ingrown toenail surgery ingrown toenail surgery

An Effective Guide On Ingrown Toenail Surgery

An ingrown toenail is a condition in which a person’s toenail grows into the person’s skin. It is a very painful condition which causes redness, swelling, inflammation and minute wounds. Sometimes these wounds get infected by Purulent exudate1, known as pus, which worsens the condition.

When the condition gets so adverse that the person cannot walk properly due to the pain caused, he has to go for an ingrown toenail surgery for relief.

Causes of an ingrown toenail

Following are a few causes of ingrown nails:

  1. The first reason for ingrown nails is that the edge of the nail is not properly trimmed. Due to this reason, the nail edge penetrates the skin.
  2. If you already have an ingrown toenail, wearing tight-fitting shoes can cause the condition to worsen.
  3. Sometimes, genetic factors can also lead to an ingrown toenail.
  4. People whose nails aren’t trimmed and shaped can also suffer the problem of ingrown toenails2 in later years.
  5. Injuries in the foot can also lead to the deformation of the toenail and cause an ingrown toenail.

Surgical treatment options for the ingrown toenails

When there is no improvement in a person’s toenail after using the other methods, he should book an appointment for ingrown toenail surgery as soon as possible. Surgical methods are necessary in the case of recurrent infection.

Nowadays, ingrown toenail surgery isn’t painful because of the use of anesthesia3 which causes numbness in the foot. You don’t feel the pain while the surgical procedure is going on.

The surgical treatment included in the ingrown toenail removal can either be partial nail avulsion or complete nail plate avulsion depending upon the condition of the toenail of a person.

ingrown toenail surgery
By Nico Becker // Pixabay // Copyright 2022

Partial nail avulsion

This ingrown toenail surgery involves the surgical team in partially removing the ingrown toenail. The surgeons only remove the side of the toenail instead of the entire toenail. This is a minor surgery and isn’t that complicated or painful.

  1. The first step involved in the surgery is giving local anesthesia to the patient, which is used as numbing medication so that the patient doesn’t feel any pain or discomfort during the nail removal.
  2. After that, the doctor cuts the edge of the nail using sterile surgical instruments.
  3. Then he applies a chemical like phenol to the nail matrix4 so that the nail doesn’t grow near the edge resulting in a narrowing nail. This application of chemicals is known as chemical matrix ectomy to ensure that the new nail doesn’t penetrate into the skin like earlier, reversing the condition.
  4. Once the procedure is completed, the nail is bandaged to prevent infection.

This ingrown toenail surgery method is used to fix the problem permanently. The nail that comes out after the surgery is perfectly normal. It takes a few weeks for the affected nail to heal completely. Till then, It is advised to follow all the precautions as suggested by the doctor and take the medicines regularly. Once the surgery is over the patient can resume all his daily activities except doing activities that put pressure on the feet, such as strenuous activities like walking, running and swimming.

Complete nail plate avulsion

This surgical procedure involves the removal of the toenail completely from the nail bed. Surgeons recommend this kind of surgery when the toenail is severely damaged, and there is little or no scope for the condition to get better without an ingrown toenail surgery.

  1. In this surgical procedure, the patient is given local anesthesia so that the toenail surgery is done without any pain and discomfort.
  2. The procedure involves the complete removal of the nail from the skin.
  3. The procedure may range from simple to complex, depending upon the severity of infection, pain and toe and skin condition.
  4. Peer-reviewed studies suggest complications in the case of a tumour in the toe; however a very rare situation.

Since the treatment involves the removal of the entire nail from the toe, it takes a little more time to heal. It takes approximately 3 to 4 weeks to heal from the surgical treatment. The toenail generally comes after a long period, as it usually takes 12-18 months for the removed ingrown region to grow.

Post – Surgical Care Routine

The most crucial phase is the post-surgical treatment procedure – to keep the infection of the removed small portion at bay. After the removal of the ingrown nail in the foot, the doctor will focus on dressing the affected ingrown toe of the foot.

Generally, normal activities are avoided for a few weeks after the ingrown toenail surgery. However, the recovery time might be different for different individuals.

  • Dressing Protocol

For the successful culmination of the treatment, the dressing is suggested in the following manner by the doctor- first, clean the toe skin with an antiseptic to prevent infection. Then gently dry the toe skin of the ingrown avulsion.

  • When to see the medical team?

Any pain, infection or discomfort during or after the treatment in or around the ingrown toe should be brought to the notice of the doctor immediately.

On any incidence of pain or infection in the ingrown toe, the doctor will prescribe medicines orally or intravenously, depending upon the severity of the pain, which might be a result of the infection.

Time-to-time check-ups by the doctor should be of utmost importance as many people are regular to the doctor before and during the ingrown toe treatment5; however, this regularity is lost after the ingrown toenail surgery leading to the complications resulting in the slower healing of the toenail.

Sometimes, mild discomfort symptoms around the ingrown toenail are not immediately reported to the doctor and are ignored. When these ‘mild’ symptoms of the ingrown toe are reported to the doctor- the condition of the affected ingrown toe has already deteriorated, leading to amputation of the ingrown toe in some cases.

Challenges To Overcome

The biggest challenge is to prevent the ingrown from further injury. It would be detrimental to the healing and worsen the situation of the affected ingrown toenail.

ingrown toenail surgery
By sq lim // Unsplash // Copyright 2022

After the ingrown toenail surgery, the toenail must be prevented from coming in contact with sharp objects such as broken glassware, knives, rusted nails and other iron or metallic objects etc., which can lead to further complications.

Apart from this, it should be mandated to keep the toenails from colliding with each other- such as the big toe against the small toes and the small toes against the big toe.

