Ingrown Toenail Surgery Explained: What to Expect
If you have a painful or repeatedly ingrowing toenail, your podiatrist may recommend nail surgery. Although the word "surgery" can make the procedure sound daunting, ingrown toenail surgery is usually a relatively straightforward minor procedure performed under local anaesthetic.
In many cases, only the small section of nail causing the problem needs to be removed. This is known as a partial nail avulsion. A chemical called phenol may then be applied to the nail matrix to reduce the likelihood of that section of nail growing back.
You'll normally be able to walk out of the clinic afterwards, although you'll need to take things easy while the toe heals.
This guide explains what happens before, during and after ingrown toenail surgery, whether it hurts, how long recovery takes and what you can expect your toenail to look like afterwards.
What is ingrown toenail surgery?
Ingrown toenail surgery is a minor procedure used to treat a toenail that repeatedly or persistently grows into the surrounding skin.
The medical term for removing part of the nail is a partial nail avulsion.
Despite the word "avulsion", the procedure doesn't usually involve removing the entire toenail. A narrow section along the problematic side of the nail can often be removed while leaving the rest of the nail intact.
For some people, removing the whole nail may be more appropriate. This is known as a total nail avulsion.
Your podiatrist will assess the nail and discuss which option is most suitable for you.
When might nail surgery be recommended?
Not every ingrown toenail requires surgery.
In some cases, particularly when the problem is mild and hasn't been present for long, a podiatrist may be able to carefully remove the offending piece of nail conservatively.
Nail surgery may be considered when:
The ingrown toenail keeps returning
Conservative treatment hasn't resolved the problem
The nail is repeatedly painful
The nail edge is deeply embedded in the skin
There is significant inflammation
Excess tissue has developed around the nail
The problem regularly becomes infected
The shape of the nail makes recurrence likely
The decision should be based on the individual nail rather than simply how painful it feels on one particular day.
What happens before ingrown toenail surgery?
Before the procedure, your podiatrist will assess your toe and general health to make sure nail surgery is appropriate.
You may be asked about:
Your medical history
Current medication
Allergies
Previous problems with local anaesthetic
Diabetes
Circulation problems
Previous nail surgery
How long you've had the ingrown toenail
Any previous infections or treatments
Your circulation may also be assessed.
The podiatrist should explain the proposed procedure, possible risks, expected healing process and aftercare before asking for your consent.
This is also your opportunity to ask questions.
Do you need to prepare for nail surgery?
Your podiatrist or clinic should give you specific instructions before your appointment.
In general, it's sensible to:
Eat normally unless you've specifically been told otherwise
Wear comfortable clothing
Bring roomy footwear that can accommodate a bulky dressing
Avoid making strenuous plans immediately afterwards
Arrange transport if advised by your clinic
Follow the instructions provided by your own podiatrist, as protocols can vary.
What happens during ingrown toenail surgery?
The exact technique can vary, but a typical partial nail avulsion involves several stages.
1. Local anaesthetic is given
Local anaesthetic is injected into the toe to take away the sensation of pain.
The injection itself can be uncomfortable and may sting briefly. However, once the anaesthetic has taken effect, you shouldn't feel pain during the nail removal.
Your podiatrist will check that the toe is properly numb before beginning.
2. A tourniquet may be applied
A small tourniquet is usually placed around the toe.
This temporarily reduces blood flow to the area and allows the procedure to be carried out in a controlled environment.
It is removed before the dressing is applied.
3. The problematic section of nail is removed
For a partial nail avulsion, the podiatrist separates and removes the narrow strip of nail that's growing into the skin.
The remaining nail is left in place.
If both sides of the nail are causing problems, sections may be removed from both edges.
In some cases, the entire nail may need to be removed.
4. Phenol may be applied
Phenol is a chemical commonly used during ingrown toenail surgery.
It's applied to the nail matrix, which is the area responsible for producing the nail.
The aim is to prevent the section that has been removed from growing back.
