Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: What is a matrixectomy for ingrown toenails? A matrixectomy is a procedure that permanently removes the nail-producing cells along one or both edges of a toenail to prevent regrowth of the offending nail border. It is performed in-office under local anesthesia, takes about 20 minutes, and has a success rate of over 95% in preventing nail regrowth.
An ingrown toenail sounds minor — but anyone who has had one knows it can be agonizingly painful, and when left untreated or managed inadequately, it can lead to serious infection, abscess, and in diabetic or immunocompromised patients, potentially limb-threatening complications. At Balance Foot & Ankle PLLC in Howell, Michigan, Dr. Tom Biernacki treats ingrown toenails with the full range of options from simple conservative trimming to definitive permanent matrixectomy, providing lasting relief with a procedure most patients describe as far easier than they expected.
What Causes Ingrown Toenails?
Ingrown toenails develop when the nail edge — most commonly the medial (inner) border of the hallux — penetrates the surrounding soft tissue, causing pain, redness, swelling, and often secondary bacterial infection. The most common causes are improper nail trimming (cutting the nail in a curved shape that encourages the edges to dig in), wearing narrow or tight shoes that compress the nail borders, hereditary nail curvature (involuted or pincer nail), and direct nail trauma.
Recurrent ingrown toenails despite proper trimming technique suggest an anatomical nail shape problem that conservative management cannot resolve long-term. These patients are ideal candidates for permanent partial nail avulsion with matrixectomy.
The Matrixectomy Procedure: What to Expect
A partial nail avulsion with chemical matrixectomy is performed entirely in the office under local anesthesia. The procedure takes approximately 20 minutes and involves the following steps. First, a digital nerve block is administered at the base of the toe using a small amount of local anesthetic — this is the only uncomfortable part of the procedure, and most patients describe it as a brief burning sensation that resolves within seconds. Once the toe is numb, the offending nail border is separated from the nail bed and removed. A chemical agent — most commonly phenol — is applied to the nail matrix (the cells that produce the nail) along the treated border, permanently destroying the nail-forming cells to prevent regrowth of that edge. The area is dressed and the patient walks out of the office in normal footwear.
Recovery involves daily wound care with antiseptic and a small bandage for 2–4 weeks while the area heals. Most patients return to normal activity including work on the same day or the next. The treated nail border does not regrow, and the cosmetic appearance of the nail is typically excellent — the remaining nail looks normal, just slightly narrower. The success rate for permanent prevention of nail regrowth with chemical matrixectomy exceeds 95%.
When Is Matrixectomy Recommended?
Matrixectomy is recommended for patients who have had two or more episodes of ingrown toenails on the same nail border, for those with a persistently curved or involuted nail that cannot be maintained comfortably with conservative trimming, and for patients with active infection or hypergranulation tissue (proud flesh) that indicates chronic nail border trauma. Patients who are physically unable to maintain proper nail care — due to mobility limitations, visual impairment, or other conditions — also benefit from eliminating the offending nail edge permanently.
Diabetic patients with ingrown toenails are treated with particular care and urgency, as infection can escalate rapidly in compromised circulation. Matrixectomy is often the preferred long-term solution for diabetic patients to eliminate an ongoing risk factor for foot infection. Call Balance Foot & Ankle at (517) 315-6969 to schedule an ingrown toenail evaluation in Howell, Michigan — same-week appointments are typically available.
Preventing Ingrown Toenails
For patients who choose conservative management or who have had successful treatment, ingrown toenail prevention focuses on proper nail trimming technique (straight across, not curved, leaving the corners), wearing properly fitted footwear with adequate toe box width and depth, avoiding repeated trauma to the nail during athletic activities, and addressing nail curvature issues before they become symptomatic. Patients with hereditary curved nails may benefit from ongoing podiatric nail care every 6–8 weeks to prevent recurrent ingrowth despite optimal self-care technique.
Dr. Tom's Product Recommendations
Dr. Scholl’s Ingrown Toenail Pain Reliever
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OTC medicated gel for temporary ingrown toenail pain relief — useful for mild early-stage ingrown toenails between appointments, not a substitute for professional treatment.
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Mild early-stage ingrown toenails without active infection seeking temporary pain relief
Infected, draining, or recurrent ingrown toenails — these require professional podiatric treatment
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New Balance 928 Wide Width Walking Shoe
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Wide-width walking shoe that reduces lateral toe compression — recommended footwear for patients prone to ingrown toenails from narrow shoe toe boxes.
Dr. Tom says: “My podiatrist told me my narrow shoes were causing my ingrown nails. Switched to these and haven’t had a recurrence.”
Patients with recurrent ingrown toenails related to toe box compression needing wide-width footwear
Patients with active ingrown toenail infection — footwear selection addresses prevention, not active treatment
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Matrixectomy is a quick in-office procedure with over 95% success rate for permanent nail correction
- Local anesthesia makes the procedure essentially painless after the initial numbing injection
- Patients return to normal footwear and most activities the same day
- Eliminates repeated painful ingrown toenail episodes in appropriately selected patients
❌ Cons / Risks
- Chemical matrixectomy has a small regrowth rate (~5%) requiring repeat treatment or surgical matrixectomy
- Wound care required for 2–4 weeks post-procedure
- Diabetic and vascular patients require extra monitoring during healing
Dr. Tom Biernacki’s Recommendation
Ingrown toenails are one of those conditions where I almost always recommend matrixectomy after the second recurrence because the math is simple: one 20-minute office procedure versus a lifetime of painful episodes, risk of infection, and restricted shoe choices. The procedure itself is so quick and well-tolerated that patients almost universally say they wished they had done it sooner. The only thing holding most people back is apprehension about what ‘nail removal’ means — and the reality is far gentler than what they imagined.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Does nail matrixectomy hurt?
The local anesthesia injection causes a brief burning sensation that resolves within 30–60 seconds. Once the toe is numb, the procedure itself is completely painless. Most patients are surprised at how comfortable the experience is. Post-procedure soreness is mild and typically managed with over-the-counter pain relievers.
Will my nail look normal after matrixectomy?
Yes — after a partial matrixectomy (one or both borders removed while preserving the central nail), the remaining nail looks normal and grows in a natural, healthy manner. The treated border heals cleanly and the final cosmetic result is typically excellent. The nail is simply slightly narrower than before.
How soon can I return to work and exercise after an ingrown toenail procedure?
Most patients return to desk work and light activity the same day. Return to athletic training typically requires 2–3 days to allow initial swelling to subside and wound care to be established. Swimming and immersive water activities should be avoided until the wound is fully healed (2–4 weeks).
Is ingrown toenail treatment covered by insurance?
Yes — ingrown toenail evaluation and treatment including matrixectomy are covered medical procedures under most health insurance plans including Medicare. Coverage is not cosmetic — ingrown toenails are a medical condition. Dr. Biernacki’s billing team can verify your specific benefits before the procedure.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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