Surgical Nail Matrixectomy
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Surgical nail matrixectomy stops part or all of a toenail growing back by destroying the nail matrix, the tissue that makes the nail. It is mainly used for ingrown toenails that are painful, keep coming back, are deformed, or haven't settled with simple care. It is done under local anaesthetic, in one session, together with removing the nail edge or the whole nail. Regrowth is the main thing to watch for, and how often it happens varies widely. Most people recover well, but infection and poor healing are more likely if you have diabetes or poor circulation.
What is it?
Surgical nail matrixectomy is a procedure that stops part or all of a toenail from growing back. It targets the nail matrix (the tissue under the skin at the base of the nail that makes the nail). When the matrix is destroyed or removed, the nail can't regrow from that spot.
It is never done on its own. It is added to a nail removal procedure, such as removing the edge of the nail (a wedge resection or partial nail avulsion) or removing the whole nail (total nail avulsion).
In a partial matrixectomy, only the part of the matrix causing the problem is treated, so the rest of the nail keeps growing. In a total matrixectomy, the whole matrix is removed, so no nail grows back.
The matrix can be destroyed in a few ways. It can be cut out with surgery, burned with a chemical such as phenol, or destroyed with heat (electrocautery).
What is it used for?
The most common use is an ingrown toenail that is painful, keeps coming back, is deformed, or hasn't settled with simple care. It is also used for more severe ingrown toenails.
It is also described for other nail problems where the growing nail causes pain by pinching or pressing on the skin. These include onychogryphosis (a thickened, curved nail), onychodystrophy (a deformed nail), and long-term swelling of the skin beside the nail.
For ingrown toenails, surgery that destroys the matrix is the best-supported option. Even so, it isn't yet clear which method works best. For the other conditions, the procedure is described as an option, but there is little firm information on how well it works.
Is it right for me?
It may suit you if your ingrown toenail is painful, keeps coming back, has a deformed nail, or hasn't improved with simple care. It is also often recommended for moderate to severe ingrown toenails.
Mild, early ingrown toenails are usually treated without surgery first. This means careful, regular care for 2 to 12 weeks. Surgery comes sooner if the nail is deformed or the problem has come back.
You don't always need the matrix treated. If you have a single ingrown toenail with no underlying nail problem, removing just the nail edge may be advised. The same goes if your healing is likely to be poor.
Your podiatrist will check your blood supply before surgery. Serious problems with the blood supply to your feet are a reason not to have the matrix destroyed. Sources disagree on how safe phenol is in this group, so circulation needs checking first.
The risk of infection and poor healing is higher with diabetes, older age, obesity, smoking, heart disease or lung disease. Phenol is described as suitable for people with well-controlled type 1 or type 2 diabetes. Tell your podiatrist about all your medicines and health conditions before surgery.
What happens?
Your podiatrist will ask about your health history and check your tetanus immunisation status. They will check for anything that makes surgery unsafe, such as poor blood supply to your foot.
Your toe is numbed with a local anaesthetic injection around the base of the toe. The ingrown edge of the nail is freed and removed, or the whole nail is removed. Matrixectomy is done in the same session.
With phenol, a tourniquet (a tight band at the base of the toe) is applied and the area is dried. Phenol is then rubbed into the corner of the matrix for about 2 to 3 minutes. It burns the matrix so the nail can't regrow. Your podiatrist keeps it off the skin around the nail, because it is toxic to that skin.
With surgical removal, the matrix is cut out along the side of the nail. The corner of the matrix must be fully removed. If a piece is left, a nail spicule (a small sharp spike of nail) can grow. In a total matrixectomy, the whole matrix is removed and the wound heals from the bottom up.
In another chemical approach, the matrix is scraped away first and a caustic liquid is applied to what remains. Some podiatrists use heat to destroy the exposed matrix and keep the healthy remaining nail.
Your podiatrist will choose a partial or total procedure based on what the rest of your nail is likely to do. A partial procedure is advised if the remaining nail could become painful. The work is done in one session. No figure is available for how many procedures are usually needed.
How well does it work?
Surgery works better than non-surgical options such as gutter treatment at stopping an ingrown toenail coming back, and probably better than nail braces. Removing the nail alone isn't advised, because about 70 per cent of toenails removed this way grow back and cause problems again.
