Ingrown toenail surgery is a minor in-office procedure where a doctor removes part or all of a toenail that has grown into the surrounding skin. It typically takes 20 to 30 minutes, uses local anesthesia, and most people walk out of the office the same day. The most common version, partial nail avulsion with chemical matrixectomy, has a recurrence rate of just 1.6 to 3 percent.
When Surgery Becomes Necessary
Most ingrown toenails start with mild redness and tenderness along the nail edge. At this early stage, conservative measures like warm soaks, proper trimming, and wearing roomier shoes can resolve the problem. Surgery enters the conversation when the condition progresses: the skin fold swells over the nail plate, the toe becomes infected, or an abscess forms. Chronic ingrown toenails that keep returning after conservative treatment are also strong candidates for a permanent surgical fix.
People with diabetes or poor circulation in their feet are often referred for surgery sooner, because even a minor nail infection can escalate quickly when blood flow to the toes is compromised.
Types of Ingrown Toenail Surgery
Partial Nail Avulsion
This is the most common procedure. The doctor removes only the strip of nail digging into the skin, leaving most of the toenail intact. On its own, simple partial avulsion cures the problem in only about 30 percent of cases, because the nail root is still capable of regrowing that same offending edge. That’s why most surgeons pair it with a matrixectomy (destroying the nail root along that strip) to prevent regrowth.
Chemical Matrixectomy
After removing the nail strip, the doctor applies a chemical, most commonly phenol, to the exposed nail root. This kills the cells responsible for growing that portion of the nail. Sodium hydroxide is another option. Chemical matrixectomy with phenol is the gold standard for recurring ingrown toenails, with recurrence rates between 1.6 and 3 percent across large studies.
Total Nail Avulsion
In severe or repeatedly infected cases, the entire toenail is removed. This is less common and reserved for situations where both sides of the nail are ingrown or the nail is too damaged to salvage. It can also be combined with matrixectomy if the goal is to prevent the nail from ever growing back.
Other Matrixectomy Methods
Some providers use laser or electrosurgical tools to destroy the nail root instead of chemicals. These achieve the same goal through heat rather than a chemical reaction. The choice often depends on what equipment the office has and the surgeon’s preference.
What Happens During the Procedure
You’ll sit or lie back in a chair with your foot elevated. The doctor numbs your toe with a local anesthetic injected near the nerves on either side of the toe’s base. The injection itself is the most uncomfortable part of the entire process. Some providers warm the anesthetic solution or mix it with a buffering agent to reduce the sting. Full numbness sets in within 5 to 10 minutes.
Once your toe is numb, the doctor places a small rubber band or tourniquet around its base to minimize bleeding. Using a narrow instrument, they separate the offending strip of nail from the nail bed and pull it out. If a matrixectomy is planned, they then apply phenol or another agent to the exposed root for a set period, usually a couple of applications lasting about 30 seconds each. The area is flushed, the tourniquet is removed, and the toe is bandaged.
You won’t feel cutting or pulling during the procedure, though you may feel pressure or a tugging sensation. The whole thing is over quickly, often in under 20 minutes of active work.
Recovery Timeline
If part of the nail was removed, expect the wound to take six to eight weeks to fully heal. A total nail removal generally takes eight to ten weeks. The toe will be sore once the anesthesia wears off, usually within a few hours. Most people manage the discomfort with over-the-counter pain relievers for the first day or two.
For the first 24 to 48 hours, keep your foot elevated as much as possible and avoid unnecessary walking. Drainage from the wound is normal during the first week or two, especially after a chemical matrixectomy, where the treated area produces a clear or slightly yellowish fluid as it heals. This is not pus and does not mean you have an infection.
You can usually return to desk work or light daily activities within a day or two. Avoid swimming until the wound has fully healed, and hold off on running, hiking, or other high-impact exercise during the healing period. Wear shoes that give your toes plenty of room. Tight or narrow footwear puts pressure on the healing site and can slow recovery.
Aftercare and Wound Management
Your provider will send you home with a bandage and specific instructions, but the general routine involves daily dressing changes. Start by gently removing the old bandage (soaking it first in warm water makes this easier if it sticks). Clean the toe with mild, unscented soap and water. If your doctor prescribed a topical ointment, apply a thin layer to the wound. Then cover it with a fresh piece of sterile gauze and tape it in place.
Many providers recommend soaking the toe in warm salt water once or twice daily starting a day or two after surgery. This helps keep the wound clean and softens any dried drainage. Pat the toe dry thoroughly before applying a new dressing, since moisture trapped against the wound can promote bacterial growth.
Risks and Complications
Ingrown toenail surgery is considered low-risk when performed properly. The most common complications are infection, prolonged swelling, and minor bleeding. Some people develop a small, raised bump of tissue called a pyogenic granuloma at the wound site, which may need additional treatment. Allergic reactions to the anesthetic are rare but possible.
Chemical matrixectomy can occasionally cause a mild chemical burn to the surrounding skin, leading to extra redness and tenderness that resolves on its own. The most notable long-term risk is nail dystrophy, where the remaining nail grows back slightly thicker or with an irregular shape. This is cosmetic rather than painful, but it’s worth knowing about beforehand.
Persistent pain, spreading redness, or increasing swelling in the days after surgery can signal infection. A small number of patients experience prolonged pain or sensitivity that takes longer than expected to resolve.
What the Nail Looks Like Afterward
After a partial nail avulsion with matrixectomy, the nail grows back slightly narrower than before because that strip of root has been permanently destroyed. Most people find the cosmetic difference barely noticeable once the nail has fully grown in. If the entire nail was removed without matrixectomy, a new nail will eventually regrow, though it often takes six months to a year and may come in with a slightly different texture. If matrixectomy was performed on the full nail, no new nail grows back, and the nail bed gradually develops a smooth, skin-covered appearance.