What is Ingrown Toenail Avulsion?

Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director

Medically Reviewed: Soula Henderson, BAFHP 18020807 HCPC CH037187, Registered Podiatrist & Foot Health Specialist

An ingrown toenail occurs when the nail’s edge grows into the surrounding skin, causing pain, swelling, and potential infection. This often affects the big toe and can make walking uncomfortable. While mild cases may improve with home care, severe or recurring ingrown toenails may require medical intervention.

Ingrown toenail avulsion is a procedure that removes part or all of the affected nail to relieve discomfort and prevent complications. Commonly performed by podiatrists, it is a safe and effective treatment when other methods fail.

Although the idea of toenail avulsion may seem intimidating, it is a routine procedure with a high success rate. Understanding how it works can help ease concerns and prepare patients for treatment.

Types of Ingrown Toenail Avulsion

Several toenail avulsion procedures exist, each suited to different severities of ingrown toenails. The choice depends on factors such as nail growth, infection severity, and recurrence.

Partial Nail Avulsion (PNA)

A partial nail avulsion procedure removes only the ingrown section of the nail while keeping the rest intact. It is commonly performed under local anaesthetic for minimal discomfort.

The podiatrist trims and lifts the affected portion of the nail.
A chemical like phenol may be applied to prevent regrowth.
Suitable for mild to moderate cases, allowing the remaining nail to grow normally.

Total Nail Avulsion (TNA)

In severe or recurring cases, the entire toenail is removed to eliminate persistent pain, infection, or deformity.

Performed under local anaesthetic, ensuring a painless experience.
The nail may regrow, but its shape and texture could change.
Phenol or similar treatments may be used to prevent regrowth if necessary.

Wedge Resection

Used when the nail is deeply embedded into the skin, this procedure removes both the affected nail section and surrounding tissue.

Reduces the risk of regrowth and further irritation.
The nail bed may be slightly reshaped to prevent recurrence.
Suitable for cases where standard PNA has not provided long-term relief.

Matrixectomy (Permanent Nail Removal)

For recurring ingrown toenails, this procedure permanently removes the nail matrix to prevent regrowth.

Can be performed surgically, chemically, or with laser treatment.
Provides long-term relief but results in permanent nail loss.
Recommended for severe cases where other treatments have failed.

Each of these procedures is designed to relieve pain and prevent future issues. A podiatrist will determine the best option based on severity and medical history.

When is Toenail Avulsion Needed?

Toenail avulsion is recommended when conservative treatments, such as warm saltwater soaks, proper nail trimming, and antibiotics, fail to relieve symptoms.

Signs That Avulsion May Be Necessary

Severe pain and persistent discomfort – When walking or wearing shoes becomes difficult due to the nail pressing into the skin.
Recurring infections – If swelling, redness, pus, or tenderness continues despite treatment.
Chronic inflammation – When the nail is deeply embedded, causing long-term irritation and affecting mobility.
Underlying health conditions – People with diabetes or poor circulation are more prone to complications, making avulsion a safer option.

If left untreated, severe ingrown toenails can lead to infections that spread deeper into the toe. Avulsion provides a reliable solution when other treatments are ineffective, helping to restore comfort and prevent complications.

Risks and Potential Complications

Toenail avulsion is a safe procedure, but like any medical treatment, it carries some risks. Proper aftercare significantly reduces these risks and promotes smooth recovery.

Common Side Effects

Temporary pain and tenderness once the anaesthetic wears off.
Swelling and minor bleeding for the first 24–48 hours.
Nail regrowth issues, where the new nail grows abnormally.
Discolouration or changes in nail shape if regrowth occurs.

Infection Risk

Keeping the toe clean and dry is essential to prevent infection.

Signs of infection include redness, warmth, pus, or increased pain.
Antibiotics may be needed if an infection develops.
Following aftercare instructions, such as regular dressing changes, reduces the risk.

Delayed Healing

Recovery times vary depending on individual health and procedure type.

Conditions like diabetes or poor circulation can slow healing.
Keeping weight off the toe and wearing suitable footwear aids recovery.
Following aftercare guidelines speeds up healing and reduces discomfort.

Permanent Nail Loss

If the nail matrix is destroyed, the toenail will not grow back.

Some people may have cosmetic concerns about permanent nail loss.
Artificial toenails may be an option for those wanting a natural appearance.
Discussing expectations with a podiatrist beforehand is important.

While complications are rare, following post-procedure care significantly lowers the risk of problems.

How is Toenail Avulsion Performed?

Toenail avulsion is a straightforward procedure performed under local anaesthetic. It typically takes 20–30 minutes, and patients can walk out of the clinic the same day.

Step 1: Preparation and Anaesthesia

The toe is cleaned and disinfected to minimise infection risk.
A local anaesthetic is injected to numb the area.
A tourniquet may be used to limit bleeding.
The patient remains awake but feels no pain during the procedure.

Step 2: Nail Removal

The podiatrist removes part or all of the nail, depending on the severity.
Specialised tools lift and trim the affected nail section.
Phenol or laser treatment may be applied to prevent regrowth if necessary.

Step 3: Wound Care and Dressing

The exposed nail bed is treated with an antiseptic to prevent infection.
A sterile dressing is applied to protect the toe and absorb any bleeding.
Patients receive aftercare instructions on keeping the area clean.

Step 4: Recovery and Aftercare

Elevating the foot reduces swelling.
Daily dressing changes and proper hygiene help prevent infection.
Most patients resume normal activities within a few days.
Wearing open-toed or loose footwear prevents irritation during healing.

Following aftercare instructions is essential for a smooth recovery and reduced risk of complications.

Ingrown toenail avulsion is a straightforward treatment for persistent or severe ingrown toenails. When home remedies fail, removing part or all of the affected nail can provide lasting relief and prevent further issues.

Understanding the different types of avulsion, reasons for treatment, and potential risks helps patients feel confident in their decisions. While mild discomfort and swelling are normal post-procedure, proper aftercare promotes healing and minimises complications.

For the best outcome, consulting a qualified podiatrist ensures the most suitable treatment based on individual needs.

Our Other Specialist Podiatry and Foot Health Procedures

While nail avulsion resolves painful ingrown nails, we also provide advanced solutions for other stubborn foot conditions:

Verrutop Verruca^® Treatment: A needle-free, comfort-first mummification treatment for viral warts.
Verruca Needling: A surgical alternative to clear deep-rooted verrucas by triggering the body’s immune response.