Toenail Surgery

Procedure overview

Toenail surgery addresses structural or infectious nail pathology through partial or total nail avulsion, matrix ablation, or tissue reshaping, aiming to relieve pain, correct deformity, and prevent recurrent ingrowth and inflammation.

• Partial Nail Avulsion: Removes the offending nail edge compressing periungual tissue, reducing focal pressure and resolving chronic granulation tissue formation.

• Chemical Matrixectomy: Uses phenol or sodium hydroxide to ablate the matrix, preventing regrowth and lowering recurrence rates in ingrown toenails.
  

Toenail surgery is typically conducted under digital block anaesthesia, followed by controlled nail avulsion, matrix modification, and meticulous haemostasis, ensuring minimal trauma and precise correction of the pathological nail elements.

• Digital Anaesthetic Technique: Lidocaine ring block ensures complete sensory blockade before avulsion and matrixectomy.

• Procedure Steps: Sequential avulsion, matrix cauterization, and dressing application promote controlled healing and minimize postoperative complications.
  

Ideal candidates

Candidates typically include individuals with chronic onychocryptosis, recurrent paronychia, painful deformities, or treatment-resistant infections causing persistent discomfort, inflammation, or functional limitations interfering with ambulation or footwear use.

• Chronic Onychocryptosis: Patients with persistent nail-fold penetration or repeated granulation tissue formation despite conservative care respond optimally to surgical intervention.

• High-Risk Groups: Diabetics or patients with peripheral vascular disease may require surgery to prevent ulceration and secondary infection.
  

Procedure details

Toenail surgery addresses structural or infectious nail pathology through partial or total nail avulsion, matrix ablation, or tissue reshaping, aiming to relieve pain, correct deformity, and prevent recurrent ingrowth and inflammation.

• Partial Nail Avulsion: Removes the offending nail edge compressing periungual tissue, reducing focal pressure and resolving chronic granulation tissue formation.

• Chemical Matrixectomy: Uses phenol or sodium hydroxide to ablate the matrix, preventing regrowth and lowering recurrence rates in ingrown toenails.
  

Costs and insurance

Costs vary by clinic, technique, and severity of pathology, typically reflecting surgical complexity, consumables, specialist expertise, and postoperative follow-up requirements necessary to ensure safe and stable recovery.

• Cost Components: Includes surgeon fees, anaesthesia, sterile equipment, and postoperative assessments.

• Insurance Factors: Coverage may apply when treating infection, pain, or structural pathology but rarely for purely cosmetic correction.
  

Benefits

Toenail surgery provides durable resolution of recurrent ingrown toenails, reduces inflammation, eliminates infection risk, and improves cosmetic appearance, restoring patient comfort, mobility, and long-term nail-fold stability.

• Functional Improvement: Reduction in periungual edema, pain, and gait impairment.

• Aesthetic Enhancement: Cleaner nail contouring and removal of chronically deformed nail segments.
  

Risks and complications

Although generally safe, toenail surgery carries risks related to infection, delayed epithelialization, excessive granulation tissue, or dystrophic regrowth, particularly in individuals with compromised microvascular perfusion or uncontrolled systemic illness.

• Infectious Risks: Postoperative cellulitis or purulent discharge, especially if signs of infection after toenail removal surgery are missed.

• Nail Dystrophy: Irregular regrowth or persistent nail-plate deformity.
  

Patient experiences

Recovery typically spans one to three weeks, during which controlled wound care, antiseptic soaks, footwear modification, and activity restriction support optimal epithelial healing and minimize risk of postoperative infection.

• Wound Care: Daily saline soaks and sterile dressings maintain moisture balance and reduce bacterial colonization.

• Activity Modifications: Avoid pressure-inducing footwear, strenuous activity, and excessive moisture exposure.
  

Expert opinions

Dermatologists and podiatric surgeons emphasize early intervention for ingrown toenails, citing high success rates, predictable outcomes, and the significant quality-of-life improvements associated with timely surgical correction.

• Expert Consensus: Chemical matrixectomy offers the lowest recurrence rates for ingrown toenail surgery.

• Clinical Recommendations: Prompt identification of infection improves outcomes and reduces systemic spread.
  
  

Regulatory and ethical considerations

Recent innovations enhance precision, decrease downtime, and improve cosmetic outcomes in ingrown toenail removal surgery, offering patients faster healing and reduced recurrence rates.

• Laser Matrixectomy: CO₂ lasers provide controlled ablation with minimal tissue trauma.

• Cryotherapy Techniques: Targeted matrix freezing reduces postoperative inflammation.
  
  

Alternative treatment

Several non-surgical and minimally invasive alternatives may be used when patients prefer conservative care or when toenail pathology remains mild, manageable, or responsive to biomechanical and antimicrobial interventions.

• Orthonyxia (Nail Bracing Systems)

• Topical Antimicrobials and Keratolytics

• Debridement and Conservative Nail Sculpting

• Partial Nail Plate Thinning or Mechanical Offloading
  

Disclaimer

This article provides medical information for educational purposes only. Patients should consult a board-certified dermatologist, podiatric surgeon, or qualified physician for personalised diagnosis and treatment recommendations.

Conclusion

Toenail surgery is a safe, effective, and predictable solution for recurrent ingrown toenails, offering significant functional and aesthetic improvement. With modern techniques and expert oversight, patients experience long-term comfort, improved confidence, and durable results.

At Cosma Beauty, we connect patients with board-certified dermatologists and aesthetic specialists. By integrating clinical expertise, evidence-based protocols, and individualized attention, we prioritize safety, natural results, and patient confidence, ensuring every treatment reflects excellence, precision, and authenticity.

FAQs

1. How long does healing take after ingrown toenail surgery?

Healing typically requires one to three weeks, depending on vascular status, wound care compliance, and the extent of matrixectomy performed.

2. What are signs of infection after toenail removal surgery?

Erythema, purulent discharge, increasing tenderness, foul odour, or spreading cellulitis indicate infection and require immediate clinical evaluation.

3. Will the nail grow back after matrixectomy?

Following chemical or surgical matrix ablation, regrowth is unlikely; partial avulsion without matrixectomy allows normal regrowth.

4. Can diabetic patients undergo toenail surgery?

Yes, with caution. Diabetics require vascular assessment and strict postoperative monitoring due to higher infection and delayed-healing risks.

5. Is toenail surgery painful?

Digital block anaesthesia prevents intraoperative pain; mild postoperative discomfort is managed with NSAIDs and protective dressings.

6. When can normal footwear be resumed?

Closed footwear is typically resumed after 7–10 days, once epithelial integrity improves and tenderness subsides.