c. Definitive Treatment. Removal of the toenail is definitive treatment for
bothersome, chronic ingrown toenails that do not respond to the following conservative
Change of footwear to minimize compression of toes.
Frequent soaking and elevation of the affected toe.
Patient education regarding proper trimming of toenails.
Elevation of the affected ingrown nail edge with a cotton wick.
d. Contraindications for Removal of the Toenail.
The toenail should not be unnecessarily removed if the patient has:
(a) Diabetes mellitus.
(b) Peripheral vascular disease.
(d) Allergy to local anesthetics (relative contraindication).
(2) Presence of soft-tissue infection or paronychia may be a relative
contraindication. It is recommended that the infection be treated prior to removing the
e. Equipment. Gather the following equipment:
A 3 or 5 ml syringe.
2 percent lidocaine without epinephrine.
Sterile scissors with straight blades (or narrow periosteal elevator).
A sterile rubber band.
Two sterile straight hemostats.
Phenol solution (88 percent) for permanent removal of the nail.
Isopropyl alcohol swabs.
Sterile cotton swabs.