It is a common misperception, perhaps spurred on by incorrect technique performed in some busy emergency rooms, that the toe is numbed from the end for toenail procedures. While this may result in a numb toe, the injection itself can be very painful and more anesthetic has to be injected in the toe to achieve the result of a numb nail area. The correct technique involves an injection on each side of the toe, with the actual needle puncturing the skin at the base of the toe on top, at each side. This results in only two total injections and is easier to tolerate and requires less anesthetic. The skin on the top is more comfortable to penetrate, unlike the skin on the tip of the toe or on the bottom. There are four nerves that need to be addressed to numb the toe. There are two sets of nerves, one on the right side of the toe and one on the left, each with a nerve on top and a nerve on the bottom. By injecting both sides of the base of the toe, from top to bottom, all four nerves are addressed and the toe efficiently becomes numb.
While no injection is necessarily painless, this technique limits the injection time to 15-20 seconds and the amount of 'pokes' to two, resulting in a more comfortable injection. In many cases, the skin can even be 'pre-numbed' with cold spray or an air-based infiltration of another numbing agent to reduce the sensation of the initial 'poke'.