An ingrown toenail develops when the edge of the toenail grows into the surrounding soft skin, causing pain, redness, and swelling. This common condition frequently affects the big toe and can quickly progress to an infection if not managed correctly. Professional care from a podiatrist is often necessary to safely remove the offending nail piece and address any underlying infection. The professional approach focuses on resolving the immediate pain and preventing the nail from growing inward again.
Initial Evaluation and Non-Surgical Options
The podiatrist first assesses the condition to determine its severity and the presence of infection. This assessment includes a visual inspection of the toe, palpation to check for tenderness and swelling, and a review of the patient’s medical history, especially concerning conditions like diabetes that complicate foot healing. Ingrown toenails are graded as mild, moderate, or severe, which guides the treatment plan. Mild cases present with slight redness and discomfort, while severe cases involve significant inflammation, pus, and granulation tissue.
For mild ingrown nails, the podiatrist may recommend conservative, non-surgical treatments to allow the nail to grow out correctly. These techniques involve soaking the foot in warm water with Epsom salts to reduce inflammation and soften the skin. The podiatrist may also perform “nail packing,” which involves gently lifting the nail edge and placing a small piece of cotton or a splint beneath it to redirect the nail’s growth away from the skin. If a minor infection is present, topical or oral antibiotics may be prescribed before any further intervention.
The Procedure for Permanent Correction
When conservative methods fail or the ingrown toenail is moderate to severe, the podiatrist recommends a minor in-office surgical procedure known as a Partial Nail Avulsion (PNA) with a chemical matrixectomy. This procedure is designed to permanently remove the problematic nail edge. The process begins with the administration of a local anesthetic, usually lidocaine, injected into the base of the toe to create a digital nerve block. This ensures the entire toe is completely numb, making the remainder of the procedure painless.
Once the anesthesia has taken effect, a sterile tourniquet may be placed at the base of the toe to control blood flow, providing a clear field for the work. The podiatrist then uses specialized instruments to carefully cut the offending sliver of nail plate longitudinally, from the tip down to the nail root, or matrix. This small section of nail, known as a spicule, is gently lifted and removed entirely, without the need for any incision or stitches to the surrounding skin.
The chemical matrixectomy prevents the removed section of the nail from growing back. A chemical agent, most commonly Phenol, is applied to the exposed nail matrix tissue at the base of the nail root. This application chemically cauterizes the matrix cells in that specific area, effectively destroying the nail-producing tissue. The chemical is applied several times to ensure the permanent destruction of the matrix cells, after which the area is cleaned, the tourniquet is removed, and a sterile dressing is applied to the toe.
Managing Recovery and Aftercare
Immediately following the procedure, the patient is able to walk, though wearing open-toed or protective surgical shoes is advised to avoid pressure on the treated toe. The podiatrist will apply a bulky, sterile dressing that should be kept intact for the first 24 to 48 hours to protect the wound and allow for initial healing. For the first day, keeping the foot elevated above heart level helps to minimize swelling and throbbing pain as the local anesthetic wears off.
Once the initial dressing is removed, the patient must begin a regimen of wound care as directed by the podiatrist, which involves daily soaking in warm water. Soaking helps to keep the area clean and promotes drainage of the wound. After soaking, a new sterile dressing, with an antibiotic cream or ointment, must be applied to prevent infection. It is normal to observe a yellowish or brownish discharge from the wound for up to several weeks; this is a byproduct of the chemical application and not necessarily a sign of infection.
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, are usually sufficient to manage any mild discomfort experienced after the numbing agent dissipates. Patients should avoid strenuous physical activity, like running or heavy exercise, for approximately two to three weeks to prevent trauma to the healing toe. The recovery period is complete when the treated area is dry and no longer requires a dressing, which generally takes between two to four weeks.
Steps to Avoid Recurrence
Preventing future ingrown toenails requires proper nail care habits. The most important preventive measure is trimming toenails correctly, which means cutting them straight across rather than rounding the corners. Cutting the nail too short also increases the risk of the surrounding skin folding over the nail, leading to the nail growing inward.
Wearing footwear that fits properly is essential. Shoes should have a wide toe box that allows the toes to move freely without being crowded or compressed. If an underlying foot structure issue or fungal infection is contributing to the problem, the podiatrist may recommend custom orthotics or specific treatment to ensure the permanent correction remains successful.