Surgical Treatment of Onychocryptosis

  • Lauren Dabakaroff
  • Tyrone Mayorga
  • Jeteen Singha
  • Bryan MarkinsonEmail author


Proper nail growth is dependent on a host of mechanical factors. Changes to the nail borders and forces affecting growth at the matrix often leads to pathology at the nail/skin interface. When conservative efforts fail there are a variety of surgical approaches and techniques available to the physician including: radical excision, rotational flap, wedge excision, partial nail avulsion (with/without matrixectomy), total nail avulsion (with/without matrixectomy). Treatment is ultimately up to the practitioner, however, the literature shows that nail removal with matrixectomy is the most effective response to a chronic ingrowing toenail. Current methods of treatment for onychocryptosis with matrixectomy are categorized either as a chemical ablation matrixectomy involving phenol or sodium hydroxide, or excisional matrixectomies which involve “cold steel” removal of the offending nail matrix with or without the nail bed. The Winograd and Frost procedures are examples of partial excisional matrixectomies indicated when an isolated nail border is affected. Some presentations may result in the need for total and permanent nail removal. These procedures involve nail plate avulsion followed by total matrixectomy by surgical excision or chemical cautery using phenol. The Zadik and Suppan procedures are examples of total excisional nail removal.


Nail surgery Matrixectomy Phenol ablation Nail avulsion Excisional matrixectomies 

Supplementary material

Phenol Procedure Video (MP4 375,668 kb)

978-3-319-65649-6_25_MOESM2_ESM.pdf (23 kb)
Patient Handout (PDF 22 kb)


  1. 1.
    DeBrule MB. Operative treatment of ingrown toenail by nail fold resection without matrixectomy. J Am Podiatr Med Assoc. 2015;105(4):295.CrossRefGoogle Scholar
  2. 2.
    Lloyd-Davies RW, Brill GC. The etiology and out-patient management of ingrowing toe-nails. Br J Surg. 1963;5(0):592–7.CrossRefGoogle Scholar
  3. 3.
    Frost LA. Root resection for incurvated nail. J Am Podiatry Assoc. 1950;40:19.Google Scholar
  4. 4.
    Al Kline DPM. Onychocryptosis: a simple classification system. Foot Ankle J. 2008;1(5):6. ISSN 1941-6806.Google Scholar
  5. 5.
    Laxton C. Clinical audit of forefoot surgery performed by registered medical practitioners and podiatrists. J Public Health Med. 1995;17:311–7.PubMedGoogle Scholar
  6. 6.
    Shaikh FM, Jafri M, Giri SK, Keane R. Efficacy of wedge resection with phenolization in the treatment of ingrowing toenails. J Am Podiatr Med Assoc. 2008;98:118–22.CrossRefGoogle Scholar
  7. 7.
    Rounding C, Bloomfield S. Surgical treatments for ingrowing toenails. Cochrane Database Syst Rev. 2005;2:CD001541.Google Scholar
  8. 8.
    Winograd AM. Modification in the technique of operation for ingrown toenail. JAMA. 1929;92:229.CrossRefGoogle Scholar
  9.  9.
    Zadik FR. Obliteration of the nail bed of the great toe without shortening of the terminal phalanx. J Bone Joint Surg Br. 1950;32:66.CrossRefGoogle Scholar
  10. 10.
    Antrum RM. Radical excision of the nailfold for ingrowing toenail. J Bone Joint Surg Br. 1984;66:63.CrossRefGoogle Scholar
  11. 11.
    Weisfeld M. Illustrated technique for the complete removal of nail matrix and hyponychium without skin incisions (Suppan nail technique n. 2). J Am Podiatry Assoc. 1975;65:481.CrossRefGoogle Scholar
  12. 12.
    Boll Of. Surgical correction of ingrowing toenails. J Natl Assoc Chiropod. 1945;35:8.Google Scholar
  13. 13.
    Boberg JS, Frederiksen MS, Harton FM. Scientific analysis of phenol nail surgery. J Am Podiatr Med Assoc. 2002;92(10):575–9.CrossRefGoogle Scholar
  14. 14.
    Kocyigit P, Bostancis, Ozdemire, et al. Sodium hydroxide chemical matrixectomy for the treatment of ingrown toenails: comparison of three different application periods. Dermatol Surg. 2005;31:744.CrossRefGoogle Scholar
  15. 15.
    Chapeskie H. Ingrown toenail or overgrown toe skin? Alternative treatment for onychocryptosis. Can Fam Physician. 2008;54:1561.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Ezekian B, Englum BR, Gilmore BF, Kim J, Leraas HJ, Rice HE. Onychocryptosis in the pediatric patient. Clin Pediatr (Phila) 2017;56(2):109–114. Epub 2016 Dec 8.CrossRefGoogle Scholar
  17. 17.
    Napoli KL, Ingall CG, Martin GR. Safety and efficacy of chloral hydrate sedation in children undergoing echocardiography. J Pediatr. 1996;129:287–91.CrossRefGoogle Scholar
  18. 18.
    Mayers DJ, Hindmarsh KW, Sankaran K, et al. Chloral hydrate disposition following single-dose administration to critically ill neonates and children. Dev Pharmacol Ther. 1991;16:71–7.CrossRefGoogle Scholar
  19. 19.
    Cordoba Diaz D, Losa Iglesias ME, Cordoba Diaz M, Becerro de Bengoa Vallejo R. Enhanced removal of phenol with saline solution over alcohol: an in vitro study. Dermatol Surg. 2012;38(8):1296–301.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lauren Dabakaroff
    • 1
  • Tyrone Mayorga
    • 2
  • Jeteen Singha
    • 3
  • Bryan Markinson
    • 4
    Email author
  1. 1.Division of Podiatric Medicine and SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.New York College of Podiatric MedicineNew YorkUSA
  3. 3.Podiatric School of Medicine and Surgery Icahn School of Medicine at Mount Sinai Department of Orthopedic SurgeryNew YorkUSA
  4. 4.The Leni and Peter W May Department of Orthopedic SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

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