Surgical treatments for ingrowing toenails

Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically.

To evaluate the effectiveness of methods of the surgical treatment of ingrowing toenails.

Electronic database searching (CENTRAL, MEDLINE, EMBASE, CINAHL) followed by investigation of reference lists of the papers identified from the initial search.

Any randomised (or quasi-randomised) controlled trial which compares one form of surgical removal of all or part of a toenail due to its impact on the soft tissues to another or others. Studies must have a minimum follow period of six months and aim to permanently remove the troublesome portion of the nail.

Data extraction was carried out independently by the two reviewers using a pre-derived data extraction form and entered into RevMan. Categorical outcomes were analysed as odds ratios with 95% confidence intervals.

Avulsion with phenol versus surgical excision: Phenolisation combined with simple avulsion of a nail is more effective than the use of more invasive excisional surgical procedures to prevent symptomatic recurrence at six months or more (OR 0.44 CI 95% 0.24 - 0.80). Avulsion with phenol versus avulsion without phenol: The addition of phenol, when performing a total or partial nail avulsion dramatically reduces the rate of symptomatic recurrence, (OR 0.07 95% CI 0.04 - 0.12). This is offset by a significant increase in the rate of post-operative infection when phenol is used (OR 5.69 95% CI 1.93 - 16.77).

The evidence suggests that simple nail avulsion combined with the use of phenol, compared to surgical excisional techniques without the use of phenol, is more effective at preventing symptomatic recurrence of ingrowing toenails. The addition of phenol when simple nail avulsion is performed dramatically decreases symptomatic recurrence, but at the cost of increased post-operative infection.