Comparative effectiveness of ingrown toenail treatments: Systematic review and network meta-analysis.

BACKGROUND: The optimal treatment for ingrown toenails remains uncertain. Previous meta-analyses have suggested that chemical matricectomy, particularly phenolization, was superior to other interventions. However, these analyses were limited to pairwise comparisons and randomized controlled trials. PURPOSE: To compare the effectiveness of available treatments for ingrown toenails using network meta-analysis. STUDY DESIGN: Systematic review and network meta-analysis. METHODS: We conducted a systematic review and frequentist random-effects network meta-analysis that included randomized controlled trials and non-randomized controlled trials published between January 2001 and October 2025. Interventions were categorized as conservative treatment, toenail avulsion, chemical matricectomy, minor surgery, and conventional wedge excision surgery. RESULTS: Forty-four studies (23 randomized controlled trials and 21 non-randomized controlled trials) involving 5,068 participants were included. Toenail avulsion was associated with the highest recurrence risk, whereas no significant differences in recurrence were observed among chemical matricectomy, minor surgery, conventional surgery, and conservative treatment. Conservative treatment was associated with the lowest pain scores and fastest recovery. Chemical matricectomy and minor surgery showed comparable outcomes for recurrence, post-procedure pain, and recovery time; however, chemical matricectomy was associated with significantly longer healing times than minor surgery and conventional wedge excision. CONCLUSIONS: Although heterogeneity was substantial for several outcomes, the findings challenge the traditional preference for chemical matricectomy, because its advantages over contemporary surgical approaches appeared less pronounced than previously reported. Minimally invasive surgical techniques may offer a favorable balance between recurrence prevention, postoperative recovery, and healing. Further studies comparing optimized chemical matricectomy protocols with contemporary surgical techniques are warranted. LEVEL OF CLINICAL EVIDENCE: 2.