Why Surgical Treatment Is Often Necessary for Ingrown Toenails

Ingrown toenails — onychocryptosis — occur when the lateral edge of the toenail penetrates the adjacent nail fold, causing pain, inflammation, and often secondary bacterial infection. While conservative treatment (cotton wick placement, warm soaks, proper trimming technique) manages early-stage ingrown nails, recurrent or infected ingrown toenails typically require in-office surgical intervention to provide lasting relief. At Balance Foot and Ankle in Howell and Bloomfield Township, Michigan, we perform both temporary and permanent ingrown toenail procedures based on each patient’s specific situation and goals.

Partial Nail Avulsion: Temporary Removal

Partial nail avulsion involves removing the offending lateral nail border under local anesthesia — the painful nail edge is removed but the nail matrix (the tissue that produces the nail) is left intact. This allows a new nail to grow back in 3-4 months. Partial avulsion is appropriate for: first-time ingrown nail without chronic recurrence history, patients who want to preserve full nail width for cosmetic reasons, and younger patients with ingrown nails from temporary causes (trauma, improper trimming). The limitation: because the nail matrix is preserved, the new nail may grow back with the same tendency to become ingrown, particularly if the underlying nail curvature is the cause.

Permanent Matrixectomy: Preventing Recurrence

Matrixectomy removes both the nail border and the corresponding portion of the nail matrix — the germinal tissue that produces the nail. With the matrix destroyed, that portion of the nail never regrows. The standard technique uses phenol (a caustic chemical) applied to the matrix after nail border removal — phenol matrixectomy has a recurrence rate of approximately 5% compared to 15-30% for partial avulsion alone. The result is a slightly narrower toenail — usually not cosmetically significant — but a permanent end to ingrown nail recurrence on that border. Matrixectomy is appropriate for patients with recurrent ingrown nails or chronic infection.

The Procedure and Recovery

Both procedures are performed in-office under digital nerve block (local anesthesia to the toe). The toe is numb within 5 minutes, the procedure itself takes 10-15 minutes, and patients walk out of the office in a surgical sandal. Recovery: the wound heals in 2-4 weeks with daily dressing changes. Most patients return to regular footwear within 1-2 weeks for partial avulsion, 2-4 weeks for matrixectomy. Normal activity is usually possible within days. Contact Balance Foot and Ankle at (810) 206-1402 for ingrown toenail evaluation and treatment — most cases can be treated same-day with prompt scheduling.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Dr. Tom Biernacki, DPM

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.