Nail matrixectomy

What is nail matrixectomy, and how does it work?

Surgical nail matrixectomy (also called matricectomy) destroys or removes the nail matrix, the tissue at the base of the nail that makes it, so the treated part of the nail can't regrow¹. A partial procedure treats only the part of the matrix causing the problem, so the rest of the nail keeps growing. A total procedure treats the whole matrix, so no nail grows back¹.

It's an add-on rather than a stand-alone operation. It's done together with removing the problem edge of the nail, or the whole nail². The matrix is then destroyed by cutting it out, or by applying a chemical called phenol, which burns the matrix and stops the nail growing back³.

What is it used for, and how well does it work?

It's mainly used for ingrown toenails that are painful, keep coming back or haven't settled with simple care⁴. It's also described for thickened or damaged nails and long-term swelling of the skin beside the nail⁵, but it isn't clear yet how well it works for those.

For ingrown toenails, surgery prevents the problem returning better than a gutter or brace fitted to the nail². Even so, the nail can still grow back. Reported rates vary widely between sources and methods, so no single figure can be promised⁶⁷. Regrowth is more likely when the matrix isn't fully destroyed⁵. Most of the research comparing methods is of poor quality⁸, and it isn't clear yet how much pain relief or what cosmetic result to expect.

Is nail matrixectomy right for me?

It tends to suit people whose ingrown toenail is painful, keeps coming back, is deformed, or hasn't settled with simple care⁹. Mild, early ingrown nails are usually managed without surgery first¹, and simple care can be given a steady go for 2–12 weeks⁷. It isn't needed for every nail: removing just the nail edge, without destroying the matrix, is suggested for a single ingrown nail with no underlying nail problem, or when healing is likely to be poor⁹.

You have a higher risk of complications if you're older, have obesity, smoke, or have diabetes, heart disease or lung disease¹⁰¹¹. The phenol method is described as suitable for teenagers and for people whose diabetes is well controlled⁵. If you're pregnant, allergic to an anaesthetic, or take blood thinners, tell the clinic before surgery so they can seek advice.

What happens during and after the procedure?

Before surgery, tell the clinic about all your medicines and health conditions.

It's planned as one visit under local anaesthetic, an injection that numbs the toe⁶. The podiatrist or doctor removes the problem edge of the nail (or the whole nail), then destroys the matrix with phenol or by cutting it out⁶². Phenol is kept off the surrounding skin because it can damage healthy tissue¹.

Afterwards your toe is dressed and a review is arranged. Follow the clinic's written aftercare. Antibiotics and special dressings after surgery don't seem to reduce infection, pain or healing time². Some oozing from the toe is common after phenol, and it can take a while to settle⁵. Healing time varies, so ask your podiatrist when you can return to usual shoes and activities.

What are the risks and side effects?

The main risks are:

• Infection of the toe¹⁰.
• Regrowth of the nail, or a sharp nail spike (a spicule) if some matrix is left behind¹⁰⁵.
• Changes to the nail: it can end up narrower and look different⁷¹⁰.
• Slow healing¹⁰.
• A rare, serious allergic reaction to the local anaesthetic¹⁰.

Phenol can also cause pain, oozing and damage to the tissue, and very rarely affects the whole body⁵. Don't assume ongoing drainage is harmless: see your GP or a podiatrist if it carries on, and the same day if redness or pain comes with it.

How does it compare with other options?

For a mild, early ingrown toenail, simple care without surgery usually comes first¹. Removing the nail alone usually isn't enough, because the problem nearly always comes back¹.

Whether phenol or cutting out the matrix is better isn't clear yet: neither is clearly better for pain, healing, complications or satisfaction, and many trials are of low quality⁸⁹. The choice often comes down to your nail, your health and what your podiatrist recommends, so ask about each option.