An ingrown toenail, or onychocryptosis, is a common but often painful condition where the edge of the toenail grows into the soft flesh of the toe, most frequently affecting the big toe. This abnormal nail growth causes inflammation, tenderness, and swelling. If the skin is punctured, bacteria can enter, leading to a localized infection that presents with pus, throbbing pain, and increased warmth. Professional removal is often necessary to alleviate the pain and prevent the infection from spreading.
Deciding Between Home Care and Professional Help
The first step in addressing an ingrown toenail is determining its severity, as this dictates whether home care is appropriate or if immediate professional attention is required. Mild cases, characterized by slight redness and minor discomfort without discharge, may respond to simple at-home measures. Soaking the affected foot in warm, soapy water multiple times a day for about 15 to 20 minutes can help reduce swelling and tenderness.
If home treatment has not resulted in improvement after three to four days, or if the condition is worsening, it is time to seek a medical provider. Signs that necessitate immediate professional care include severe, worsening pain, an unpleasant odor, or the presence of pus or thick drainage. Red streaks extending from the toe toward the foot indicate the infection may be spreading, which requires urgent evaluation.
Individuals with pre-existing conditions like diabetes, peripheral artery disease, or any disorder affecting circulation or nerve sensation should bypass home care entirely. Poor blood flow can increase the risk of a minor infection escalating into a serious complication, such as cellulitis or a bone infection (osteomyelitis). For these patients, even a slightly tender toe warrants immediate consultation with a foot specialist.
Types of Healthcare Providers Who Perform Removal
The choice of where to go for ingrown toenail removal depends on the complexity of the case and the desired long-term outcome. Podiatrists (Doctors of Podiatric Medicine) are foot and ankle specialists who offer the most comprehensive care for this condition. They possess the specialized training to diagnose the root cause of the ingrown nail, manage severe infections, and perform advanced, minimally invasive surgical procedures to prevent recurrence. Starting with a podiatrist is often the most efficient route, especially for chronic or severe cases, as they can perform both temporary and permanent solutions in their office.
Primary Care Physicians (PCPs) can often handle simple, acute, and non-recurring ingrown toenails. A PCP can trim the offending nail edge, manage mild infections with oral antibiotics, and provide immediate symptom relief. However, PCPs typically do not perform the specialized, permanent procedures, often referring patients to a podiatrist for recurrent problems or when the case requires a matrixectomy.
Urgent Care Clinics offer a fast and accessible option for acute pain or suspected infection, but their treatment is focused on initial stabilization. Staff can drain an abscess, prescribe antibiotics, and perform a simple partial nail avulsion to remove the immediate source of pain. These clinics are best used for a quick intervention to manage an acute flare-up. Since they are not equipped to perform a matrixectomy, patients are advised to follow up with a podiatrist for definitive, long-term treatment.
What to Expect During the Procedure
Professional ingrown toenail removal is a minor, in-office procedure that begins with the administration of a local anesthetic. The provider will inject a numbing medication, typically at the base of the toe, to ensure the entire digit is pain-free throughout the procedure. A small rubber band or tourniquet is often placed around the toe to control blood flow, providing a clear, sterile field for the procedure.
The most common procedure for temporary relief is a Partial Nail Avulsion (PNA), which involves surgically removing only the small wedge of nail growing into the skin. This provides immediate relief and allows the infection to clear. However, the nail edge is likely to grow back, potentially causing recurrence. For a permanent solution, the provider performs a Matrixectomy or chemical ablation.
After the partial nail section is removed, a chemical agent, most commonly phenol, is applied to the exposed nail matrix, which is the tissue responsible for nail growth. Phenol chemically cauterizes the matrix cells in that specific area, preventing the removed section of the nail from ever growing back. This results in a slightly narrower, but permanently corrected, nail.
Following the procedure, the toe is dressed with a bulky bandage, which should remain in place for 24 hours to control any initial bleeding. Patients are usually advised to elevate the foot for the rest of the day and can manage any mild post-procedure discomfort with over-the-counter pain relievers. After the initial 24 hours, the patient will begin soaking the toe in warm salt water and applying fresh dressings, a process that typically continues for two to four weeks until the surgical site is fully healed.