Do Ingrown Toenails Grow Back After Removal?

Ingrown toenails frequently grow back after removal, but how often depends almost entirely on what kind of removal you had. A simple nail avulsion, where the offending nail border is pulled out without doing anything to the growth center, carries the highest recurrence risk of any treatment approach.¹ When the nail matrix (the root tissue that produces the nail) is destroyed during the procedure using a chemical agent, a laser, or a scalpel, the treated portion of the nail is permanently prevented from regrowing, and recurrence rates drop dramatically. The gap between these two approaches is so large that the choice of procedure matters far more than anything you do afterward.

Why Pulling the Nail Out Is Not a Permanent Fix

A nail avulsion is the simplest and quickest procedure for an ingrown toenail. The doctor numbs your toe, slides an instrument under the nail border, and pulls the embedded strip of nail free. Relief is almost immediate, and the toe heals relatively fast. The problem is that the matrix, the crescent of cells tucked under the skin at the base of your toe, is left completely intact. It does exactly what it is designed to do: grow a new nail. Within a few months, the nail border grows back into the same shape it had before, and if the underlying anatomy or habits that caused the ingrown nail have not changed, the nail digs into the skin fold again.

A recent network meta-analysis comparing all major treatment types found that nail avulsion was associated with the highest recurrence risk among all the options studied, including chemical matricectomy, minor surgery, conventional surgery, and even conservative (non-surgical) treatment.¹ That last finding surprises people: simply leaving the nail alone and managing the problem conservatively can, in some studies, produce outcomes comparable to ripping the nail out. The reason is that avulsion does not address the root cause, so it functions more like a reset button that gets pressed every few months than a cure.

Chemical Matricectomy With Phenol

The most widely studied way to prevent regrowth is to destroy the nail matrix with a chemical agent, usually phenol. After the offending nail border is removed, the doctor applies concentrated phenol to the exposed matrix tissue. The chemical cauterizes the cells responsible for nail production, so that strip of nail never regrows. The rest of the nail, the healthy portion that was not bothering you, continues to grow normally. The cosmetic result is a slightly narrower nail.

A systematic review and meta-analysis of randomized controlled trials found that adding phenol to a nail avulsion reduced the risk of recurrence substantially compared with avulsion alone.² A separate meta-analysis reported that phenol matricectomy was associated with roughly 49 fewer recurrences per thousand patients compared with other treatment approaches and combined a low recurrence rate with a favorable side-effect profile.³ In one randomized clinical trial, the recurrence rate after phenol matricectomy was under 3%.⁴

The trade-off is healing time. Phenol creates a chemical burn in the tissue, and the wound weeps and takes roughly three weeks to close. That same trial found a mean healing time of about 21 days for the phenol group compared with about 8 days for a group that had a different surgical technique (aesthetic reconstruction) without phenol.⁴ Despite the longer recovery, phenol remains the most commonly recommended approach for moderate-to-severe ingrown toenails because the recurrence rate is so much lower than avulsion alone.

Sodium Hydroxide as an Alternative Chemical Agent

Some practitioners use sodium hydroxide (NaOH) instead of phenol for chemical matricectomy. One reason is that phenol is considered toxic and has occupational-safety concerns for the practitioner; sodium hydroxide is easier to handle. The question is whether it works as well.

A study comparing the two chemicals found no statistically significant difference in reoperation rates (about 7% for phenol versus about 8% for sodium hydroxide) or in recurrence of painful nail borders (roughly 11% for phenol versus about 8% for sodium hydroxide).⁵ A controlled trial found that sodium hydroxide produced faster tissue normalization, with the wound area returning to normal in about half the time compared with phenol, while achieving comparable efficacy.⁶ If your doctor offers NaOH matricectomy, the evidence suggests it is a reasonable alternative to phenol with a potentially faster recovery.

Surgical Techniques That Physically Remove the Matrix

Instead of chemically burning the nail root, some procedures cut it out. These approaches vary in how much tissue they remove and whether they focus on the nail side or the skin fold side.

