I had one while on a family vacation from Nebraska to Oregon when I was 14. Had to go to a doctor no one knew but had an opening. He numbed the toe and took a scalpel and cut the toenail straight down the middle, parallel with the toe. Blood was pouring out into a metal bucket and the sound nearly made my mom pass out, and she had a strong stomach.
Then he, no shit, took a hot needle and burned holes into the remaining nail, using the holes like eyelets on a shoe and stitched it shut.
Gross AND awesome.
On mine he took a little scissors, stuck it under the nail all the way to the back. Cut a slice off the toenail, yanked it out with a pliers, then went in there with that narrow scraper/razor thing to get the roots.
Yeah, I watched the whole thing. He numbed it up real good with shots in the toe knuckle.
Good ol' family doc.