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Partial Nail Avulsion (Ingrown Toenail Correction Surgery)

Permanently remove ingrown toenails

Partial nail avulsion, also known as wedge resection, is a minimally invasive surgical procedure that manages chronic nail ingrowth by ablating the section of the nail that is growing into the skin.

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What is an ingrown toenail?

Ingrown nails, medically referred to as onychocryptosis or unguis incarnatus, are a type of onychosis (nail disease/deformity) that can affect the nails growing on the fingers and/or toes; the most common type of onychocryptosis is onychocryptosis of the toenails, particularly the big toenail.  

Ingrown toenails are defined as a condition where the affected nail grows in a manner that causes it to cut into the tissue border around the nail and/or the nail bed on one or both sides of the affected nail. As seen in the above diagram comparing a normal nail to an ingrown nail, the corners/edges of the ingrown nail “dig” into the paronychium (soft tissue boarding the nail) and nail bed.

Depending on the severity of the condition, symptoms of an ingrown toenail range from tenderness and mild pain along sides of the nail to swelling, inflammation, and even an infection in cases where the nail punctures the flesh. Do note that swelling, redness, and pus are signs of an infection, and it is highly advisable to contact a doctor if you develop an infection.

What causes ingrown toenails?

The most common cause of ingrown toenails is ill-fitting or tight footwear that crowd the toenails and/or apply pressure to the top or side of the foot and big toe. Footwear with poor breathability can also cause ingrown toenails as increased perspiration in addition to the damp atmosphere in the shoe can soften the nail and skin of the foot, making it easier for the nail to cut into the flesh or for the nail to “bend” inwards into the skin.

Other causes of ingrown toenails include:

  • Improper nailcare; cutting the toenail too short or cutting the nail in a way that causes its corners to be rounded off.
  • Trauma/injury to the toenail such as stubbing the toe, breaking the toenail, or dropping heavy objects on the toe.
  • Nail infections or medical conditions like diabetes.
  • Genetic or physical predispositions such as having atypically shaped nail beds or naturally softer skin tissue that may encourage the ingrowing of nails.


Surgical treatment of ingrown toenails

Partial nail avulsion involves the surgical removal of the section(s) of the toenail (from its nail root) that is growing into the flesh of the toe. Depending on if the procedure is done with or without chemical matrixectomy, results may be temporary or permanent.

This procedure is generally considered quick (taking around 30 minutes to complete) and minimally invasive as it does not involve any medical incisions or stitches being made to the toe and does not require hospitalisation after the procedure.

Chemical matrixectomy

Also referred to as phenol and alcohol procedure (P&A) or phenolisation, chemical matrixectomy is the chemical removal of the nail-forming tissue (growth area) of the toenail. Matrixectomy of the lateral nail matrix permanently prevents the ablated section from growing back after partial nail avulsion is performed, ensuring that the width of the nail plate in permanently reduced to better fit the lateral nail fold.

While partial nail avulsion can be performed without chemical matrixectomy, chemical matrixectomy is usually recommended as re-growth of the nail after partial avulsion can lead to post surgery problems:

  • Chronically ingrown nails mas the removed section/nail often grows back.
  • Worsening pain as the removed section may grow back deformed, thicker, or wider.

Is surgical treatment suitable for me?

Surgical treatment is usually employed in cases where the condition of the ingrown nail is severe, such as in cases where the patient is experiencing excruciating pain or in cases where the ingrown nail has pierced the flesh and is causing an infection; mild to moderate cases are typically treated via nail bracing or other conservative treatment methods including the use of a splint or topical antibacterial medication to soothe the inflammation.

However, as ingrown toenail surgery offers a permanent solution to correcting ingrown nails, it is also recommended for patients who suffer from recurring episodes of ingrown toenails even after undergoing conservative treatment.

Note that this procedure may not be suitable for you if you suffer from:

  • Diabetes/diabetic foot complications
  • Hemophilia or other bleeding disorders
  • Poor blood circulation in or to the foot
  • Inability to heal from wounds due to a medical condition

What to expect during the procedure

Partial nail avulsion is conducted under local anaesthesia to minimise any pain or discomfort that may be felt during the procedure. Before the procedure starts, local anaesthesia will be administered via an anaesthetic injection to just the affected toe. Once the toe is numb:

1. The ingrown section(s) of the nail is identified and lifted from its edge.

2. A cut is made to split the nail all the way down to its root and the ingrown section is removed.

3. Phenol is applied to the matrix area of the removed section to selectively destroy the nail-forming tissue that is causing the ingrown portion of the nail

4. Upon completion of the procedure, sterile surgical dressing will be applied to the toe.

Note that after partial nail avulsion is performed, there will be a gap between the remaining nail and the paronychium. This is normal, the gap will reduce/close as the toe heals.

Treat chronic pain from ingrown toenails in just 30 minutes


Recovery typically takes between 2 to 4 weeks for most patients. Note that physical activity should be avoided, and open-toed footwear should be worn during the recovery period to avoid irritating the wound. As no hospitalisation is required, you are free to leave the clinic immediately after the procedure.

Partial nail avulsion is done under local anaesthesia to minimise any pain or discomfort felt during the procedure. Re-dressing of the toe at home or at the clinic during follow up consultations will be required during your recovery period and slight pain/swelling is to be expected as your toe heals. Our doctors will prescribe pain relief medication if needed.

All surgical procedures involve risk, but partial nail avulsion is generally considered to be safe and low risk. The most common complication post-surgery is an infection if the wound does not heal properly. There is also a chance for the nail to regrow over time even if chemical matrixectomy is done.

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