Tools Used by Podiatrists for Ingrown Toenail Removal
Podiatrists primarily use a scalpel (surgical blade) for partial nail avulsion to remove ingrown toenails, with the #11 blade being specifically recommended for precise dissection with minimal trauma to the nail bed. 1
Primary Surgical Instruments
Scalpel/Surgical Blade
- The #11 surgical blade is the preferred instrument for nail avulsion, as it causes significantly less trauma to the nail bed compared to nail clippers and results in better post-procedure outcomes with shorter downtime 1
- The scalpel allows for precise separation of the ingrown nail edge from the lateral nail fold during partial nail avulsion procedures 2, 3
Nail Clippers (Less Preferred)
- Traditional nail clippers have historically been used for simple nail avulsion, but this approach causes more detachment between the nail plate and nail bed due to the crushing force applied 1
- This method results in longer recovery times and more trauma compared to blade techniques 1
Conservative Management Tools (Non-Surgical)
Before surgical intervention, podiatrists may use:
Manual Debridement Tools
- Emery boards or nail files for filing nail surfaces after softening in warm water 4, 5, 6
- These tools help smooth rough edges and reduce nail thickness when combined with keratolytic agents 4
Gutter Splints
- Gutter splints can be applied to separate the ingrown nail edge from the lateral fold, providing immediate pain relief 2
- Cotton wisps or dental floss may be placed under the ingrown nail edge as a conservative measure 2, 3
Advanced Surgical Techniques
For definitive treatment beyond simple avulsion:
Chemical Ablation
- Phenol is applied after partial nail avulsion to perform chemical matricectomy, preventing recurrence 7, 2, 3
- Silver nitrate may be used for chemical cauterization 4
Energy-Based Devices
- Electrocautery, radiofrequency ablation, and carbon dioxide laser can be used for nail matrix ablation 3, 8
- These techniques are alternatives to traditional surgical excision 8
Clinical Approach Algorithm
For mild cases (Grade 1): Use conservative tools—emery board filing after warm soaks, gutter splinting, and topical steroids 2
For moderate to severe cases (Grades 2-3): Proceed directly to surgical intervention with #11 scalpel for partial nail avulsion, followed by phenol matricectomy to prevent recurrence 2, 3, 1
The combination of partial nail avulsion with phenolization is more effective than surgical excision alone at preventing symptomatic recurrence, though it carries a slightly increased infection risk 3