An ingrown nail is a condition in which the nail edge has grown into the surrounding soft tissue, resulting in possible pain, inflammation, or infection. This condition most commonly occurs in the great toes and may require surgical management. Other conditions may also require avulsion of part or all of the nail.
Treatment of a simple uncomplicated or asymptomatic ingrowing nail by removal of the offending nail spicule, not requiring local anesthesia, is considered to routine foot care. Trimming, cutting, clipping, and debriding of a nail distal to the eponychium are also considered routine foot care.
Nail avulsions usually offer only temporary relief for ingrown toenails. The nail often grows back to its original thickness, and the offending margin may again become problematic, resulting in another nail avulsion. Therefore, a partial or complete excision of nail and nail matrix may be the preferred course of treatment for recurrent ingrown nails.
Avulsion of a nail plate is, generally, performed under local anesthesia. This procedure involves the separation and removal of a border of the nail or removal of the entire nail from the nail bed to the eponychium.
Excision of nail and nail matrix is performed under local anesthesia and requires removal of part or all of the nail along its length, with destruction or permanent removal of the matrix (e.g., chemical/surgical matrixectomy).
Wedge excision of skin of nail fold is designed to relieve pressure on the nail/soft tissue and requires an excision of a wedge of the soft tissue and ingrown nail from the involved side of the toe.