By Dr. Kayla Wright, DPM
That is why repeatedly digging out the corner can create a frustrating cycle: short-term relief, nail regrowth, renewed pressure, and another painful flare.
The nail edge grows from a matrix
The nail plate is produced by growth tissue called the nail matrix. If an ingrown border is simply cut or partially removed but the corresponding matrix remains intact, that strip can grow back.
In a one-time mild case, regrowth may be perfectly acceptable. In a nail that has become ingrown repeatedly in the same location, it may be the reason the problem keeps recurring.
A partial matrixectomy treats the narrow segment of growth tissue responsible for the ingrown border while preserving the rest of the nail.
Five common reasons an ingrown toenail recurs
1. The nail is repeatedly cut down the side
People often try to relieve pressure by trimming a deep “V” or digging down the painful corner. That can leave a sharp nail spicule behind or create a border that grows back into the fold.
For routine prevention, nails are generally trimmed straight across rather than aggressively rounding the corners.
2. The nail plate is naturally curved or wide
Some people have a nail shape that mechanically crowds the nail fold even with appropriate trimming. A highly curved nail can repeatedly press into the skin as it grows.
This is one reason recurrence is not always something the patient caused.
3. Shoes or sports keep pushing the nail into the skin
A narrow toe box, tight cleats, work boots, dance shoes, or repeated downhill impact can drive the nail fold and nail edge together.
Runners may also develop repetitive trauma when the foot slides forward in the shoe or the toenail repeatedly contacts the upper.
4. The toe has had repeated trauma
Stubbing the toe, dropping an object on it, or repetitive microtrauma can distort nail growth. A damaged nail may regrow with a new shape, thickness, or direction that increases the chance of ingrowing.
5. Prior treatment removed the edge but not the source of recurrence
Simple partial avulsion can relieve symptoms, but if the same nail border predictably becomes ingrown again, a matrix procedure may offer more durable recurrence prevention.
A 2023 systematic review of randomized trials found that adding phenol to nail avulsion reduced recurrence compared with avulsion alone, although the certainty of evidence was rated very low because of limitations in the studies.
That qualifier is important: the evidence favors matrix treatment for recurrence prevention, but no procedure should be sold as a 100% guarantee.
When is a matrixectomy considered?
A matrixectomy is more likely to enter the discussion when:
- the same nail border has become ingrown multiple times
- previous partial removal gave only temporary relief
- the nail repeatedly develops painful inflammation or granulation tissue
- the condition interferes with shoes, work, running, or sport
- anatomy makes recurrence likely
The most common procedure removes the problem strip and then treats that small portion of matrix chemically, surgically, or with another accepted method.
See what actually happens during ingrown toenail removal for the step-by-step procedure and recovery.
Does phenol permanently stop that edge from growing?
That is the intent of a phenol matrixectomy: destroy the responsible strip of matrix so it no longer produces the same nail border.
Published recurrence rates vary by technique, follow-up, and study quality. AAFP summarizes phenol matrixectomy studies with recurrence rates generally in the low single digits over months to years, while systematic-review evidence supports lower recurrence when phenol is added to avulsion than with avulsion alone.
But recurrence can still happen if matrix tissue survives or regenerates, and a small nail spicule can occasionally regrow.
What if the toenail becomes ingrown on the other side later?
Treating one side does not prevent the opposite border from ever becoming ingrown. A unilateral matrixectomy narrows only the treated edge.
If both sides are repeatedly involved, the clinical discussion changes. Some patients may be candidates for bilateral partial matrix treatment while still preserving the central nail plate.
Can you prevent recurrence without a procedure?
For mild disease, reducing mechanical pressure and improving nail care can help.
Trim straight across
Avoid cutting the nail so short that the corners are buried below the skin line.
Give the toes room
A shoe should not compress the nail folds against the nail plate. This is especially relevant for athletic footwear and work shoes worn for long periods.
Address repeated trauma
If a nail problem began after changing running shoes, increasing downhill mileage, starting soccer, or repeatedly jamming the toe, the mechanical trigger deserves attention.
Do not perform repeated “bathroom surgery”
Digging deeper into an inflamed nail fold with clippers or sharp tools can worsen trauma and increase infection risk.
What if it keeps getting infected?
Redness and drainage do not always mean a spreading bacterial infection. The nail itself acts as a foreign-body irritant and can produce substantial local inflammation.
However, spreading redness, worsening warmth, significant pus, fever, or concern for cellulitis should be evaluated. Patients with diabetes, neuropathy, poor circulation, or immune compromise should have a lower threshold for professional care.
AAFP guidance does not recommend routine oral antibiotics for every ingrown toenail; antibiotics are generally reserved for cellulitis or another appropriate clinical indication.
Can fungus cause an ingrown toenail?
A fungal nail can become thickened or distorted and may increase pressure within the nail fold, but fungus is not the explanation for every ingrown nail. If the nail is yellow, thick, crumbly, or changing across multiple toes, the clinician may also evaluate for toenail fungus.
Treating a fungal infection and treating an ingrown border are different decisions.
Frequently asked questions
How many recurrences are “too many” before a matrixectomy?
There is no fixed number. If the same border repeatedly causes pain, inflammation, drainage, or activity limitation, it is reasonable to discuss a more definitive strategy rather than continuing repeated temporary trimming.
Can an ingrown toenail grow back after phenol?
Yes, though recurrence is less common than after nail avulsion alone. Incomplete matrix destruction or regrowth can produce a recurrent edge or nail spicule.
Why does my nail hurt again months after removal?
If the matrix was not treated, the removed portion may simply have grown back. Other possibilities include a new nail spicule, trauma, fungal nail changes, or a different nail-fold problem.
Are curved toenails genetic?
Nail shape can have an inherited component, but footwear, trauma, age, and other conditions also affect nail shape over time.
Should I keep cutting out the corner when it starts hurting?
Repeated deep trimming may worsen the cycle. For a recurring nail, an examination is more useful than progressively cutting farther down the side.
Recurrent ingrown toenail treatment in Tempe
If the same nail border keeps coming back, Metro Foot & Ankle can determine whether the problem is best managed with nail-care changes, partial removal, or a recurrence-reducing matrix procedure. Learn more about ingrown toenail treatment or request an evaluation in Tempe.
This article is for general educational purposes and does not replace individualized medical advice, diagnosis, or treatment.
Sources
- Exley V, Jones K, O'Carroll G, Watson J, Backhouse M. A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms. Journal of Foot and Ankle Research. 2023;16:35. https://pubmed.ncbi.nlm.nih.gov/37301845/ (opens in a new tab)
- Vinay K, Ravivarma VN, Thakur V, et al. Efficacy and safety of phenol-based partial matricectomy in treatment of onychocryptosis: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2022;36(4):526-535. https://doi.org/10.1111/jdv.17871 (opens in a new tab)
- Mayeaux EJ Jr, Carter C, Murphy TE. Ingrown Toenail Management. American Family Physician. 2019;100(3):158-164. https://www.aafp.org/pubs/afp/issues/2019/0801/p158.html (opens in a new tab)