Ingrown toenail removal is a quick outpatient procedure that typically takes about 20 to 30 minutes, including numbing the toe. The most common approach, called a partial nail avulsion, removes only the sliver of nail digging into your skin rather than the entire toenail. Here’s what actually happens at each stage.
When Surgery Is Necessary
Not every ingrown toenail needs a procedure. Mild cases, where the nail edge is just slightly pressing into the skin and causing redness, can often be managed at home with soaking, taping, or packing cotton under the nail edge. Surgery is typically reserved for cases where the skin around the nail has become swollen, infected, or started forming raised granulation tissue along the nail fold. It’s also the next step when conservative care hasn’t worked after about three months.
Numbing the Toe
The procedure starts with a digital nerve block, which numbs the entire toe. Your provider injects a local anesthetic (usually lidocaine) on both sides of the base of your toe, near where it meets the foot. The needle goes in at a 90-degree angle on one side, and the anesthetic is slowly injected as the needle advances toward the bottom of the toe. The process is then repeated on the other side.
The injection itself is the most uncomfortable part of the entire procedure, often described as a sharp sting followed by pressure. It takes about two to five minutes for the numbness to fully set in. Once the block is working, you won’t feel pain during the rest of the procedure, though you may feel some pressure or tugging sensations.
Removing the Nail Edge
With the toe completely numb, the provider uses a specialized nail splitter to cut a narrow strip, about 2 to 3 millimeters wide, along the ingrown side of the nail. The cut runs lengthwise from the tip of the nail all the way back to the base, where a small surgical blade finishes the split through the softer portion of nail near the root.
Next, a small retractor frees the cut strip from the skin folds and the nail bed underneath. Then the provider grips the strip with locking forceps and gently rotates it toward the center of the nail, easing it free. The whole removal takes only a few minutes. If both sides of the nail are ingrown, the same steps are repeated on the other edge.
Preventing the Nail From Growing Back
Simply pulling out the offending nail edge doesn’t solve the problem long-term. Without an additional step, the nail regrows in the same shape and the ingrown edge comes back more than 70% of the time. That’s why most providers follow the removal with a chemical matrixectomy, which destroys the strip of nail root so that narrow section of nail never regrows.
The most common method uses a cotton-tipped applicator soaked in 89% phenol, pressed into the exposed nail matrix. Application time varies by provider. Research shows that a one-minute application is standard practice, though some studies suggest a longer application of around four minutes more thoroughly destroys the nail-producing cells. Sodium hydroxide (10%) is an alternative chemical that works similarly, sometimes applied for one to three minutes. Studies comparing phenol, sodium hydroxide, and surgical matrix removal have found no significant differences in recurrence rates, side effects, or patient satisfaction across the three methods.
After the chemical is applied, the area is flushed with saline or alcohol to neutralize it, and the toe is bandaged.
The Vandenbos Procedure for Severe Cases
For severe or repeatedly recurring ingrown toenails, some providers offer a different approach called the Vandenbos procedure. Instead of removing nail, this technique removes a wedge of the swollen skin fold pressing against the nail and lets the wound heal on its own over several weeks. The nail itself is left completely intact.
The advantage is a very low recurrence rate. Across nearly 1,200 patients reported in medical literature, there were essentially no cases of the ingrown nail returning. Cosmetic results also tend to be better than with other surgical methods, and patient satisfaction is high. The trade-off is a longer healing period while the open wound closes.
What Recovery Looks Like
Most people can return to work or school the next day. The numbness from the anesthetic wears off within a couple of hours, and you can expect some soreness and throbbing for the first day or two, which over-the-counter pain relievers typically handle well.
Your first dressing change happens 12 to 24 hours after the procedure. Soaking your foot in warm water beforehand helps keep the bandage from sticking to the wound. After that, you’ll change the dressing once or twice a day. Many providers recommend soaking the toe two to three times daily in warm water with Epsom salts to reduce swelling, then patting the area dry and applying antibiotic ointment before rebandaging.
You’ll want to wear open-toed or loose-fitting shoes for the first couple of weeks, as anything that presses on the toe will be uncomfortable. If a partial nail removal was done, expect the site to fully heal in about six to eight weeks. A full nail removal takes closer to eight to ten weeks. During this time, the exposed nail bed gradually hardens and the surrounding skin settles into its new shape. The remaining portion of your toenail continues growing normally, just slightly narrower than before, which is the whole point: that narrow strip that used to dig into your skin is permanently gone.