Surgery for Ingrown Toenails: Procedure, Recovery, and Prevention

An ingrown toenail—medically known as onychocryptosis—refers to a toenail that has grown into your skin. The top corner of the nail grows into the flesh, causing pain and inflammation.

Most ingrown toenails occur in the big toe. Common causes include wearing shoes that are too tight, cutting your toenails too short, or having toenails that naturally grow curved. Injuries to the nail or toe may also increase the risk of an ingrown toenail. 

Ingrown toenails are treatable. However, if it hasn’t improved with at-home treatment or has become infected, you may want to consider surgical options.

Talk with your healthcare provider if you are concerned that your ingrown toenail may require surgery. They will likely refer you to a podiatrist (foot doctor) specializing in toenail surgery. 

You may require ingrown toenail surgery if:

• Home remedies have not helped
• The ingrown toenail keeps coming back
• Your nail appears infected and shows signs of swelling, redness, pus, or pain, or you develop a fever
• You have other health conditions, such as diabetes or nerve damage in your foot, that raise the risk of complications

Several surgical treatments are available, depending on the severity of your ingrown nail, if you have any complications, and whether you’ve had toenail surgery before. A podiatrist or orthopedic surgeon usually performs ingrown toenail surgery. 

Surgical options for ingrown toenails include:

• Partial nail avulsion: The surgeon will remove only the ingrown part of the nail. Ingrown toenails commonly come back after this procedure.
• Wedge resection: The surgeon will remove part of the nail and the surrounding soft tissue. This simple procedure is usually considered for mild to moderate cases. 
• Nail bed ablation: After removing part of the toenail or the whole nail, the surgeon will use a technique to prevent the nail from growing back. They may apply a chemical solution (usually phenol) to the area where the toenail usually grows. Other methods include electrocautery (heat), radiofrequency, or carbon dioxide. This surgery reduces the risk of recurrence and is recommended in moderate cases. 
• Zadik’s procedure: The surgeon removes the entire toenail and nail bed. This procedure was once used for severe cases, but it’s no longer as common because it has a higher risk of recurrence and infection.
• Soft-tissue nail fold excision: The surgeon removes the soft tissue around the toenail, not touching the nail itself. This type of surgery may be appropriate in moderate to severe cases or when other surgical options don’t work.

Ingrown toenail surgery is typically an outpatient procedure.

Knowing what to expect can help your procedure go smoothly.

Before the Procedure

Ingrown toenail surgery is generally an outpatient procedure, so you don’t need to prepare for an overnight stay. You’ll be able to go home the same day.

On the Day of Surgery

Ingrown toenail surgery does not require general anesthesia, so you can eat and drink normally before the procedure.

You may want to wear open-toed shoes to your appointment because your toe will have a large bandage after surgery. Try to avoid thong-style flip-flops because the strap may get in the way of the bandage.

You’ll need to bring any necessary paperwork and your photo identification. If you plan to use insurance, bring your health insurance information.

Because this surgery doesn’t use general anesthesia, you’ll be awake for it. Your healthcare provider will give you local anesthesia, usually by injecting a numbing medication into the toe. Once it takes effect, you should not expect to feel any pain during the procedure. 

Your recovery time will vary depending on the severity of the ingrown toenail and the type of surgery you had. Most people heal within several weeks. 

To help with healing, it’s important to follow your healthcare provider’s instructions for wound care and recovery. If you have any questions or concerns, call the clinic or hospital.

The main goals of recovery are typically to manage pain and keep your toe clean and dry.

Tips for Pain Management

You may feel some pain or soreness as the local anesthesia from surgery wears off. To help ease pain at home:

• Take any prescription medications, such as antibiotics, exactly as prescribed
• Plan to rest and stay off your feet for the first day or two after ingrown toenail surgery
• While resting, keep your foot elevated to help prevent swelling
• Take over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) as needed for pain or soreness

Tips for Cleaning and Care

These strategies may help you keep your surgical wound clean and dry so it can heal well:

• After 24 hours, gently clean your toe daily by soaking it in warm water and patting it dry; talk to your healthcare provider about using Epsom salts, soap, or antiseptics in the soak
• Keep your toe covered with a fresh bandage after each cleaning
• Apply an antibiotic ointment to the surgical site whenever you change the bandage
• Wear loose or open-toed shoes for at least two weeks to give your toe room to heal
• Avoid running or any strenuous workouts for at least two weeks

After ingrown toenail surgery, the nail can sometimes become ingrown again. Talk with your surgeon about steps you can take to lower the risk of recurrence. The following tips may also help:

• Wear proper-fitting shoes that don’t squeeze your toes together
• Trim your toenails in a straight line, and avoid cutting them too short
• Soak your nails before cutting them
• Talk with your healthcare provider about proper foot care if you have diabetes or poor circulation in your feet

Before opting for surgery, your healthcare provider will likely recommend you try other approaches, such as:

• Lifestyle approaches: Wear properly fitting shoes, soak the toe in warm water, keep the area clean and dry after soaking, and trim the nails in a straight line and not too short.
• Antibiotics: If at-home treatments aren’t effective and the area appears infected, your healthcare provider may prescribe antibiotics to treat the infection.
• Other care: Your healthcare provider may also recommend wearing a special splint to keep the toenail from growing further into the skin. They may place a cotton swab or dental floss between the nail and your skin.

If these treatments are unsuccessful, surgery may be the next step.

Ingrown toenails are common and can often be treated at home. If home remedies don’t work or if you have repeated ingrown toenails, your healthcare provider may recommend surgery.

A podiatrist or orthopedic surgeon can perform ingrown toenail surgery to remove part of the nail, the entire nail, the nail bed, or the surrounding soft tissue.