Nail & Skin Disorders

A Doctor's Notes on Ingrown Toenail Surgery

Ingrown toenails often become severe enough to require surgery. Dr. Mix shows you step by step what happens in the ingrown toenail surgery procedure.

When It’s Too Much for You

Those clients whose ingrown nails are already infected and clients whose toenails you have questions about should be sent to your podiatrist. She will decide whether routine nail care is indicated or whether the patient would be better serviced by a permanent removal of the nail margin. Ingrown toenail surgery is one of the most common procedures that podiatrists do to correct an ingrown nail problem. If the shape of the nail causes it to be deeply incurvated along the nail margin and the patient has chronic pain and infections, permanent correction (surgery) is the treatment of choice. No amount of trimming will give any lasting comfort in these cases. The following pictures illustrate a permanent removal of an ingrown nail using the “phenol technique.”

Toenail Surgery, Step by Step

1. The big toe has been anesthetized and prepared for the correction of an ingrown nail. The toe is bluish in color because a rubber band tourniquet has been applied to the base of the toe.


2. A chisel-like surgical blade called a nail splitter is used to cut the nail from the free edge to the back of the matrix bed. The blade is then used to loosen the part of the nail to be removed from the nail bed and matrix bed. The nail splitter doesn’t cut into the nail bed, only the nail plate.


3. Hemostat forceps are then used to grasp the nail to be removed. With a twisting motion, the nail border is avulsed (separated from the body by cutting) from the nail margin.


4. This shows the nail margin after it was avulsed from the nail groove. Compare its size to what you can actually see of the nail margin in the second photograph. Also, notice the small hook on the bottom of the nail. The sharp part of the hook is what was growing into the soft tissue and causing the pain.


5. Phenol- (89% carbolic acid) soaked cotton applicators are then inserted into the matrix bed area to sterilize the exposed matrix cells. Fresh soaked applications are gently manipulated in the area for approximately three minutes to complete this process.


6.  A tube gauze bandage is applied over the toe. It looks large but easily fits into the shoe. This bandage is removed in two days and the patient is instructed to wash the surgical area daily with warm soapy water. Use a triple antibiotic ointment on the site and keep it covered with a small adhesive bandage.

This is a tried and true procedure, and my recurrence rate is less than 1%. While the patient is recovering there is also minimal discomfort. Most people can wear shoes and the patient only has to wear an adhesive bandage just two or three days after the procedure. The nail margin will drain slightly for two to three weeks while it’s healing. I have used other techniques, including the laser, but have always gone back to the phenol procedure.

-- Godfrey F. Mix, D.P.M. has been a podiatrist for 25 years. He is a member of the American Podiatric Medical Association, has served on the California Board of Podiatric Medicine, and is board-certified by the American Board of Podiatric Surgery. He is a regular contributor to NAILS Magazine.


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Citric acid is derived from citrus fruits (like oranges and lemons) and used as a preservative, pH-balancer, and astringent.
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