After matrix destruction, the problem most often returns in 5 to 18 per cent of people. Some reports of phenol give lower figures: 1.1 to 3.9 per cent, or less than 1 to 2 per cent. Others have found the problem came back in 48 per cent of partial and 50 per cent of total procedures. Results vary a lot, so no one figure can be promised.
The biggest factor is how completely the matrix is destroyed. If some is left behind, the nail or a spicule can grow back.
Phenol time may also matter. In one comparison, the problem came back in 12.9, 3.9 and 2.1 per cent of people with 1, 2 and 3 minutes of phenol. Pain was the same, but oozing lasted longer with 2 and 3 minutes. Shorter times may heal faster but may allow more regrowth, and the best time isn't known.
No firm figures are available for how much pain eases, how satisfied people are, or how the nail looks afterwards.
Risks and side effects
The risks include:
- infection of the toe after surgery
- bleeding
- slow healing
- the nail or a spicule growing back
- a remaining nail that is distorted or permanently narrower
- scarring or a nail that doesn't look the way it did
- a painful nail spur
Rarely, a serious allergic reaction (anaphylaxis) to the local anaesthetic can happen.
Phenol can damage tissue, cause pain, and leave the toe oozing for longer. Rarely, if phenol stays on for longer, it can affect the whole body, with belly pain, dizziness, blue-tinged skin, dark urine or an irregular heartbeat. Chemical destruction can also injure the bone under the nail. If you have an infection as well, this can delay finding a bone infection.
If blood vessel disease was hidden, healing after chemical destruction can be poor.
Afterwards
Your podiatrist should give you written aftercare advice, including what to watch for and who to contact. Follow it closely. Check your toe each day for signs of infection (listed below).
Taking antibiotics or using special dressings after the procedure doesn't lower the chance of infection, pain or healing time. Follow your podiatrist's advice about dressings.
No firm healing time can be given, so your podiatrist is the best person to tell you what to expect. Some oozing is common after phenol, but oozing that goes on and on needs to be checked.
After healing, keep an eye out for a nail edge or spike growing back, or pain that doesn't settle. Tell your podiatrist, as regrowth is the main thing to watch for.
When to see a podiatrist
When to book
Book an appointment with your podiatrist if an ingrown toenail is painful, keeps coming back, or hasn't settled within 7 to 14 days or is getting worse. Also book if you've had the procedure and the nail edge or a spike grows back, or you still have pain after healing. See your GP soon if you notice a dark streak or a new dark spot under a nail.
When to get help sooner
Call your local emergency number if, after toe surgery or with an infected toe, you feel very unwell with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, as this could be sepsis. Call your local emergency number if your leg, foot or toes suddenly turn cold and pale or blue, with pain or numbness, or if you suddenly can't move your leg or foot. This needs urgent medical assessment: contact your podiatry service or GP the same day, or go to the nearest emergency department, without waiting for a routine appointment, if after surgery you notice new redness, heat or swelling, increasing pain, bad-smelling discharge, redness tracking up the toe, foot or leg, or flu-like symptoms. The same goes for oozing that keeps going, especially with redness or pain, because it needs checking for infection. If your podiatry service can't be reached, use an after-hours GP or a health advice phone line, if there is one where you live. Contact the service that did your surgery straight away if your toe bleeds heavily afterwards. This also needs urgent medical assessment: any ingrown toenail that looks infected, especially if you have diabetes or poor circulation. Unusual pain, heat or swelling in your feet (particularly if you have numbness or nerve damage), or a sudden change in the shape of your foot, needs the same. Infection and poor healing are more likely if you have diabetes or poor circulation, so don't wait.
Frequently asked questions
Is phenol better than cutting out the matrix?
It isn't clear yet. Some reports favour phenol for stopping regrowth, but the evidence for this is limited. In one comparison, the problem came back after 7 procedures in each group. Phenol can cause more oozing and slower healing. Your podiatrist will advise which suits you.
Can children and teenagers have it?
Phenol is described as safe in children and young people, who heal well. It is often used for early-stage ingrown toenails in young or adolescent patients. Your podiatrist will decide if it suits your child and explain the steps.
What should I tell my podiatrist before surgery?
Tell them about all your medicines and health conditions, including diabetes, circulation problems, smoking, and heart or lung disease. These can affect how safe the procedure is and how well your toe heals. Your podiatrist will also check your tetanus immunisation status.