This is called a phenolisation or chemical matrixectomy.
5. The toe is dressed
Once the procedure is complete and the tourniquet has been removed, a sterile dressing is applied.
The initial dressing may be relatively bulky to protect the toe and manage any bleeding or drainage.
You'll then receive instructions about what to do when you get home and when your first dressing change or follow-up should take place.
Does ingrown toenail surgery hurt?
This is understandably one of the most common questions.
The part people tend to find most uncomfortable is the local anaesthetic injection. You may experience a sharp sting or pressure for a short period while the anaesthetic is being administered.
Once the toe is completely numb, you shouldn't feel pain while the nail is being removed. You may still be aware that something is happening to your toe, such as movement or pressure, but this shouldn't be painful.
As the anaesthetic wears off later, the toe may become sore or tender.
Your podiatrist can advise you about appropriate pain relief based on your individual circumstances.
How long does ingrown toenail surgery take?
The nail removal itself is usually relatively quick, although the entire appointment will take longer.
Time is needed to:
Complete your assessment
Discuss the procedure and consent
Administer the local anaesthetic
Allow the toe to become fully numb
Perform the procedure
Apply the dressing
Explain your aftercare
You shouldn't assume that a short procedure means you can immediately return to all your normal activities afterwards. Giving the toe time to settle is an important part of recovery.
What happens after nail surgery?
Once the procedure is finished, you'll usually be able to leave the clinic and your toe will remain numb for a period afterwards.
You will normally be advised to rest and keep activity to a minimum initially. Elevating the foot may also help with bleeding and throbbing.
Your clinic should give you clear instructions about:
When to change the dressing
How to clean and redress the toe
What dressings to use
When you can return to normal footwear
What activities to avoid
When your follow-up appointment is
Which symptoms should prompt you to contact the clinic
Always follow the aftercare advice provided by the podiatrist who performed your procedure.
What does the toe look like after nail surgery?
Don't be alarmed if the toe doesn't immediately look "normal".
Following a partial nail avulsion, the toenail will be slightly narrower because the problematic section has been removed.
Initially, you may notice:
Redness
Mild swelling
A small amount of bleeding
Clear or yellowish fluid on the dressing
A visible gap where the nail section was removed
If phenol has been used, the toe may continue to produce some fluid while it heals. This doesn't automatically mean the toe is infected.
Over time, the skin settles and the nail generally looks much more natural.
How long does ingrown toenail surgery take to heal?
Healing time varies between individuals.
Following nail surgery with phenol, healing often takes several weeks rather than several days.
The exact time depends on factors including:
Whether part or all of the nail was removed
The amount of inflammation before surgery
Your general health
Your circulation
How well aftercare instructions are followed
Whether complications develop
It's important not to judge healing solely by whether the toe is still producing a small amount of fluid.
Your podiatrist can monitor progress and tell you whether the toe is healing normally.
How do you look after your toe after nail surgery?
Aftercare protocols vary between clinics, so follow the instructions you've been given.
Typically, keeping the area clean and appropriately dressed is important while the wound heals.
You may be advised to:
Keep the initial dressing dry and in place until instructed to remove it
Clean the toe as directed
Apply a fresh sterile dressing
Avoid picking at the wound
Avoid footwear that presses against the toe
Attend follow-up appointments if arranged
Monitor for signs of infection
Wash your hands before changing the dressing and avoid touching the healing area unnecessarily.
When can you wear normal shoes after nail surgery?
This depends on the dressing, your comfort and how quickly the toe settles.
Immediately after surgery, roomy or open footwear is often more comfortable because the initial dressing can be bulky.
As the dressing becomes smaller and the toe heals, you can gradually return to normal footwear provided it doesn't put pressure on the area.
Avoid forcing a tender, dressed toe into a tight shoe.
When can you return to work after ingrown toenail surgery?
This depends considerably on your job.
Someone working from home or in a predominantly seated role may be able to return relatively quickly.