The Winograd procedure excises the ingrown nail border along with the underlying matrix tissue. A study of 76 toes treated with this technique reported a recurrence rate of about 4% and a wound infection rate under 3%.⁷ The Vandenbos procedure takes a different approach: instead of removing nail tissue, it excises a wedge of the swollen skin fold next to the nail, allowing the nail to grow without anything pressing against it. A comparative study found that the Winograd method had a 14% recurrence rate while the Vandenbos procedure had zero recurrences in the same trial.⁸

The Vandenbos procedure’s low recurrence is appealing, but it involves a larger open wound that heals by secondary intention, meaning it is left open and fills in from the bottom over several weeks. It also preserves the full width of the nail, which some people prefer cosmetically. The best approach depends on the severity of the ingrown nail, the shape of your nail and toe, and what kind of recovery you are willing to go through.

CO2 Laser Matricectomy

Carbon dioxide lasers offer another way to destroy the nail matrix. The laser vaporizes the root tissue with precision, and the claimed advantage is less collateral damage to surrounding tissue compared with phenol. A retrospective study of 135 toenails treated with CO2 laser matricectomy found a success rate of about 94%, with 8 cases of recurrence, all of which were successfully retreated with the same method.⁹ An earlier study of 344 treated nail margins reported an even lower recurrence rate of about 1.5% over an average follow-up of 15 months.¹⁰

Laser equipment is expensive and not available in every clinic, so this option is more common in dermatology or podiatry practices that already have a CO2 laser for other procedures. When it is available, the results are comparable to phenol matricectomy, with the potential benefit of less post-operative drainage.

What Actually Causes Recurrence

Even after a well-performed matricectomy, ingrown toenails can come back. Understanding the risk factors helps explain why, and more importantly, which ones you can control.

A prospective case-control study identified several independent risk factors for ingrown toenails. The strongest was improper nail trimming, which increased the odds roughly sevenfold. Other significant factors included poor foot hygiene, foot or toe deformities, increased nail curvature, excessive sweating of the feet, fungal nail infection, and higher body mass index.¹¹ The researchers noted that most of these factors are modifiable, meaning that addressing them after surgery can reduce the chance of recurrence.

The nail-trimming issue deserves emphasis because it is so common. Rounding the corners of your toenails, the way many people do instinctively, leaves a short spike of nail at the edge that can dig into the skin fold as it grows forward. Cutting toenails straight across and leaving them long enough that the corners sit above the skin fold is the single most effective preventive measure. Tight shoes that compress the toes also push skin into the nail edge, so footwear matters too.

Research in people with diabetes found additional predisposing factors, including previous toe trauma, reduced arterial blood flow to the foot, thickened nails, and specific nail morphologies.¹² Nearly half of the diabetic patients with ingrown nails in that study had peripheral arterial disease, a reminder that circulation problems can affect nail growth and healing in ways that raise the risk of recurrence.

When a Bone Growth Is Hiding Underneath

Sometimes an ingrown toenail keeps coming back no matter what procedure is done because there is a bony outgrowth on the tip of the toe bone (distal phalanx) pushing the nail plate upward and distorting its shape. This condition, called subungual exostosis, creates a vicious cycle: the bump pushes the nail into the skin fold, the nail is removed or treated, but it grows back over the same bump and becomes ingrown again.¹³ Patients with this problem often have a history of multiple procedures and repeated episodes of infection around the nail.

A morphologic study of ingrown nails found that the mechanical cause of ingrown nails may be related to nail bed contraction causing overcurvature of the nail, and that bony changes in the distal phalanx may be a result of, rather than a cause of, this overcurving deformity.¹⁴ The relationship between bone and nail is still debated, but the practical takeaway is clear: if you have had multiple failed procedures for the same toenail, an X-ray of the toe is worth requesting. If a bony spur is present, removing it during the same surgery as the nail procedure can break the cycle.

