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 penetration often leads to inflammation, swelling, and sometimes infection. While conservative measures treat mild cases, surgery is the definitive treatment for chronic or severely infected ingrown toenails. Surgical success is measured by resolving the immediate issue and permanently preventing the nail from growing inward again.
Understanding the Surgical Options
The choice of surgical procedure primarily influences whether an ingrown toenail returns. The simple partial nail avulsion removes only the offending spike or edge of the nail. This temporary procedure provides immediate relief but leaves the nail root (matrix) intact, allowing the problematic nail edge to regrow. The more permanent solution is a matrixectomy, which aims to destroy the cells that produce the portion of the nail that grows inward.
Procedures that include a matrixectomy are performed under local anesthesia and are considered minor in-office operations.
Chemical Matrixectomy
This is typically achieved through chemical ablation, most often using a caustic agent like phenol or sodium hydroxide to cauterize the lateral nail matrix.
Surgical Excision
Alternatively, the surgeon may use surgical excision to physically cut out the nail matrix tissue. This permanently narrows the nail plate so it can no longer press into the skin.
Likelihood of Recurrence After Surgery
The likelihood of an ingrown toenail returning depends highly on the surgical procedure performed. Simple partial nail avulsion, without destroying the nail matrix, has a significantly higher chance of recurrence, with rates reported as high as 70%. This high recurrence is expected because the underlying cause—the width of the nail matrix—is not addressed.
Procedures that include a permanent matrixectomy, particularly those using chemical agents like phenol, have much lower recurrence rates. The success rate for partial nail avulsion combined with chemical matrix ablation is high, with recurrence rates generally falling between 5% and 10%. Failure is usually attributed to incomplete destruction of the matrix cells during chemical application, allowing a small nail spicule to grow back. Other factors, such as a naturally curved nail shape or persistent pressure from tight footwear, can also contribute to recurrence.
Essential Post-Procedure Healing Care
Proper care immediately following the procedure ensures the wound heals correctly and prevents infection, which could complicate recovery. For the first 24 to 48 hours, keeping the foot elevated and minimizing activity helps manage swelling and bleeding. Since stitches are typically not used, a sterile dressing is applied and must be kept dry for the first day.
After the initial period, soak the affected foot in warm water, often mixed with Epsom salts, once or twice daily for 15 to 20 minutes. Soaking cleans the wound and encourages drainage, which is normal following a chemical matrixectomy. Following the soak, apply antibiotic cream to the site and secure a fresh, clean bandage. Increasing pain, excessive redness, warmth, or a thick, yellow discharge worsening after the first week are signs of infection and require contacting a healthcare provider.
Long-Term Habits to Prevent Future Ingrown Toenails
Even after a successful, permanent procedure, long-term behavioral changes are necessary to prevent new ingrown nails from developing. Prevention focuses on several key habits:
- Trimming toenails straight across, ensuring the edges are not rounded or cut too short.
- Selecting appropriate footwear with a wide toe box that allows the toes to move freely without pressure.
- Avoiding tight or pointed shoes, which compress the toes and cause trauma.
- Managing chronic conditions, such as excessive foot sweating or fungal infections that can thicken the nail.