An ingrown toenail (onychocryptosis) is a common condition where the nail edge grows into the surrounding skin, causing discomfort and inflammation. When non-surgical treatments fail, professional removal is recommended for lasting relief. This minor procedure, often involving the permanent removal of the problematic nail section (partial nail avulsion), is performed using local anesthesia to ensure the process is pain-free.
Managing Pain During the Removal Procedure
The core procedure is painless because a local anesthetic, typically lidocaine, is administered via a digital block. This injection effectively numbs the specific nerves transmitting pain signals from the toe, ensuring you will not feel the removal or cutting. The anesthetic is injected at the base of the toe, which is a less sensitive area than the inflamed site of the ingrown nail.
The only discomfort is usually a brief sting or pinch as the local anesthetic is initially injected, similar to a quick vaccination. Clinicians use fine-gauge needles and inject the solution slowly to minimize this sensation. Once the anesthetic takes full effect (typically within five to fifteen minutes), the entire toe will feel completely numb and heavy.
The doctor will test the area to confirm the nerve block is fully active before beginning the removal. During the procedure, you may feel pressure or movement, but there should be no sharp pain. The numbness generally lasts for about two to four hours, giving the doctor ample time to complete the procedure.
Expectations for Post-Procedure Pain and Healing
Once the local anesthetic wears off, usually a few hours after the procedure, some discomfort is normal. This is typically a dull ache or throbbing sensation, signaling the start of the body’s natural healing process. This initial discomfort is generally manageable and often less severe than the constant, sharp pain caused by the ingrown nail beforehand.
Standard over-the-counter pain relievers, such as ibuprofen or acetaminophen, are usually sufficient to control post-procedure pain. These medications help reduce inflammation and dull the throbbing sensation. It is helpful to take the first dose before the anesthetic fully wears off.
For the first three to seven days, you may notice the most discomfort, particularly when standing or walking for long periods. Keeping the foot elevated and resting helps reduce swelling and throbbing pain. In rare cases of extensive inflammation or severe pre-existing infection, a doctor may prescribe stronger pain medication. The initial healing phase, where the worst discomfort subsides, usually takes about one to two weeks.
Understanding the Types of Removal Procedures
The most common method to resolve a recurring ingrown toenail is a Partial Nail Avulsion (PNA), where only the offending wedge of the nail is removed. To prevent regrowth, this is frequently combined with a chemical Matrixectomy. This involves applying a chemical, such as phenol, to the nail matrix—the tissue where the nail grows from—to permanently destroy the small section that produces the problematic nail edge.
Alternatively, a total nail avulsion involves removing the entire nail plate, which is usually reserved for cases where the nail is severely deformed or diseased. A PNA with chemical matrixectomy is generally considered less invasive, often resulting in a shorter overall healing time compared to a total nail avulsion. Though the technique varies, pain management protocols remain similar for both procedures.