown toenails in the future.
A better option may be to actually aggressively debride the fungal toenail prior to laser treatment. In that case, the podiatrist would simply trim back and grind down/file away the vast majority of the nail, but retain enough of the nail plate to keep the skin folds intact without contracting. This should increase the chances of success, without adding the increased risk of deformity of the toe that could lead to ingrown toenails.
In either case, it is important to make sure that all of the other sources of fungus (including shoes, socks and any fungal infection in the skin) are treated simultaneously. If not, your chances of success may be lower.
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