SLR - January 2024 - Exantus
Title: A Systematic Review and Meta-analysis of Randomized Control Trials of Surgical Treatments for Ingrown Toenails Part II: Healing Time, Post Operative Complications, Pain and Participant SatisfactionReference: Exley, V., Jones, K., O’Carroll, G. et al. A systematic review and meta-analysis of randomized controlled trials of surgical treatments for ingrown toenails part II: healing time, post-operative complications, pain, and participant satisfaction. J Foot Ankle Res 16, 55 (2023). https://doi.org/10.1186/s13047-023-00655-7
Level of Evidence: Level I
Scientific Literature Review
Reviewed By: Esther Exantus, DPM
Residency Program: University Hospital-Newark, NJ
Podiatric Relevance: Ingrown toenails are one of the most common nail pathologies that a podiatric surgeon encounters in their daily practice. The prevalence has been suggested to be between 2.5% to 5%. Mild, early cases can be treatment conservatively, but many require some sort of nail procedure. When the clinician is deciding which nail procedure to do, they must take multiple components into account. As it stands, there is lack of current high quality systematic reviews and meta-analysis that aim to tailor the best treatment. This study aims to systematically search and synthesize the literature relating to the effectiveness/efficacy of surgical methods for treating ingrown toenails.
Methods: Five databases were searched for randomized control trials evaluating the effects of surgical interventions for ingrown toenails from inception to January 2022. Secondary outcomes which included post operative complication, pain, healing time, and participant satisfaction were reviewed.
Results: 36 randomized trials were included in the systematic review of the 3,928 that were identified. Healing time was assessed in 14 of the studies which findings suggested that shorter application time and use of phenol resulted in a faster healing time as did the addition of curettage. 20 studies assessed post operative complications which some of the studies showed that the addition of curettage to chemical matrixectomy increased bleeding but reduced infection rates. Participant satisfaction was reported in 9 studies and in all the studies, satisfaction was reported to be improved.
Conclusion: The authors concluded that despite the large volumes of clinic trial that have been conducted on nail surgery for ingrown toenails, few clinical conclusions can be drawn due to the poor quality of the studies. Higher quality studies are needed in order to better answer questions in terms of surgical treatment for ingrown toenails.