Surgery to correct ingrown toenails is common, and typically results in permanent relief. The nail forms under the skin back by the cuticle, and any ingrowth of the side of the nail begins there. In order for an ingrown toenail to be permanently treated, the side of the nail that is pinching in needs to be removed, and the cells growing the nail in this spot need to be destroyed so that no further nail grows in this spot. This leaves a nail that has a straight edge that does not pinch into the skin. Without this second step of destroying the nail root cells, the ingrown side of the nail will simply grow again, causing further problems in the future.
In order to make this procedure comfortable, the toe must be numbed with a local anesthetic. This process involves injecting the toe along both sides at the base of the toe. Each side takes about 10 seconds to inject, as injecting any faster usually leads to more pain. The injection stings a little, and the toe feels like tight pressure is being applied to the base. This sensation lasts briefly, then goes away as the local anesthetic takes effect. From there onward, the toe will be numb for 4-6 hours. The skin is then cleansed with an antiseptic solution.
The toe is checked to ensure it is numb completely, and a small rubber tourniquet is applied to the toe base to decrease blood oozing that can neutralize the chemical used to destroy the nail root cells. Bleeding in this procedure is minimal to none, but still must be controlled for the best possible outcome. Following the tourniquet application, the side or sides of the nail are removed with a straight jaw nail clipper, back to the base of the nail. Several applications of an acid called phenol are then given to the cells that grow the nail at its base, to destroy them chemically. The remaining acid is rinsed with an alcohol solution, and the site is cleansed of any loose skin debris. The toe is then covered with antibiotic ointment and dressing.
Once the numbing medication wears off, most people do not have significant pain beyond slight throbbing for a day or two, which is typically relieved with over-the-counter anti-inflammatory medication like ibuprofen or naproxen. Care at home consists of daily soaking in warm soapy water, followed by application of antibiotic ointment and a band aid to the toe itself. The skin bed and side of the nail usually heals in 2-3 weeks.
The procedure results in a permanent cure to the development on an ingrown toenail. It is possible for some cells to survive the procedure and regrow a sliver of nail tissue. This is uncommon, and usually is caused by body fluid like blood neutralizing the applied chemical before it can destroy all the nail root cells. Out of the many hundreds of nail procedures our doctors perform each year, very few have regrowth. Equally uncommon is infection of the skin following this procedure. This normally occurs in those who do not follow the care instructions at home, although unanticipated infections do arise out of the blue from time to time and are easily treated with a short course of oral antibiotics. Overall, though, this procedure is generally safe, effective, and permanent.