What actually happens during ingrown toenail surgery

If the word “surgery” is what’s stopping you booking, this article is for you. Ingrown toenail surgery is one of the smallest procedures in medicine that still gets to call itself surgery: twenty minutes in the chair, a numb toe, and you walk out the door you walked in. Here’s exactly what happens at my clinic in Shepperton, in order, with nothing left out.

First, the assessment

Nobody goes straight to surgery. At your first appointment I look at the toe and work out whether you actually need a permanent fix or whether careful conservative treatment will do. A first-time ingrown nail caused by a bad trim or tight football boots often just needs the offending spike removed, which takes minutes and needs no anaesthetic. Surgery is for the toe that keeps doing it, or the one that’s badly dug in.

If surgery is the right call, I explain everything below in person, you ask whatever you like, and we book the procedure appointment. You’ll know the exact cost before anything is decided.

Step one: numbing the toe

The local anaesthetic is the only part of the appointment anyone finds uncomfortable, and it’s brief. Two small injections at the base of the toe, a few seconds of stinging each, and then the toe goes completely numb over five to ten minutes. I always test before starting: if you can feel anything sharp, we wait, and top up if needed. You stay awake and we talk through what I’m doing, or you watch something on your phone. Plenty of people do.

Step two: removing the ingrowing edge

Once the toe is numb, I lift and remove the strip of nail that’s been digging in, usually just a few millimetres from one side. The rest of the nail stays where it is. From the outside, most healed toes look so normal that people forget which side was done.

If both sides of the nail are ingrowing, both edges can be done in the same sitting. If the nail is too damaged or deformed to save, removing the whole nail is sometimes the better option, and I’ll have discussed that with you at the assessment, never sprung on the day.

Step three: the phenol, which is why it doesn’t come back

This is the part that separates proper nail surgery from just pulling the nail edge out. The narrow strip of nail-growing tissue (the matrix) that produced the ingrowing edge is treated with phenol for a couple of minutes. That stops that strip growing nail again, which is what makes the fix permanent rather than a repeat appointment waiting to happen. You can read more about regrowth rates in Will it come back?

Step four: dressing on, and home

The toe is dressed with a sterile, slightly bulky dressing, and you’re done. Wear something roomy on your feet that day: sandals, sliders or a loose trainer with the laces slackened all work. You can walk immediately, and driving is fine for most people the same day once the anaesthetic has worn off, though if it’s your right foot and you’d rather be collected, Ferry Lane has easy pick-up right outside.

You leave with a written aftercare sheet, spare dressings, and a review appointment booked so I can check the toe is healing as it should. The full week-by-week picture is in the recovery guide.

What patients say afterwards

The most common thing I hear at the review appointment, by a mile, is some version of “why did I put that off for two years?” A recurring ingrown toenail costs people whole seasons: winters of dreading boots, summers of hiding feet at the lido. The fix is twenty minutes.

If your toe has been at it for months, book an assessment and let’s look at it properly.