‘Moisture is the foe’ should be kept in mind while healing the ingrown toe – as moisture leads to pus, fungal and several other secondary infections around the ingrown region, further adding to the victim’s woes.

Avoid coming in contact with water directly or indirectly as it will lead to delayed recovery, an erroneous or infinite recovery. Moisture attracts microorganisms which in turn might lead to unresolved complications.

If any unusual discharge is observed around the ingrown part, one shouldn’t ignore it.

Footwear to be used during and after treatment

Footwear is the main accessory of the entire procedure, which is the anchorage of the pre, during, post, and follow-up treatment.

ingrown toenail surgery
By Pexels // Pixabay // Copyright 2022

One should wear loose shoes and allow fresh air to reach the affected site to replenish the toe with oxygen to exasperate the healing process. One should keep in mind not to wear shoes that are tight as they further cause constriction of the wound after the treatment causing failure of the instrument.

The most crucial phase is treatment, where shoes are completely avoided. The individual is prescribed to wear loose oversized surgical slippers and footwear to facilitate surgical treatment after the surgery.

However, during the surgery, footwear is totally avoided but is allowed only for day-to-day activities such as using the washroom. Oversized footwear is prescribed as it alleviates the pressure on the foot, otherwise aggregated by tight footwear.

Do’s and Don’ts after the ingrown toenail surgery

  1. In case you have recently undergone an ingrown toenail surgery, you should avoid any such activity in which you have to put pressure on your toes because if you do so, you will strain your toenail, which would cause pain.
  2. Avoid wearing shoes. Instead, wear footwear like slippers and sandals so your feet can breathe. This will promote healing and prevent sweat production.
  3. Don’t forget to take all the medicines as prescribed by the doctor. Don’t skip even a single dose for fast and effective healing.
  4. Make sure that the dressing is changed regularly.
  5. Maintain proper foot hygiene for faster healing.

Alternatives for the ingrown toenail surgery

Since ingrown toenail surgery is a painful process. Here are a few alternative treatment options that can be considered before opting the toenail surgery.

1) Using an antibiotic ointment: If the condition isn’t too severe, before going for an ingrown toenail surgery, you should consider using any suitable antibiotic ointment. Various antibiotics available can provide you relief, like Neosporin, Polysporin etc.

2) Taking oral antibiotics: This option can be considered if you don’t want to go for an ingrown toenail surgery. Since this surgery is a little complicated and painful, people tend to avoid it. n such a situation, you can take antibiotics like ibuprofen or acetaminophen to alleviate pain.

ingrown toenail surgery
By Public Domain Pictures // Pixabay // Copyright 2022

3) Soaking your foot in warm water: Soaking your foot in warm water provides a little relief from the pain. But don’t completely rely on this. Keeping the infected foot in water can be used as first aid treatment.

What else can be done to ease the situation?

  1. Cut your nails properly. Half of your problems will be solved if your nails are cut correctly. Avoid growing nails too long or cutting them too short. These can also sometimes cause ingrown toenails.
  2. Wear loose-fitting shoes: When you have an ingrown toenail, don’t wear tight shoes, as this will worsen the condition.

Key Points:

For many, a nail avulsion- a complete or partial- might be a small issue or not an issue. However, this issue is as resilient as any fever or any other health issue.

Everything matters: Every cell, tissue and organ is there to perform its intended function. An ingrown toenail requires as much tending and care as an open wound or disease.

Another grave issue is pre and post-treatment ignorance: If people ever tend to this issue, then they either go for pre-treatment sessions around the ingrown region. If they get relief after pretreatment sessions, they call off the treatment of the ingrown then and there. However, a complete pre- and post-treatment follow-up is required to heal the avulsion.

The battle is not won after seeing the doctor, surgery, or medicines: The fight ensues until the corrective toenail grows back from the nail plate. Another noteworthy point here is that a normal toenail grows back after the ingrown toenail surgery.


Q. How effective is ingrown toenail surgery?
  • Nail avulsion surgery has a 98.5 percent success rate, but in the rare case that the surgery is unsuccessful, we will organize to re-do the procedure at no extra cost to you. Depending on your medical history and whether there is an infection due to the ingrown toenail, healing can vary from person to person.
Q. Is ingrown nail surgery safe?
  • Ingrown toenail surgery is generally safe and effective. If you have a partial toenail removal, your nail may grow back in approximately three to four months. If you had your toenail totally removed, regrowth can take up to a year. The nail that grows back will be thinner than it was before.
Q. How much time does the surgery take to heal?
  • The duration of the treatment depends upon the severity of the avulsion. Generally, a partial avulsion takes less time to heal than a complete one. However, a follow-up appointment is as essential as the first treatment. Getting the wound bandaged, too, is an art. Doctors might suggest using a mild acid such as boric acid at the surgical site to prevent any pathogenic growth in the wound.
  1. Ko, Kwan Soo, et al. “New species of Bordetella, Bordetella ansorpii sp. nov., isolated from the purulent exudate of an epidermal cyst.” Journal of clinical microbiology 43.5 (2005): 2516-2519. ↩︎
  2. Heidelbaugh, Joel J., and Hobart Lee. “Management of the ingrown toenail.” American family physician 79.4 (2009): 303-308. ↩︎
  3. Mellon, R. Daniel, Arthur F. Simone, and Bob A. Rappaport. “Use of anesthetic agents in neonates and young children.” Anesthesia & Analgesia 104.3 (2007): 509-520. ↩︎
  4. Higashi, Nobuhiko. “Melanocytes of nail matrix and nail pigmentation.” Archives of Dermatology 97.5 (1968): 570-574. ↩︎
  5. Heifetz, Carl J. “Ingrown toe-nail: a clinical study.” The American Journal of Surgery 38.2 (1937): 298-315. ↩︎


Yashika Mahajan

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