When an ingrown toenail is unresponsive to simple treatment methods, surgical treatment options are available. At our institution, 100 patients with 142 affected toes were surgically treated by one of five techniques and observed for a mean of 9.7 years (range, 7.8 to 10.0 years). Plastic nail wall reduction was effective (four of four nail edges) for mild disease. After marginal nail excision with chemical matrix ablation, the recurrence rate was 20% (12 of 61 nail edges); eight required further surgical treatment. Marginal nail excision combined with surgical excision of the associated nail matrix (Heifetz procedure) was more successful: recurrence occurred in only 6% (6 of 95 nail edges), and only one toe required further surgical treatment. For severe nail deformity, nail ablation with matrix excision (Zadik procedure) was followed by recurrence in 33% (three of nine toes); all three required additional surgical treatment. After terminal amputation (Lapidus/Thompson-Terwilliger procedure), the recurrence rate was 12% (2 of 17 toes); only one nail required additional surgical treatment.