Ingrown toenail removal: what to know before, during and after

An ingrown toenail happens when the edge of the nail, usually on the big toe, presses into the skin fold beside it. The fold gets sore, red and swollen, and it can drain or grow extra tissue. Runners, hikers and anyone in tight shoes know it well. Mild cases often improve with home care. When they don't, a quick office procedure removes the problem edge, and an extra step can keep it from growing back.

What the procedure is

After the toe is numbed, the doctor lifts and cuts away the narrow strip of nail that's digging in, from the tip back to the root. The rest of the nail stays. If the problem keeps coming back, the root of that strip can also be treated, most often with a chemical called phenol, so that edge doesn't regrow.

Who it's for

• A painful, swollen or draining nail fold that makes walking or wearing shoes hard.
• Home care that hasn't worked after a fair try.
• Ingrown nails that keep coming back, where permanent treatment of the nail root makes sense.
• Thick, curved or deformed nails that keep irritating the skin.

Who should wait, or see a specialist

• Poor circulation in the feet (peripheral artery disease). Healing can be slow, so this needs extra care or a specialist.
• Diabetes, especially if it isn't well controlled, or with numbness in the feet. A procedure is often still the right call, but we'd plan it carefully.
• Pregnancy. Phenol isn't used; removing the strip alone is still an option.
• An allergy to local numbing medicine or a bleeding disorder.

Benefits and risks

Alternatives

• Warm soaks for 10 to 20 minutes in warm, soapy water a few times a day, with roomier or open-toe shoes.
• Lifting the edge: a small wisp of cotton or dental floss tucked under the corner of the nail, changed daily, until the nail grows past the fold. This can take 2 to 12 weeks.
• A gutter splint or cotton nail cast placed in the office, which often eases pain quickly without removing any nail.
• Taping the skin fold away from the nail.
• Do nothing. Mild cases sometimes settle as the nail grows, but painful or infected ones usually don't.

To help prevent it: cut toenails straight across, not too short, and wear shoes with room in the toe box.

Step by step

1. CheckWe look at the toe together, decide between removing the strip alone or adding phenol, and you sign consent.
2. NumbA digital block: numbing medicine is injected at the base of the toe. It stings briefly, and after 5 to 10 minutes the whole toe is numb.
3. CleanThe toe is scrubbed with an antiseptic. No tourniquet is needed.
4. Free the edgeThe ingrown strip is gently lifted from the nail bed and cut straight back to the root.
5. RemoveThe strip is pulled out and the groove is checked for leftover pieces.
6. Treat the root (optional)For a permanent fix, phenol is applied to the root of that strip for a short time, then rinsed.
7. DressPetroleum jelly gauze and a bulky bandage go on. You walk out in an open-toe shoe or sandal.

Aftercare

• First 12 to 24 hours: rest with the foot up. Acetaminophen or an anti-inflammatory usually controls the soreness once the numbing wears off.
• After 24 to 48 hours: take off the first dressing and go back to normal walking in roomy shoes.
• Daily: soak the toe in warm water a few times a day, then apply petroleum jelly and a clean bandage, for 1 to 3 weeks.
• Drainage is expected: clear or slightly bloody fluid for 2 to 3 weeks, longer after phenol. It's part of healing, not a sign of infection on its own.
• Running and hiking: most people return within a few days, as long as the shoe doesn't press on the toe.

When to call

• Redness spreading up the toe or foot, increasing warmth or swelling, pus or red streaks.
• Fever.
• Pain getting worse after the first few days instead of better.
• Healing that's clearly stalled several weeks out.

Which procedures Peak Health offers in the office will be confirmed before opening. You can see the full list on the Services page, and the rest of these guides in the procedure guides library.

Sources: Mayeaux EJ Jr, Carter C, Murphy TE. Ingrown toenail management. American Family Physician. 2019;100(3):158–164. aafp.org. Heidelbaugh JJ, Lee H. Management of the ingrown toenail. American Family Physician. 2009;79(4):303–308. aafp.org.