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Ingrown Toenail

Typical recovery: Ingrown-toenail surgery is usually a minor outpatient procedure under local anaesthesia. Patients can generally walk soon afterwards, although resting and elevating the foot during the first day reduces discomfort. Normal daily activity is often resumed within a few days depending on footwear and occupation. The nail fold may continue to drain lightly for two to three weeks after chemical matrixectomy while final healing occurs.

Key points

  • An ingrown toenail is caused by interaction between the nail edge and the adjacent skin rather than simply by infection.
  • The great toe is most commonly affected.
  • Incorrect nail trimming, especially repeatedly cutting the corners short or rounding them deeply, can contribute to recurrence.
  • Tight footwear and repeated toe trauma can worsen symptoms.
  • Mild disease can often be treated conservatively without removing the nail.
  • Moderate, severe or recurrent ingrown toenails are more likely to benefit from a surgical approach.
  • For most localised cases requiring surgery, removal of only the affected lateral strip of nail is preferred to routine total nail avulsion.
  • Simply removing the nail edge without addressing the responsible portion of nail matrix can allow the same nail edge to grow back and cause recurrence.
  • Chemical or surgical matrixectomy aims to permanently narrow the nail at the problematic side.
  • Current evidence suggests that adding phenol matrix treatment to nail avulsion reduces recurrence compared with nail avulsion alone, although the overall quality of comparative evidence is limited.
  • A 2023 systematic review found substantially less recurrence with nail avulsion plus phenol than with nail avulsion alone, but rated the certainty of this evidence as very low.
  • Phenol, sodium hydroxide, surgical matrix excision, electrosurgery and other methods can all be used for matrix treatment depending on experience and individual circumstances.
  • Routine oral antibiotics do not improve outcomes after treatment of an ingrown toenail unless there is clear cellulitis or another specific infection indication.
  • Granulation tissue and local inflammation do not by themselves mean that oral antibiotics are necessary.
  • Peripheral arterial disease requires particular caution before nail surgery because healing may be impaired.
  • Uncontrolled diabetes and significant vascular disease are relative contraindications to chemical matrixectomy and require individual assessment.
  • Phenol should not be used when the patient or procedural team member is pregnant because of exposure concerns.
  • Persistent recurrence usually reflects regrowth of the offending nail edge or incomplete destruction of the relevant portion of nail matrix.

Overview

An ingrown toenail, also called onychocryptosis, occurs when the edge of the nail presses into or penetrates the adjacent nail fold. The great toe is most commonly affected. Early disease causes pain, tenderness and swelling along one nail edge. As inflammation progresses, the nail fold may become red, swollen and produce granulation tissue or discharge. Recurrent or more severe cases can cause marked nail-fold hypertrophy and persistent difficulty wearing footwear. Contributing factors include trimming the nail too short or rounding the corners, tight footwear, repeated trauma, naturally curved nails and excessive sweating. Mild cases can often be treated without surgery by correcting footwear and nail-care habits and by gently separating the nail edge from the inflamed fold. Moderate, severe or recurrent cases are usually treated more definitively by removing the offending lateral strip of nail. To reduce recurrence, the corresponding part of the nail-forming matrix may also be treated chemically, surgically or with another ablative technique. Partial nail treatment is usually preferred to complete nail removal because most of the normal nail can be preserved. Antibiotics are not routinely required simply because an ingrown toenail is inflamed or has local granulation tissue; they are reserved for clear spreading cellulitis or another specific infection indication.

Signs & symptoms

  • Pain or tenderness along one or both sides of the toenail.
  • Redness and swelling of the nail fold.
  • Pain when wearing closed shoes or when pressure is applied to the toe.
  • Difficulty walking comfortably in more advanced cases.
  • Granulation tissue growing over the edge of the nail.
  • Bleeding from inflamed tissue around the nail.
  • Serous or pus-like discharge in more advanced disease.
  • Recurrent swelling and tenderness at the same nail edge.
  • Thickening or enlargement of the surrounding nail fold in chronic cases.

How assessment and treatment are planned

  1. 1

    Assess the severity of the ingrown toenail and look for cellulitis, abscess, granulation tissue, vascular disease and other factors that may alter treatment.

  2. 2

    For mild disease, advise appropriate footwear and allow the nail to grow beyond the end of the toe rather than repeatedly cutting the corner short.

