When is surgery necessary?
Following surgery, it is advisable to keep a bandage around the wound until it heals.
An ingrown toenail, which doctors might call onychocryptosis, is a common complaint. About 20% of people who see their doctor for foot problems need help with an ingrown toenail.
This painful condition happens when the toenail grows down into the skin. It most commonly affects the big toe, with the corner of the nail growing into the nail bed. In most cases, it occurs due to tight fitting footwear or improper trimming of the nails.
People can often treat ingrown toenails at home by wearing sandals to avoid putting pressure on the toe, soaking the toe in warm water, and keeping the area clean to help it heal on its own.
However, if there are signs of infection, a person should see a doctor rather than trying to treat the nail at home. People should also seek medical care for an ingrown nail if they have a health condition — such as diabetes, nerve damage, or poor circulation — that makes home treatment risky.
Ingrown toenails irritate the skin. As a result, they can make it easier for bacteria and other microbes to get in, which increases the risk of infection. Promptly treating an ingrown toenail reduces this risk. Some signs of infection include:
If the toenail is very swollen or inflamed, or it does not get better after a few days, a doctor may diagnose an infection and prescribe antibiotics. They might also prescribe a special splint to prevent the toenail from growing deeper into the skin. If the toe still does not heal, a doctor may recommend surgery.
Surgery for an ingrown toenail is an outpatient procedure.
Ingrown toenail surgery is usually an outpatient procedure that involves the use of local anesthesia. Local anesthesia means that the person remains awake, but the doctor numbs the area so that the person cannot feel their toe.
Some doctors offer a sedative or twilight anesthesia during the surgery. With twilight anesthesia, the person remains awake but groggy, and they may not remember the procedure.
If a person prefers general anesthesia, the surgery may take longer and require more preparation. With general anesthesia, the individual will be unconscious, making it a good option for people who are very anxious about surgery.
Several surgical procedures can treat an ingrown toenail. An orthopedic surgeon or podiatrist can offer advice on the best option, but a person should be sure to make them aware of relevant health issues, including any prior history of ingrown toenails.
The most common surgeries for ingrown toenails include:
- Wedge resection. Here, a doctor removes a portion of the toenail to prevent it from digging into the skin. This procedure is also called a partial nail avulsion.
- Toenail removal. A doctor may decide to remove the entire toenail. Removing the whole nail makes it more likely that the nail will grow back misshapen or deformed, which can increase the risk of future ingrown toenails. It can take up to 18 months for the nail to regrow fully. This procedure is also called complete nail plate avulsion.
- Surgery on the tip of the toe. If other surgeries are unsuitable for a person, or previous procedures have failed, a doctor may remove and reshape the soft tissue at the tip of the toe.
- Matrixectomy. This procedure may be necessary if nail removal or wedge resection fails. It involves the removal of the nail bed in addition to the nail.
A doctor may also cut deep into the nail bed to relieve swelling or drain infected tissue.
Recovery timeline and tips
A person can help speed their recovery after ingrown toenail surgery by:
- soaking the foot in warm water or Epsom salts every day
- taking a nonsteroidal anti-inflammatory drug (NSAID) to help with pain and swelling
- applying an antibiotic ointment twice daily or as often as a doctor recommends, if there is an infection
- keeping the wound bandaged until it heals, which usually takes several weeks
- keeping the wound clean and dry, except when showering or cleaning the area
- avoiding strenuous activity that puts pressure on the nail until a doctor permits a return to exercise
- wearing properly fitted shoes that are not too tight
- avoiding picking at the wound
For most people, the wound will heal within several weeks. The pain will steadily lessen in the days following surgery and should have gone by the time the wound heals. It can take several months for the nail to regrow, but the length of time will vary from person to person.
A person should talk to their doctor about the benefits and risks of surgery.
Minor complications are common following nail surgery, though serious complications are rare. However, an untreated ingrown toenail carries a much higher risk of complications than nail removal.
People should discuss the benefits and risks of surgery with their doctor, who will take into account their particular risk factors. People with a history of anesthesia complications and those with weakened immune systems may be more vulnerable to complications.
Possible ingrown toenail removal complications include:
- Toenail deformity. Toenails may grow back misshapen or deformed. In some cases, they might not regrow, or they may not reach their previous length.
- Subsequent ingrown toenails. Removing one ingrown toenail does not necessarily prevent a person from developing future ingrown toenails. In some cases, a person might need another surgery or even multiple surgeries.
- Infection. A person may develop an infection following surgery. Surgery creates an open wound that makes it easier for bacteria and other pathogens to enter the body. It is important to see a doctor for any signs of infection following surgery because untreated infections can seriously damage the toe or lead to amputations.
- Anesthesia complications. A person may have trouble waking up from general anesthesia or have an adverse reaction — such as an allergic reaction — to local anesthesia.
- Allergic reactions. A person may have an allergic reaction to some of the surgical equipment. People with a latex allergy should disclose this information to the medical team.
Ingrown toenails can be painful, but with proper home or medical treatment, they are rarely serious. Surgery presents some risks, but it can alleviate the chronic pain of an ingrown toenail.
People with ingrown toenails should discuss their treatment options with a skilled, experienced podiatrist or orthopedic surgeon. Excellent medical care and diligent home management can reduce the risk of complications following surgery and increase the likelihood of a full recovery with the regrowth of a healthy nail.