Ingrown Toenails in Children and Teenagers

Ingrown toenails in young patients are common and recurrence rates tend to be higher than in adults, partly because children are still growing and partly because compliance with aftercare can be challenging. A review of surgical treatment in children found that about half underwent two or more procedures. Simple avulsion or wedge avulsion without phenol had the highest recurrence rates, while nail bed excision combined with phenol application had the lowest recurrence, though still around 18%.¹⁵

Interestingly, one study comparing non-operative management to nail avulsion in children and adolescents found that the avulsion group actually had a higher recurrence rate (about 8%) than the non-operative group (about 3%) at six-month follow-up.¹⁶ This echoes the pattern seen in adults: simple avulsion without matrix destruction is not a reliable long-term solution. A retrospective study comparing wedge resection to the Vandenbos procedure in children found that wedge resection had a recurrence rate of about 11% compared with 2% for Vandenbos.¹⁷

For children with mild or early-stage ingrown toenails, conservative management with proper nail trimming, cotton wedging, and sometimes topical antibiotics is often tried first. Surgery is generally reserved for recurrent or severe cases, and when it is done, a procedure that addresses the matrix or skin fold tends to produce better long-term results than simple nail removal.

How the Anesthetic Technique Affects Outcomes

One detail that matters more than people realize is how the toe is numbed. The traditional approach uses a digital nerve block combined with a tourniquet (a tight rubber band at the base of the toe to reduce bleeding). An alternative is to use a local anesthetic that contains epinephrine, which constricts blood vessels and reduces bleeding without requiring a tourniquet.

A clinical trial comparing these two approaches during phenol matricectomy found no difference in recurrence rates between them. However, the tourniquet group had significantly more post-operative bleeding and experienced a weaker anesthetic effect during the procedure.¹⁸ In practical terms, if your doctor uses epinephrine in the anesthetic, you may have less bleeding and better pain control during surgery, without any trade-off in long-term outcomes. The old concern that epinephrine could cut off blood supply to the toe and cause tissue death has been largely put to rest by modern evidence, at least in patients without pre-existing circulatory problems.

Medications That Affect Nail Growth

Certain medications can cause nail abnormalities that lead to ingrown toenails or make them harder to treat. Cancer chemotherapy drugs are among the most common culprits, and some targeted therapies used in cancer treatment are well known for causing painful ingrown nails as a side effect. Retinoids (used for severe acne and other skin conditions), certain antibiotics, and antimalarial drugs can also alter nail growth.¹⁹

When a medication is causing or contributing to ingrown toenails, treating the nail problem alone may not prevent recurrence as long as the drug continues. In some cases, conservative management throughout the course of treatment is the best option, with definitive surgical treatment deferred until after the medication is stopped and nail growth returns to normal. If you are on a medication that seems to be affecting your nails and you develop recurrent ingrown toenails, raising this with both your prescribing doctor and whoever treats the nail is important so the two treatments are not working at cross purposes.

Orthonyxia and Non-Surgical Alternatives

Orthonyxia refers to the use of braces, wires, or clips attached to the nail plate to gradually flatten its curvature and lift the edges away from the skin fold. The concept is similar to orthodontic braces for teeth: gentle, sustained force reshapes the nail over weeks to months. It is an attractive option for people who want to avoid surgery, and it is painless during application.

A study comparing orthonyxia (using a clip) to partial matrix excision found no statistically significant difference in recurrence between the two approaches, though the study was small and the result was not definitive.²⁰ The limitation of orthonyxia is that it does not permanently change the nail matrix, so once the brace is removed, the nail may eventually return to its original curvature. It works best for mild cases or for patients who are not candidates for surgery, and it sometimes buys enough time for a growing teenager’s toe anatomy to change on its own.

How to Reduce Your Chances After Any Procedure

Regardless of what procedure you had, some habits meaningfully affect whether the problem returns. Cutting toenails straight across rather than rounding them is the single most impactful change, given that improper trimming was the strongest independent predictor of ingrown toenails in case-control research.¹¹ Wearing shoes with enough room in the toe box matters, especially during the healing period after surgery. Keeping feet dry and clean reduces the risk of both infection and fungal nails, which is relevant because fungal nail infection was itself an independent risk factor for ingrown toenails in the same study.

If you have excess sweating of the feet, using moisture-wicking socks and antifungal foot powder can help. If your nails naturally curve excessively, a podiatrist may recommend periodic filing or thinning of the nail plate to reduce the inward pressure. And if your weight is a factor you can modify, even modest changes may help: each unit increase in BMI was associated with a small but statistically significant increase in ingrown toenail risk.¹¹

None of these measures guarantee that an ingrown toenail will not return, especially if you had a simple avulsion without matrix destruction. But for people who have already had a matricectomy and want to protect the investment, managing the controllable risk factors is the best insurance available.