If your job involves prolonged standing, walking, heavy physical work or protective footwear, you may need more time or temporary adjustments.
Discuss your individual circumstances with your podiatrist before the procedure so you can plan appropriately.
When can you exercise after nail surgery?
Avoid strenuous exercise immediately after the procedure.
Running, football, gym activities and other sports can increase pressure, friction and trauma around the healing toe.
Swimming should also be avoided while there is an open wound because of the risk of infection.
Your return to exercise should be gradual and guided by how the toe is healing and the advice given by your podiatrist.
Can you drive after ingrown toenail surgery?
It's generally sensible to arrange alternative transport following nail surgery.
Your toe may still be numb, you'll have a bulky dressing and you need to be able to operate the pedals safely and perform an emergency stop without hesitation or pain.
Your insurance arrangements may also be relevant.
Follow the advice of your treating podiatrist and don't drive until you can safely control the vehicle.
Does the toenail grow back after surgery?
That depends on the procedure.
If the nail is removed without treating the nail matrix, it can usually grow back.
If phenol is used to destroy the section of nail matrix responsible for the ingrowing edge, the intention is for that section not to regrow.
After a successful partial nail avulsion with phenol, the remaining nail continues to grow normally but is slightly narrower.
Can an ingrown toenail come back after surgery?
Yes, recurrence is possible, although nail surgery with matrix treatment is designed to significantly reduce the likelihood.
Occasionally, a small section of nail can regrow.
If you notice a sharp nail edge, recurring pain or inflammation after the toe has healed, contact your podiatrist for assessment.
What are the risks of ingrown toenail surgery?
Nail surgery is generally a safe procedure, but as with any medical treatment, there are potential risks.
These may include:
Infection
Bleeding
Delayed healing
Continued pain
Reaction to local anaesthetic
Regrowth of part of the nail
Changes to the appearance of the nail
Rarely, complications associated with the chemical used during matrix treatment
Your podiatrist should discuss the risks and benefits with you before you consent to treatment.
How do you know if the toe is infected after surgery?
Some redness, tenderness and drainage can be part of normal healing, particularly when phenol has been used.
However, seek advice if you notice:
Increasing rather than improving pain
Increasing swelling
Redness spreading away from the toe
Significant heat
Thick or foul-smelling discharge
Feeling generally unwell
Fever
If you're unsure whether what you're seeing is normal, contact the clinic that performed your procedure.
Is nail surgery better than repeatedly cutting out an ingrown toenail?
For a recurrent ingrown toenail, repeatedly cutting away the painful corner may provide temporary relief without addressing why the problem keeps returning. It can also leave sharp pieces of nail behind.
Where nail surgery is clinically appropriate, removing the problematic section and treating the corresponding nail matrix can provide a much more permanent solution.
When should you see a podiatrist about an ingrown toenail?
You don't need to wait until an ingrown toenail becomes severe before seeking help.
Arrange an assessment if:
The nail is painful
The problem keeps returning
The surrounding skin is swollen or inflamed
There is discharge or bleeding
You're struggling to wear normal footwear
You've repeatedly tried to cut the nail yourself
You think the toe may be infected
If you have diabetes, poor circulation, reduced sensation or a condition that affects healing or immunity, seek professional advice rather than attempting to treat an ingrown toenail yourself.
Final Thoughts
Ingrown toenail surgery may sound intimidating, but it's a commonly performed minor procedure that can provide lasting relief from a painful or repeatedly ingrowing toenail.
For many people, only a narrow section of nail needs to be removed. Local anaesthetic is used to numb the toe, and phenol may be applied to prevent the problematic section from growing back.
The procedure itself is only one part of successful treatment. Following your podiatrist's aftercare instructions and allowing the toe enough time to heal are equally important.
Most importantly, you don't need to wait until an ingrown toenail becomes severely painful or infected before asking for help. If a nail repeatedly causes problems, a podiatrist can assess why it's happening and discuss whether conservative treatment or nail surgery is the most appropriate solution.
Comments