Background: We wanted to evaluate whether partial matrix excision and orthonyxia are equally effective in the treatment of ingrown toenails of the hallux. Study Design: We conducted a prospective randomized clinical trial with 12-month observer-blinded followup, in the surgical outpatient department of a teaching hospital. We randomized 105 consecutive patients with a total of 109 ingrown toenails to either partial matrix excision (n = 58) or an orthonyxia procedure (n = 51). The main outcomes measurements were rate of recurrence after 12 months, postoperative morbidity, and time to complete recovery. Results: The 12-month followup was completed in 55 of 58 patients undergoing partial matrix excision and 47of 51 patients having orthonyxia. There were four ingrown toenails, four recurrences in the partial matrix excision group, and eight in the orthonyxia group (NS, p = 0.14). Postoperative morbidity parameters (redness, pus, postoperative bleeding); time to complete recovery, wearing shoes (p < 0.01), and performing activities of daily living and hobbies; postoperative symptoms; and patient satisfaction all favored orthonyxia. Conclusions: Partial matrix excision and orthonyxia are equally effective treatments for ingrown toenails. But the orthonyxia procedure showed better results, with less postoperative morbidity, shorter time to complete recovery, fewer postoperative symptoms, and greater patient satisfaction.