Ingrown Toenail Removal: What to Expect at the Podiatrist (2026)
Ingrown toenail removal at a podiatrist’s office is a 15-30 minute in-office procedure under local anesthesia. The 2 main techniques: (1) partial nail avulsion — just the offending nail edge is removed (regrows in 3-4 months, may recur), or (2) partial nail avulsion with phenol matrixectomy — the affected nail edge is permanently destroyed using phenol acid on the nail-growth cells (~95% never-recurrence rate, 2-3 week healing).
In my Michigan podiatry clinic, I recommend phenol matrixectomy for any recurrent ingrown toenail — it’s the gold standard. The procedure: numb with lidocaine, remove the ingrown spike, apply phenol to the matrix for 60 seconds, dress with antibiotic ointment and gauze. Pain after: mild for 1-2 days, easily managed with Tylenol/Advil. Most patients walk in regular shoes within 48 hours and back to running within 2 weeks. Diabetic patients are excellent candidates — better than risking an ulcer.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: What happens during ingrown toenail removal at the podiatrist?
Temporary vs. Permanent Ingrown Toenail Treatment
Ingrown toenails — nails that grow into the surrounding skin, causing pain, swelling, redness, and sometimes infection — are one of the most common conditions treated by podiatrists. There are two fundamentally different approaches to ingrown toenail treatment, and understanding the difference helps patients make the right choice for their situation. Temporary (conservative) treatment removes the offending nail border without preventing it from regrowing. Permanent (matrixectomy) treatment removes both the nail border and the nail matrix cells that produce that portion of the nail, preventing regrowth.
Conservative treatment — in-office nail edge removal without chemical matrixectomy — is appropriate for first-time presentations in patients who are willing to modify their nail trimming technique and footwear, and who are good candidates for preventing recurrence with behavioral changes alone. The procedure is quick, performed under local anesthesia, and allows immediate return to activity. However, the nail border regrows normally over 3–6 months, and without correction of the underlying causes (improper trimming, too-narrow shoes), the ingrown nail typically recurs.
Permanent treatment — partial nail avulsion combined with chemical matrixectomy using phenol or sodium hydroxide — is the preferred approach for chronic or recurrently ingrown nails and for patients who want a definitive solution. The same local anesthesia, the same nail border removal, followed by application of the chemical agent to the exposed nail matrix for 30–60 seconds, reliably destroys the matrix cells responsible for the offending nail border. The nail grows back permanently narrower, eliminating the ingrown portion without any visible difference to the nail appearance from the front.
The Ingrown Toenail Procedure: Step by Step
The procedure begins with thorough cleansing of the toe and application of local anesthetic — typically a digital block at the base of the toe using 1–2% lidocaine injected into the medial and lateral aspects. Most patients report minimal discomfort from the injection, which is the only painful part of the procedure. The toe becomes completely numb within 5–10 minutes, at which point the procedure is entirely painless.
The offending nail border is then separated from the surrounding skin using a nail elevator — a small instrument that gently loosens the nail from the nail bed — and cut along the entire length from free edge to matrix with nail splitters or scissors. The nail border segment is removed as a single piece, immediately eliminating the sharp edge that was embedded in the skin fold. The nail bed is inspected for infection, and any granulation tissue (overgrown tissue responding to chronic irritation) is removed.
For permanent procedures, a cotton tip applicator saturated with phenol (88%) is applied to the exposed nail matrix for 30 seconds, repeated twice, followed by neutralization with 70% isopropyl alcohol. The procedure is then dressed with antibiotic ointment and sterile gauze. Patients walk immediately after the procedure, typically without significant pain once the anesthesia wears off (2–4 hours post-procedure). Mild soreness for 2–3 days is normal and manageable with over-the-counter analgesics.
Recovery and What to Expect After Ingrown Toenail Removal
Post-procedure care is straightforward: daily soaking of the toe in warm water, application of antibiotic ointment, and fresh bandage for 1–2 weeks until the toe is fully healed. The area where the nail matrix was treated may produce a small amount of drainage — this is normal and not a sign of infection. True infection after a properly performed nail procedure is uncommon but identifiable by increasing redness, warmth, and purulent drainage.
Most patients return to normal footwear within 24–48 hours. Athletic shoes are preferred during the first week to allow some extra toe box room while the skin heals. Open-toed shoes or sandals may be worn if preferred, provided the toe is protected with a bandage. Tight-fitting shoes, particularly dress shoes with pointed toe boxes, should be avoided for at least 1–2 weeks.
Success rate for permanent phenol matrixectomy is approximately 95% — meaning 1 in 20 patients may have partial regrowth of the treated nail border and require repeat treatment. The factors most associated with treatment failure include incomplete chemical application and inadequate duration of phenol contact with the matrix. Dr. Tom Biernacki performs ingrown toenail procedures routinely at Balance Foot & Ankle and can schedule most patients for same-week appointments, providing fast relief from this common and often very painful condition.
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✅ Pros / Benefits
- Procedure is fast (15–20 minutes) with immediate pain relief
- Local anesthesia makes the procedure entirely painless during treatment
- 95% success rate for permanent matrixectomy
- Recovery requires only daily soaking and dressing changes for 1–2 weeks
❌ Cons / Risks
- 5% partial regrowth rate may require repeat treatment
- Drainage from the treated matrix area persists for 1–3 weeks during healing
- Tight or narrow footwear must be avoided during the 1–2 week healing period
- Infected ingrown nails require antibiotic treatment before or alongside the procedure
Dr. Tom Biernacki’s Recommendation
Ingrown toenail removal is one of my favorite procedures to do because the result is so immediate and dramatic. The patient walks in with a toe they’ve been wincing on for weeks, and they walk out 20 minutes later with the pain completely gone. The permanent procedure — where we destroy the matrix to prevent regrowth — is almost always the right choice for chronic ingrown nails. There’s no reason to keep coming back for temporary fixes when a 5-minute chemical application eliminates the problem permanently.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Is ingrown toenail removal painful?
The local anesthetic injection causes brief discomfort, but once numb (within 5–10 minutes), the procedure is completely painless. Most patients are surprised by how easy it is.
How long until I can wear regular shoes after ingrown toenail removal?
Most patients wear comfortable, wider shoes immediately. Athletic shoes are preferred for the first week. Normal footwear including dress shoes is appropriate once the toe is fully healed, typically 1–2 weeks.
Will my ingrown toenail come back after the permanent procedure?
The permanent procedure has a 95% success rate. If partial regrowth occurs, repeat chemical matrixectomy is performed. Two treatments resolve virtually all cases.
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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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