Do I Need Surgery for an Ingrown Toenail?
Ingrown toenails are a surprisingly common foot problem—and while they might seem minor at first, they can become increasingly painful and even lead to infection if not treated properly. You may be wondering – “Do I need surgery for this?” The answer depends on the severity of the condition and how your toe responds to initial treatments.
The symptoms of an ingrown toenail
Pain along the nail edge
One of the earliest symptoms is discomfort where the nail meets the skin—usually along one or both sides of the toenail. This pain can range from a dull ache when walking to sharp, stabbing pain when pressure is applied, such as when wearing tight shoes.
Swelling around the affected area
As your body reacts to the nail pushing into the skin, the area can start to swell and turn red. It might look a bit puffy and feel warm to the touch. The skin around the nail can also start to feel firm and irritated.
Drainage or pus formation (Signs of infection)
If bacteria enter the broken skin, the area can become infected. This often leads to:
• Yellow or white fluid or pus draining from the side of the nail
• A foul smell coming from the toe
• Intensified redness that may spread around the toe
• Throbbing pain or a feeling of pressure within the toe
If the problem has been going on for a while, you might see a soft, red bit of skin growing over the edge of the nail. This is called granulation tissue, and it forms as part of the body’s healing response. But in the case of an ingrown toenail, it can actually make things worse by encasing the nail edge and deepening the ingrowth.
Do I need surgery?
While conservative treatment—like warm foot soaks, topical antibiotics, and proper nail care—is often enough to resolve mild cases of ingrown toenails, there are times when these methods are no longer effective. In such cases, surgical intervention becomes the most appropriate solution.
Here are the primary indications for surgery:
Persistent or severe pain
Pain is one of the earliest and most reliable indicators that an ingrown toenail has progressed beyond the point of home management. If you are experiencing significant discomfort that interferes with walking, standing, or wearing shoes, and the pain has not improved after several days of at-home care, surgery is usually needed.
Deep penetration of the nail
If the edge or corner of the toenail has grown far into the soft tissue and cannot be gently lifted or separated from the skin, the nail may need to be partially or fully removed. The longer the nail remains embedded, the more likely it is to cause infection or lead to nail deformities.
Recurrent ingrown toenails
Some people experience repeated ingrown toenails on the same toe, often due to factors like nail shape, improper trimming habits, or genetic predisposition. When the problem keeps coming back, a surgical procedure to remove part of the nail matrix (the root that generates nail growth) may be recommended.
Underlying medical conditions that increase risk
Individuals with certain medical conditions should not ignore even mild ingrown toenails. These include those with:
• Diabetes
• Peripheral arterial disease
• Neuropathy
• Compromised immune systems
Because these conditions make it harder to fight infections and heal properly, what might be a minor issue for someone else could become a serious health concern. In these cases, even early-stage ingrown toenails are often referred for medical or surgical treatment to avoid complications like ulcers, severe infection, or tissue damage.
What type of surgery is typically performed?
If surgery is recommended, it’s important to know it’s usually a quick, outpatient procedure with minimal downtime.
Options include:
• Partial nail avulsion (PNA): Removal of the ingrown edge of the nail. A chemical like phenol may be applied to destroy part of the nail matrix and prevent regrowth.
• Total nail avulsion: Removal of the entire toenail (only recommended in more severe or repeated cases).
• Matrixectomy: Often combined with nail avulsion; it permanently removes part of the nail matrix to prevent recurrence.
The toe is numbed with local anaesthesia, and the procedure typically takes less than 30 minutes. Most people are able to resume normal activity within a few days, with full healing in 2–4 weeks.
