An ingrowing toenail is a nail edge cutting into the skin beside it. A partial nail avulsion under local anaesthetic removes that edge, and applying phenol to the nail bed underneath is what stops it growing back. The procedure takes about 30 minutes and costs £595.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
An ingrowing toenail happens when the side of the nail plate presses into the skin fold beside it. The skin reacts, swells and then becomes infected, and the swelling presses the nail in harder. It is almost always the big toe.Cochrane Database of Systematic Reviews Eekhof, 2012
The pain is out of proportion to the size of the problem. People describe not being able to wear a shoe, not being able to have a bedsheet on the foot, and months of managing it before they do anything about it.
Cutting the nail curved rather than straight across, shoes that press on the sides, sweaty feet, a naturally wide nail plate and picking at the corners are the common causes. Some of it is the shape of the nail you were born with.Cochrane Database of Systematic Reviews Eekhof, 2012
Once granulation tissue forms at the nail fold, the cycle is established and conservative measures stop working. That is the point at which people who have been managing it for months usually decide to have it dealt with.Cochrane Database of Systematic Reviews Eekhof, 2012
One thing is not an ingrowing toenail and is worth naming. A new dark streak running the length of the nail, or a dark patch spreading onto the skin at the base of it, needs a specialist opinion rather than nail surgery, because melanoma can present under a nail.British Association of Dermatologists BAD guideline, 2022
Send us what you are seeing and we will tell you what it is likely to be.
The diagnosis takes seconds and is made on looking at the toe. The useful part of the appointment is deciding which edge is involved, whether both sides need doing, whether there is infection to settle first, and how your circulation and sensation are.
Anyone with diabetes, peripheral vascular disease or reduced sensation in the feet is assessed differently, because healing is slower and the threshold for specialist involvement is lower. Circulation and sensation are checked before any nail surgery is agreed.NICE NG19, 2019
Where diabetes is known and the last HbA1c is more than 6 months old, it is repeated before nail surgery. Blood sugar held near target is what makes a toe wound heal on time, and it is a number worth having whatever you decide about the nail.NICE NG28, 2022
Cutting the nail straight across
Prevention rather than treatment. It works before the nail fold is inflamed and does nothing once granulation tissue has formed.
Salt water soaks and packing
Helps a mildly inflamed toe. It buys time and does not change the shape of the nail that is causing it.
Antibiotics
Treats the infection around the nail. Surgery does not need to wait for antibiotics to finish, and antibiotics alone do not resolve an ingrowing nail.Cochrane Database of Systematic Reviews Eekhof, 2012
Simple nail avulsion
Taking the nail edge off without treating the nail bed. It relieves the pain and the nail regrows the same shape, so recurrence is common.Cochrane Database of Systematic Reviews Eekhof, 2012
Partial avulsion with phenol
The nail edge removed and phenol applied to the matrix underneath so that strip does not regrow. Adding a chemical to the nail bed substantially reduces recurrence compared with surgery alone, and it is what is done here. The permanent change to the shape of the nail is explained before you agree to it.General Medical Council GMC guidance, 2020
The procedure takes about 30 minutes and you walk out. The toe is dressed for 24 hours, then redressed daily until it stops weeping, which is usually 2 to 4 weeks with phenol. Phenol makes the wound weep for longer than surgery alone, and it is the trade for the lower recurrence.Cochrane Database of Systematic Reviews Eekhof, 2012
The nail looks narrower afterwards, permanently, on the side that was treated. Most people say they stop noticing within a few months. Recurrence after phenol is uncommon but not impossible.Cochrane Database of Systematic Reviews Eekhof, 2012
Infection after nail surgery is uncommon and antibiotics are not given routinely to prevent it. Redness confined to the nail fold in the first week is normal healing. Redness spreading up the toe or the foot is not, and needs to be seen.NICE NG125, 2020
Cut the nail straight across, not curved, and never below the level of the end of the toe. Do it after a bath when the nail is soft. This is the single change that prevents most first episodes and it costs nothing.
For a toe that is sore but not infected, soak it in warm salty water for 10 minutes twice a day and wear open or wide shoes for 2 weeks. If it is no better in that time it will not settle on its own, and continuing to wait makes the eventual procedure no easier.
Bring the shoes you wear most. The shape of the toe box is often the cause and it is the part of the plan you can change yourself.
Do not buy a nail brace or a corrective clip for a toe that is already infected with granulation tissue. They are for prevention and mild cases, and using one on an established ingrowing nail delays the thing that works.Cochrane Database of Systematic Reviews Eekhof, 2012
Do not pay for a simple avulsion without phenol if you want it to stop happening. It costs less today, the nail regrows in about 6 months in the same shape, and you pay again.Cochrane Database of Systematic Reviews Eekhof, 2012
Step 1
Which edge, one side or both, whether there is infection, and how your circulation and sensation are.
Step 2
A ring block at the base of the toe. Two injections, about 5 minutes to work, and you feel nothing after that.
Step 3
The nail edge removed and the matrix treated so that strip does not regrow. Dressing on, aftercare explained, and a review if you want one.
Ask before you book if you are not sure this is the right appointment.
The procedure is £595, which covers the consultation, the local anaesthetic, the avulsion, the phenol and the first dressing. That price is the same whether one edge or both edges of the same nail are treated.
The ring block at the base of the toe stings for about 20 seconds. After that you feel pressure only. Most people take paracetamol or ibuprofen for the first evening and nothing after that.
Yes. You walk out. Wear an open shoe or a wide trainer for the first few days, keep the foot up when you can for the first evening, and avoid running and football for 2 weeks.
Rarely, when phenol is used on the nail bed. Removing the nail edge on its own has a much higher recurrence rate, because the nail regrows in the same shape that caused the problem.
Usually 2 to 4 weeks with phenol, longer than with surgery alone. That is expected rather than a complication, and it is the trade you are making for the lower chance of it returning.
Narrower on the treated side, permanently. The nail keeps growing normally in the middle. Most people stop noticing within a few months and would choose it again over the pain.
It needs assessing rather than booking straight in. Healing is slower and the risk from a foot wound is higher, so the doctor checks circulation and sensation first and will say plainly if a specialist foot service is the safer route.
Usually not. Surgery does not have to wait for a course of antibiotics to finish, and treating the cause resolves the infection in most cases. Where there is spreading cellulitis, that is treated at the same time.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
British Association of Dermatologists
Guidelines for the management of people with cutaneous melanomaBAD guideline, 2022
Cochrane Database of Systematic Reviews
Interventions for ingrowing toenailsEekhof, 2012
General Medical Council
Decision making and consentGMC guidance, 2020
NICE
NICE
Surgical site infections, prevention and treatmentNG125, 2020
NICE
Type 2 diabetes in adults, managementNG28, 2022
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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