An ingrown toenail (onychocryptosis) is a common and painful condition where the edge of the nail grows into the surrounding soft flesh of the toe. This causes inflammation, pain, and sometimes infection in the skin fold next to the nail. While removing the offending nail section provides immediate relief, the problem is often not permanently solved. A removed ingrown toenail can absolutely grow back, and the likelihood of recurrence depends entirely on the specific removal method used.
Why Regrowth is Possible
The process of nail growth originates from the nail matrix, a specialized tissue located at the base of the nail plate, hidden beneath the skin. This matrix continuously produces the cells that form the toenail. The majority of nail growth comes from the germinal matrix deeper inside the toe.
If a healthcare provider simply removes the visible, embedded edge of the nail—a procedure known as a partial nail avulsion—the problem will almost certainly return. This temporary fix leaves the entire nail matrix intact and functional. Because the matrix is still present, it continues to generate new nail tissue in the same shape. This new growth is likely to grow back into the skin fold within a few months, leading to high rates of recurrence. The ingrowth is a problem of the nail’s path, and simply cutting the part that has gone astray does not alter the path itself.
Surgical Options for Permanent Removal
To prevent an ingrown toenail from growing back, the procedure must permanently address the source of the nail growth in the affected area. The lasting solution is a matrixectomy, which involves destroying or removing the portion of the nail matrix responsible for the ingrowth. This procedure is typically performed in an office setting using a local anesthetic.
The most common and effective technique is a Partial Nail Avulsion combined with a chemical matrixectomy, often referred to as phenolization. After the offending nail edge is removed, a chemical agent, most commonly phenol, is applied to the exposed nail matrix underneath the cuticle. Phenol works by cauterizing the matrix cells, effectively preventing nail growth in that specific section.
This combined procedure boasts a very low recurrence rate, often cited as less than 5%, compared to simple nail avulsion alone, which can have recurrence rates up to 33%. The goal is to remove only the ingrowing part, leaving the rest of the nail intact with a slightly narrower appearance.
Immediate Aftercare and Healing
Proper care immediately following the removal procedure is important for minimizing complications and promoting recovery. The toe will be covered with a sterile dressing that should remain intact for the first 24 to 48 hours to protect the wound. It is normal to experience mild discomfort after the local anesthetic wears off, which can usually be managed with over-the-counter pain relievers.
For the first day or two, keeping the foot elevated above heart level helps reduce swelling and throbbing pain. After the initial dressing is removed, the wound typically requires daily cleaning and re-dressing, often involving soaking the foot in warm water with Epsom salt. Monitoring the site for signs of infection, such as increasing pain, excessive redness, warmth, or pus-like discharge, is necessary.
Long Term Prevention
Even after a successful procedure, adopting preventive habits is the best defense against developing new ingrown toenails or recurrence. The most important preventative measure is mastering the proper technique for trimming toenails. Nails should be cut straight across, avoiding rounding the corners or cutting them too short.
Footwear choices also play a significant role in prevention. Tight or ill-fitting shoes place excessive pressure on the toes. Selecting shoes with a wide toe box allows the toes to move freely, preventing compression that can force the nail into the skin. Wearing appropriate, well-fitting footwear is particularly important for people who are active or who play sports. Maintaining good foot hygiene by keeping the feet clean and dry also helps prevent the skin from softening excessively, which makes it easier for the nail to pierce the tissue.