An ingrown toenail (onychocryptosis) occurs when the edge of the toenail grows into the surrounding skin, most often affecting the big toe. This intrusion causes the skin to become tender, swollen, and red. Increased pain can make it difficult to walk or wear certain shoes.
Deciding Between Home Care and Professional Help
For a mild ingrown toenail, where the pain is manageable and there are no signs of open skin or discharge, home care may be a suitable initial approach. Safe self-treatment involves soaking the foot in warm, soapy water for 10 to 20 minutes several times a day to soften the surrounding skin and reduce inflammation. You can then gently try to lift the ingrowing nail edge and place a small piece of cotton or waxed dental floss underneath to encourage the nail to grow above the skin.
If specific symptoms are present, seek professional attention immediately. These signs include pus or liquid discharge, severe or worsening pain, spreading redness, warmth around the toe, or an inability to bear weight. Individuals with pre-existing conditions like diabetes or poor circulation should bypass home remedies entirely, as even minor foot injuries can quickly lead to serious complications and infections.
Types of Professional Removal Procedures
When professional treatment is necessary, a medical provider will select a procedure based on the severity and recurrence of the ingrown toenail. The most common approach for a non-recurrent ingrown nail is a Partial Nail Avulsion, often called a wedge resection. This minor, in-office surgery involves numbing the toe with a local anesthetic before the provider removes only the small, offending wedge of nail plate digging into the skin.
For cases that are chronic or have recurred after a simple avulsion, a Matrixectomy is performed to provide a permanent solution. This procedure combines the partial nail avulsion with the destruction of the nail matrix—the tissue at the base of the toe responsible for nail growth. The matrix is typically destroyed using a chemical agent, most commonly phenol, which prevents the problematic section of the nail from growing back.
A Total Nail Avulsion (TNA), which involves the complete removal of the entire toenail, is reserved for severe or complex cases. This is generally considered a temporary measure to allow a severe infection to drain and heal, or it may be followed by a full matrixectomy to permanently stop nail growth. The entire procedure is performed under local anesthesia, and while the healing time for a TNA is longer, it can effectively resolve widespread issues.
Where to Seek Treatment
The choice of where to seek professional ingrown toenail removal depends on the severity of your condition and whether you require a permanent solution. A Podiatrist, a doctor specializing in foot, ankle, and lower leg conditions, is the most recommended specialist for ingrown toenails, especially for recurrent or complex cases. They possess the specialized tools and expertise to perform both simple avulsions and permanent matrixectomies in their office setting.
Your Primary Care Physician (GP or Family Doctor) can often manage minor, non-infected ingrown toenails and may prescribe antibiotics if an infection is present. However, for the more definitive surgical procedures like matrixectomies, they will likely refer you to a foot specialist. Urgent Care or walk-in clinics can provide prompt relief for acute pain or initial infection management, often performing a simple partial nail removal.
Urgent care centers are helpful for quickly addressing signs of infection like pus or severe swelling. While they can offer initial treatment, they may not always have the capacity or specialization to perform the chemical matrixectomy procedure necessary to prevent recurrence. In some instances, a Dermatologist, who specializes in skin and nail conditions, may also be able to perform these surgical removals.
Aftercare and Preventing Recurrence
Following a professional removal procedure, diligent aftercare is crucial for proper healing and minimizing the chance of complication. For the first 24 hours, you will need to keep the initial dressing dry and elevated to control swelling and bleeding. After the first day, the typical instructions involve soaking the toe in warm water, sometimes with Epsom salts or a mild antiseptic, for 20 to 30 minutes twice daily for two to four weeks.
The expected healing time varies depending on the procedure; a simple partial nail avulsion usually heals within two weeks, allowing a quick return to normal activities. A matrixectomy, which involves a chemical burn to prevent nail regrowth, may take longer, with the area appearing red or draining for up to four weeks. You must monitor the wound closely for signs of a new infection, such as increased warmth, pain, or foul odor, and contact your provider if these occur.
To prevent recurrence, adopt specific habits for long-term foot health. Always trim your toenails straight across, taking care not to cut them too short or round the corners, which encourages the nail to grow into the skin. Avoid wearing footwear that is too tight or narrow in the toe box, as this pressure can force the nail into the surrounding tissue.