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Ingrown toenail surgery
Published by Bupa's health information team, February 2008.
This factsheet is for people considering having their ingrown toenail removed. An ingrown toenail is when one or both sides of the nail pierce the skin of the toe.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your podiatrist's or surgeon's advice.
About ingrown toenails
Ingrown toenails occur when one or both sides of your nail grow into, and pierce the skin of, your toe. Cutting your nails too short or wearing tight-fitting shoes is often the cause. Fungal infections and toe injuries can also cause your nail to grow into your skin.
The first symptoms of an ingrown toenail are pain, swelling and redness in the skin around your nail. If left untreated it can lead to infection.
In its early stages, your podiatrist can help remove the bit of nail that is piercing your skin.
You should soak your foot in warm water four times a day to help soften your nail before the treatment. Your podiatrist will use a cotton bud to gently push the skin away from your ingrown toenail. The nail that is digging into your toe is lifted gently and cut away. As your nail grows back, a small roll of cotton may be pushed underneath your nail to stop it from growing into your skin.
If your nail is infected your podiatrist or GP may suggest having the nail surgically removed. This is usually done as a day case in hospital.
Preparing for your operation
Ingrown toenails are usually removed under local anaesthesia. This means that your toe will be completely numb but you stay awake. You may be offered a sedative to help you relax during the operation. Very rarely, the operation is done under general anaesthesia. This means you will be asleep throughout the operation.
If you are having local anaesthesia you can eat and drink as usual on the day of your operation.
If you are having general anaesthesia you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
Your surgeon will advise which type of anaesthesia is most suitable for you and explain how to prepare for your operation.
You should remove any nail varnish from your toenails before coming into hospital. Bring with you a sandal or an old slipper that you don't mind cutting open to wear after your operation. You will have a bandage on your toe and it will be uncomfortable to wear your usual shoe for the first few days.
At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.
Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure, and have given your permission for it to go ahead.
About the operation
Your toe will be cleaned with antiseptic. If you are having the operation under local anaesthesia, this will be injected into the base of your toe. The injection will sting but within a few minutes your whole toe will become numb.
If you are having a general anaesthetic, this is injected into a vein in the back of your hand. Within seconds you will fall asleep. You may be given an injection of local anaesthetic while you are asleep, so that your toe is numb when you wake up.
Removing an ingrown toenail
Usually only the sides of the nail that are ingrowing are removed, but sometimes the whole nail is taken out. The folds of skin alongside the nail may also be removed.
By simply removing the nail there is a chance it may ingrow again. To reduce the risk of this happening, your surgeon may suggest removing the cells from which the nail grows. These cells lie at the base of your nail called the nail bed.
Removing cells from the nail bed
The cells from the nail bed can be surgically removed by doing an operation called Zadik's procedure. Alternatively a strong alkaline chemical called phenol may be used to destroy the cells. Your surgeon may remove all or some of the cells from the nail bed. Afterwards the toe is covered with a dressing.
What to expect afterwards
You will be able to go home when you feel ready. However, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Take special care not to bump or knock your foot because it will be numb for a few hours. Your toe will feel sore as the local anaesthetic wears off and you may need painkillers.
Before your go home your nurse will give you advice about caring for your healing wound. Your surgeon may prescribe antibiotics for a few days.
Recovering from your toenail operation
For pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.
General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.
Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.
For the first few days keep your foot raised to help reduce swelling.
You will find it difficult to walk until the dressing is removed. Wear soft shoes or open-toed sandals until your toe is fully healed.
If you had cells removed only from part of your nail bed a slightly narrower toenail will grow back. Your nail will not grow back if you had all the cells removed from your nail bed. In this case new skin will eventually grow over your old nail area.
Phenol treatment is more effective at preventing nail re-growth but it can take up to six weeks for the area to heal after this treatment. With surgical treatment alone the area may heal within two to three weeks, but there's a chance the nail may ingrow again.
Your surgeon will give you advice about when you can return to work, as this will depend on the job that you do.
Contact your GP or the hospital if you develop:
a high temperature
severe swelling or redness
an unpleasant smell from the toe
increasing pain, or pain that can't be controlled with painkillers
What are the risks?
The operation for removing an ingrown toenail is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted, but mostly temporary effects of a successful procedure. Your toe will feel sore, stiff and swollen for several days afterwards.
Your nail bed may weep and look greyish for a few weeks after phenol treatment.
This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include infection, excessive bleeding or an unexpected reaction to the anaesthetic.
Complications specific to this operation are rare. It's possible for an ingrown toenail to re-occur. This is more likely if the nail cells are left in place.
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
- Zuber TJ. Ingrown toenail removal. Am Family Physician 2002; 65:2547-2549
- Ingrowing toenail treatments. Bandolier.
accessed 27 September 2007
- Ingrown toenails. eMedicineHealth.
accessed 27 September 2007
- Goldberg AS. Review: avulsion with phenol prevents recurrence of ingrown toenails. Evid Based Med 2000; 5:26
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr A Robinson, BSc FRCS(orth), Consultant Foot and Ankle Surgeon, Addenbrooke's Hospital, Cambridge and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2008.