Twenty-nine consecutive patients with onychogryphotic toenails in whom conservative treatment had failed, were entered into the study over a one year period and followed-up prospectively for a further year. All patients were treated by simple nail avulsion. The incidence of recurrence was 27 out of 29 patients (93%); only five of these were symptomatic (17%). Only two patients required further surgery. We conclude that simple avulsion of onychogryphotic toenails offers symptomatic relief in the majority of patients, particularly in this elderly population in whom the use of a tourniquet may be contraindicated.