Onychocryptosis, commonly known as an ingrown toenail, occurs when the edge of the nail plate grows into the surrounding skin, leading to inflammation, pain, and sometimes infection. This condition frequently affects the big toe and can cause significant discomfort, often prompting people to seek professional medical intervention. Ingrown toenail treatment typically involves a minor in-office procedure, and understanding the steps involved can help alleviate concerns about the process.
When Is Numbing Necessary?
The decision to use local anesthesia depends entirely on the severity of the ingrown toenail and the planned method of treatment. Mild cases, categorized by minimal swelling and pain without signs of severe infection, are often managed conservatively. This non-surgical approach may involve warm soaks, topical antibiotics, and careful lifting or trimming of the offending nail edge. If conservative care is successful, no numbing is required.
Local anesthesia becomes necessary when the condition progresses to a moderate or severe stage, involving intense inflammation, chronic recurrence, or the presence of pus and hypertrophic granulation tissue. These advanced cases require a minor surgical intervention to permanently remove the problematic section of the nail. Any procedure that involves cutting or applying a chemical agent to the nail-producing tissue mandates the use of a numbing agent to ensure a pain-free experience.
If the practitioner determines that the nail must be partially removed, or that the nail matrix—the root of the nail—needs to be chemically treated to prevent recurrence, then numbing the toe is a required preparatory step. This minor surgery is significantly more effective than non-surgical options for preventing the problem from returning.
How Local Anesthesia is Administered
The method used to achieve numbness is called a digital nerve block. This technique targets the specific nerves that supply sensation to the toe, ensuring the entire digit is anesthetized without requiring general sedation. The most common anesthetic agents used are lidocaine or sometimes a longer-acting agent like bupivacaine, both administered without epinephrine to avoid potential complications in the toe’s circulation.
The injection is performed using a fine-gauge needle, typically at the base of the toe, away from the painful and inflamed area of the ingrown nail. The practitioner injects the solution slowly near the digital nerves on both sides of the toe, a process sometimes referred to as the H-block or ring block technique. Patients generally feel a brief, sharp sting or burning sensation as the anesthetic solution is initially introduced.
Full anesthesia is usually achieved within five to ten minutes. At this point, the patient should feel no pain, only pressure or movement, if any sensation remains. The goal of this targeted injection is to completely block all pain signals from the toe, making the subsequent minor surgery entirely comfortable.
The Ingrown Toenail Procedure
Once the digital nerve block has taken full effect, the procedure begins. The patient feels only the movement and manipulation of the toe, not pain. The toe is thoroughly cleaned with an antiseptic solution, and a thin tourniquet is often applied temporarily to the base of the toe to control bleeding and maintain a clear surgical field.
The primary surgical method is a Partial Nail Avulsion (PNA), where the offending vertical strip of the nail plate is removed. Using a specialized instrument, the surgeon separates the lateral section of the nail from the underlying nail bed, cutting it back to the nail root. This small, detached section of nail is then gently pulled away with forceps. Removing this strip immediately eliminates the physical cause of the pain by taking the sharp nail edge out of the surrounding skin fold.
To prevent the problematic nail strip from regrowing, a chemical agent is applied in a process called matrix ablation or matricectomy. The most common agent is phenol, a caustic chemical, which is carefully applied to the nail matrix where the nail was removed. Alternatively, sodium hydroxide or trichloroacetic acid may be used. These chemicals work to destroy the specific cells responsible for growing that portion of the nail.
The chemical application is precise, typically performed using a small cotton-tipped applicator, and is confined only to the targeted area of the matrix. This chemical cauterization is what makes the procedure a long-term solution for preventing recurrence. After the chemical application, the area is flushed, the tourniquet is removed, and a sterile dressing is applied.
Recovery and Post-Procedure Care
Following the minor surgery, the initial numbness from the local anesthesia will typically last for one to two hours before gradually wearing off. Patients may experience some throbbing or mild to moderate pain once sensation returns, which is usually manageable with over-the-counter pain relievers such as acetaminophen or ibuprofen. Elevating the foot frequently during the first 48 hours is recommended to minimize swelling and reduce discomfort.
The practitioner will provide instructions for changing the dressing, which is usually required daily for the first week. The dressing change often involves soaking the toe in warm water to loosen the old bandage before gently cleaning and reapplying a fresh dressing with an antibiotic ointment. It is important to monitor the toe for signs of infection, such as excessive redness spreading beyond the surgical site, unusual warmth, or thick, discolored discharge.
Activity restrictions promote healing. Patients are generally advised to avoid strenuous activity, running, or heavy exercise for at least the first one to two weeks. For the first few days, wearing open-toed shoes or very loose-fitting footwear is recommended to prevent pressure on the surgical site. While light activity can usually be resumed within a day or two, the complete healing process typically takes between two and four weeks.