By Davan 
Ingrown toenail removal is a process that should ideally be performed by a healthcare professional, like a podiatrist, because of the potential for complications such as infection or damage to the surrounding tissue. However, I can outline the general steps of the procedure, so you can understand the process:
1. Initial Preparation
- Numbing the area: The area around the ingrown toenail is usually numbed using a local anesthetic (injection), so you won’t feel pain during the procedure.
- Cleaning the area: The foot and nail are cleaned and disinfected to minimize the risk of infection.
2. Removal Process
- Lifting the nail: In some cases, if the ingrown toenail has penetrated the skin but is still largely intact, the podiatrist may lift the edge of the toenail and trim or remove the part that is embedded in the skin.
- Partial toenail removal: If necessary, part of the toenail will be removed. This may involve trimming the edge that is causing the irritation or removing a portion of the nail.
- Full toenail removal (for severe cases): In more severe cases, the entire toenail may need to be removed to prevent recurrence of the ingrown nail.
3. Post-Procedure Care
- Disinfection: After removal, the area is disinfected to avoid infection.
- Bandaging: A sterile dressing is applied to the toe to keep it clean and protected while it heals.
- Instructions for aftercare: The podiatrist will give you instructions on how to care for the wound, which may include soaking the toe, keeping it dry, and changing the dressing regularly. You may also be prescribed antibiotics if there’s any sign of infection.
4. Possible Follow-up
- Depending on the severity of the ingrown toenail and the method of removal, a follow-up appointment might be needed to ensure proper healing.
- In some cases, a chemical or other procedure may be used to prevent the nail from growing back improperly (permanent removal).
At-Home Care (if you’re managing an ingrown toenail without surgery):
- Soaking: Soak your foot in warm water with Epsom salts for 15–20 minutes to soften the nail and reduce inflammation.
- Cotton or dental floss: Gently placing a small piece of cotton or dental floss under the ingrown edge can help the nail grow above the skin.
- Pain relief: Over-the-counter pain relievers like ibuprofen can help with pain and swelling.
- Proper footwear: Avoid tight shoes and wear comfortable footwear to reduce pressure on the affected toe.
Ingrown Toenail (Onychocryptosis) Overview
An ingrown toenail occurs when the edge or corner of the toenail grows into the skin of the toe, typically on the big toe. This can cause pain, swelling, redness, and sometimes an infection. If left untreated, the condition may worsen and lead to more significant complications.
Indications for Ingrown Toenail Removal
- Severe pain or tenderness around the nail.
- Infection in the surrounding tissue.
- Recurrent ingrown toenails that don’t respond to conservative treatments (like soaking, wearing proper shoes, etc.).
- Signs of chronic inflammation or deformity in the nail.
Step-by-Step Process of Ingrown Toenail Removal
1. Initial Evaluation and Diagnosis
Before any procedure, a podiatrist (or other healthcare professional) will evaluate the severity of the ingrown toenail. They may take a detailed medical history, perform a physical examination, and sometimes use imaging to rule out underlying bone or joint issues. In most cases, diagnosis is clinical.
- Reference: “Ingrown Toenail: Diagnosis and Treatment” from American Family Physician (2018). American Family Physician.
2. Preparation for Procedure
Once a diagnosis is confirmed, the toe is prepared for the procedure:
- Sterilization: The toe and surrounding area are thoroughly cleaned with an antiseptic to reduce the risk of infection.
- Anesthesia: Local anesthesia is injected into the skin near the affected toenail to numb the area. This ensures the patient won’t feel any pain during the procedure.
- Reference: Journal of Foot and Ankle Surgery (2010), which explains the importance of local anesthesia for ingrown toenail removal.
3. Removal Procedure
There are a few techniques for removing an ingrown toenail, and the method chosen will depend on the severity and type of ingrown toenail.
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Partial Nail Removal (Partial Nail Avulsion): This involves removing a portion of the toenail, usually the edge that is embedded into the skin. The podiatrist will use sterilized scissors or a scalpel to trim the nail.
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Complete Nail Removal (Total Nail Avulsion): For more severe or recurrent cases, the entire toenail may be removed. The nail bed is then cauterized (burned) or chemically treated to prevent the nail from growing back. This process is often called “matrixectomy.”
- Reference: “Surgical treatment of ingrown toenails” published in Clinical Podiatry. In cases of recurrent ingrown toenails, matrixectomy (destruction of the nail matrix) is performed to prevent regrowth.
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Nail Elevation: If the nail is not fully ingrown but simply growing too close to the skin, the podiatrist may lift the edge of the nail and insert a small piece of cotton, gauze, or a splint between the nail and the skin to promote proper nail growth and prevent it from growing into the skin.
4. Post-Procedure Care
After the ingrown toenail is removed, proper aftercare is essential to prevent infection and promote healing.
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Disinfection: The toe is cleaned with an antiseptic, and a sterile bandage is applied to the area.
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Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can be recommended for pain relief. In some cases, a prescription for stronger pain medications might be given.
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Antibiotics: If there was an infection prior to the removal, or if the procedure carries a risk of infection, antibiotics may be prescribed.
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Rest and Elevation: It’s typically advised to rest and elevate the foot, especially during the first 24–48 hours, to reduce swelling and encourage healing.
- Reference: “Podiatric Management of Ingrown Toenails” from The Journal of the American Podiatric Medical Association (2017) for post-operative care.
5. Preventing Recurrence
To prevent ingrown toenails from recurring, several options may be considered:
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Wearing Proper Footwear: Tight shoes or socks that place pressure on the toe can exacerbate or cause ingrown toenails. Wearing shoes that provide ample space for the toes helps reduce the risk.
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Nail Care: Properly trimming toenails (cutting them straight across, not too short) is crucial in preventing the nails from growing into the skin.
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Matrixectomy: For recurrent cases, the doctor might perform a matrixectomy (removal of the nail matrix) to prevent the toenail from growing back.
6. Complications and Risks
As with any medical procedure, there are risks. Possible complications include:
- Infection: If not properly cared for after surgery, the toe could become infected.
- Nail Regrowth Issues: Incomplete removal or improper matrixectomy may result in abnormal nail regrowth.
- Pain and Swelling: While rare, some patients experience persistent discomfort or swelling after the procedure.
7. Follow-Up Appointments
A follow-up appointment may be scheduled to check the progress of healing. In severe cases, additional treatment may be necessary.
- Reference: “Ingrown Toenails and their Surgical Management” in The Journal of Foot and Ankle Surgery (2021), which outlines the follow-up care after ingrown toenail procedures.
Alternative Treatments
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Conservative Management: Soaking the foot in warm water with Epsom salts, using topical antibiotics, and wearing properly fitting shoes can sometimes relieve minor cases of ingrown toenails.
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Nonsurgical Options: In some cases, a podiatrist may suggest nonsurgical treatment such as inserting a small piece of cotton under the nail edge to help guide it above the skin.
References for Further Reading:
- American Family Physician – “Ingrown Toenail: Diagnosis and Treatment” (2018). Link
- The Journal of Foot and Ankle Surgery – “Surgical treatment of ingrown toenails” (2010). Link
- Clinical Podiatry – “Surgical treatment of ingrown toenails” (2019). Link