By Dr Ozan Amir (Podiatric Surgeon)
A toenail that repeatedly pierces the skin can turn putting on shoes, walking to the train or simply brushing against bed sheets into a painful event. Ingrown toenail surgery is a minor procedure designed to address the cause of that recurring pain, rather than simply settling the latest flare-up. For people who have tried careful nail care, footwear changes or treatment for infection without lasting relief, it can be a reliable next step.
An ingrown toenail occurs when the edge or corner of the nail grows into, or presses into, the surrounding skin. It most often affects the big toe. The skin may become red, swollen and tender, and sometimes develops discharge, bleeding or overgrown tissue. While mild, early cases may settle with conservative treatment, a stubborn or recurring problem deserves specialist assessment.
When ingrown toenail surgery may be recommended
Surgery is not automatically required for every sore toenail. If the problem is mild and recent, changing footwear, avoiding pressure on the toe and carefully managing the nail edge may be enough. However, these measures are less likely to provide a permanent answer when the nail has a strong tendency to regrow into the same area.
A surgical assessment is commonly appropriate when pain keeps returning, there have been repeated infections, or the toe is preventing you from wearing normal shoes, exercising or working comfortably. It may also be considered where a section of nail has become thickened, curved or distorted after trauma, fungal nail disease or previous procedures.
People with diabetes, reduced circulation, peripheral neuropathy or a weakened immune system should not attempt to manage an infected ingrown toenail themselves. These conditions can affect healing and raise the consequences of even a small wound. Early assessment allows treatment to be planned with the right precautions.
The key question is not simply whether the nail looks ingrown. It is whether the condition is continuing to affect your comfort, mobility and skin health despite sensible care.
What happens during ingrown toenail surgery?
The procedure is usually performed with a local anaesthetic, meaning you remain awake but the toe is numb. The anaesthetic injection can sting briefly, but once the toe is fully numb, you should not feel pain during the procedure. A specialist will confirm which side of the nail is causing the problem and discuss the planned treatment before proceeding.
In many cases, only the offending strip of nail is removed. This is called a partial nail avulsion. It is often preferable to removing the entire nail because the healthy portion is preserved and the toe generally retains a natural appearance as it heals.
For recurrent ingrown toenails, the procedure may also include treatment of the nail matrix – the part beneath the skin that produces the nail. A chemical or surgical matrix procedure can stop the narrow problem edge from growing back. This creates a slightly narrower nail, but significantly reduces the chance of the same edge continuing to pierce the skin.
Whether matrix treatment is appropriate depends on your nail shape, previous history, the condition of the surrounding skin and your goals. A first episode caused by a temporary injury may not need it. A toe that has flared up several times over years often benefits from a more definitive approach.
Is the whole toenail removed?
Not usually. Full nail removal is reserved for selected situations, such as a severely damaged nail, disease affecting the entire nail plate or a problem involving both sides. It is understandable to worry about how the toe will look afterwards, but removing only the affected border is commonly enough to resolve the issue while maintaining the appearance and function of most of the nail.
Preparing for your procedure
A proper consultation helps ensure the treatment matches the problem. Your surgeon will examine the toe, ask about previous infections and treatments, and review relevant health conditions and medications. Let the team know if you take blood-thinning medication, have medication allergies, have diabetes or have had difficulties with wound healing in the past.
Wear footwear that can accommodate a dressing after the procedure. Open footwear or a roomy sandal is often more comfortable for the trip home, provided it is safe and suitable for the weather and your travel arrangements. It is also sensible to arrange transport if you are uncomfortable driving after the procedure, particularly if your foot has been bandaged or you have had an anaesthetic.
Avoid cutting deeply down the sides of the nail in the days leading up to your appointment. This can leave sharp fragments behind, irritate the skin and make it harder to accurately assess the nail edge.
Recovery after ingrown toenail surgery
Most patients can walk carefully after the procedure, although it is sensible to rest with the foot elevated for the remainder of the day where possible. Some throbbing or tenderness can occur after the local anaesthetic wears off. Your surgeon will provide advice on appropriate pain relief, dressings and when it is safe to return to work, exercise and closed footwear.
The toe may produce a small amount of fluid during the early healing period, particularly if matrix treatment has been performed. This is not always a sign of infection. The more useful signs to watch are worsening pain, spreading redness, increasing heat, cloudy discharge, a strong odour or feeling unwell. If these occur, contact your treating team promptly.
Recovery time varies. A desk-based worker may return relatively quickly if footwear and travel are manageable, while someone whose job involves long shifts standing, safety boots or frequent walking may need more time or modified duties. Running, field sports and swimming should wait until the wound has healed sufficiently and your surgeon has advised that it is appropriate.
Follow-up is an important part of treatment. Dressing changes and wound checks allow the surgical site to be monitored and give you a chance to raise concerns early. A carefully managed recovery is one of the best ways to reduce complications and help the toe heal well.
Reducing the risk of another ingrown nail
Even after successful treatment, nail and skin care still matters. Cut nails straight across rather than rounding deeply into the corners, and avoid cutting them too short. Choose shoes with enough room through the toe box, especially if your work or sport places repeated pressure on the forefoot.
Trauma is another common trigger. If your toenails are repeatedly bumped in tight shoes, boots or sporting footwear, review the fit rather than assuming the nail itself is the only problem. Thick, discoloured or difficult-to-cut nails may also need assessment, as fungal disease and nail deformity can influence how a nail grows.
Avoid home surgery, including digging beneath the nail with sharp tools or trying to remove a deeply embedded edge. These approaches can worsen inflammation, introduce infection and leave a nail spike behind. Professional treatment is particularly worthwhile when the toe is already swollen, bleeding or producing discharge.
Choosing a specialist surgical opinion
A recurring ingrown toenail can appear minor from the outside, yet the impact can be significant when every pair of shoes hurts or an infection keeps returning. A specialist consultation provides a clear diagnosis, an explanation of your options and a treatment plan based on the nail, your health and your daily demands.
At Sydney Foot & Ankle Surgeon, patients can discuss conservative management and definitive surgical options with a practitioner focused on foot and ankle conditions. The aim is to help you understand what is causing the problem, what treatment involves and what recovery is likely to require.
You do not need to wait until the pain becomes intolerable. Seeking advice while the problem is persistent, rather than repeatedly trying to manage it alone, can help protect the surrounding skin and get you back into comfortable shoes with greater confidence.