  3. 3

    Selected mild or moderate cases may be treated by gently separating the nail edge from the lateral fold using techniques such as cotton packing, a gutter splint, taping or nail-bracing methods.

  4. 4

    When symptoms are moderate, severe, recurrent or associated with significant granulation tissue, discuss definitive nail surgery.

  5. 5

    Numb the affected toe using local anaesthetic, usually with a digital nerve block.

  6. 6

    Remove the narrow lateral portion of nail that is penetrating the nail fold rather than routinely removing the entire nail.

  7. 7

    If recurrence prevention is required, treat the corresponding lateral part of the nail matrix so that this narrow section of nail does not regrow.

  8. 8

    Matrix treatment may be performed chemically, commonly using phenol or another suitable agent, or by surgical or electrosurgical techniques depending on the clinical situation and surgeon's technique.

  9. 9

    Remove excessive granulation tissue when necessary.

  10. 10

    Ensure haemostasis and apply an appropriate dressing.

  11. 11

    Review healing and watch for recurrence, infection or formation of a new nail spicule.

Preparation

  • Tell the surgeon how long the problem has been present and whether it has previously recurred.
  • Mention any previous nail avulsion, matrixectomy or other nail procedure.
  • Tell the clinician if the same side of the nail has regrown after previous surgery.
  • Report diabetes, peripheral arterial disease, neuropathy or previous diabetic-foot problems.
  • Mention any history of poor wound healing.
  • Bring a current medication list, particularly anticoagulants and antiplatelet medicines.
  • Do not stop blood-thinning medication without specific medical advice.
  • Tell the clinician if you are pregnant or may be pregnant because this can affect the choice of matrix-treatment technique.
  • Wear loose footwear or sandals on the day of the procedure if possible because a dressing will be applied to the toe.
  • Arrange appropriate transport if discomfort or dressing bulk may interfere with driving.

Recovery and aftercare

  • Rest and elevate the foot during the first 12 to 24 hours when possible.
  • Use simple pain relief as advised.
  • Keep the initial dressing clean and dry until the advised dressing change.
  • The dressing is commonly changed after approximately 24 to 48 hours.
  • A small amount of clear or blood-stained discharge is common after matrix treatment.
  • Sterile drainage from the treated nail bed can continue for two to three weeks, especially after chemical matrixectomy.
  • Wear roomy footwear until pressure on the toe is comfortable.
  • Normal walking can usually be resumed relatively quickly according to comfort.
  • Avoid picking at the healing nail fold or trying to dig out the edge of the nail.
  • Seek review if pain, redness or swelling is progressively worsening rather than improving.
  • Seek medical attention for spreading cellulitis, fever, significant pus formation or poor wound healing.
  • Once healed, trim the nail relatively straight across and avoid repeatedly cutting deeply into the corners.

Risks and possible complications

  • Temporary pain and swelling after the procedure.
  • Bleeding.
  • Local wound infection.
  • Delayed wound healing.
  • Prolonged serous discharge after chemical matrixectomy.
  • Recurrence of the ingrown toenail.
  • Formation of a small recurrent nail spicule if part of the nail matrix survives.
  • Permanent narrowing of the nail after partial matrixectomy, which is the intended result.
  • Nail deformity or irregular regrowth.
  • Rare permanent loss of more nail than intended.
  • Chemical injury to surrounding skin if a matrix-treatment agent spreads beyond the intended area.
  • Poor healing in patients with significant vascular disease or poorly controlled diabetes.
  • Rare chronic pain or persistent sensitivity around the nail.

When to arrange prompt medical assessment

  • Persistent pain and swelling despite correcting footwear and nail-care habits.
  • Recurrent ingrowth at the same side of the nail.
  • Granulation tissue, recurrent bleeding or persistent discharge around the nail.
  • Difficulty wearing normal shoes or walking because of pain.
  • Increasing redness around the toe, particularly if it is spreading beyond the nail fold.
  • An ingrown toenail in a patient with diabetes, neuropathy or known poor circulation.
  • Failure of a previously treated nail to heal as expected.

When to go to an emergency department now

  • Rapidly spreading redness associated with fever or systemic illness.
  • Severe infection in a patient with diabetes, significant peripheral arterial disease or immune suppression.
  • Black, dusky or poorly perfused tissue around the toe.

Myth vs fact

Frequently asked questions

Sources

Medically reviewed by Dr. Shams Alam Mohammed Tahir, MBBS, MS (General Surgery). Last reviewed 2026-09-18.

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