Comparison of outcomes of banding, nail brace, and Winograd techniques in the treatment of ingrown toenails

Year 2025, Volume: 7 Issue: 2, 159 - 163, 21.03.2025

Oğuzhan Çiçek , Dursun Karakaş , Hakan Uslu , Bedirhan Sarı

Abstract

Aims: This study aims to evaluate the clinical outcomes of three commonly used treatment methods—banding, nail brace, and the Winograd procedure—in patients with Heifetz stage 2 ingrown toenails. Parameters such as recurrence rate, infection rate, postoperative pain, and patient satisfaction were assessed to guide clinical decision-making.
Methods: This retrospective study included 91 patients diagnosed with Heifetz stage 2 ingrown toenail, who were treated using one of three methods. Patients were divided into three groups: banding, nail brace, and Winograd procedure. Visual Analog Scale (VAS) scores were recorded on the third postoperative day to assess pain levels. The short-term outcomes, recurrence rates, and complications were analyzed. Ethical approval was obtained and the study adhered to the principles of the Declaration of Helsinki.
Results: The nail brace method showed a significantly shorter return-to-work duration (mean 10.2±9.5 days) compared to the Winograd procedure (19.0±6.4 days, p<0.001). Postoperative pain levels were significantly lower in the nail brace group (VAS score: 4.1±1.3) than in the Winograd group (6.0±1.5, p<0.001). Recurrence rates were similar across the nail brace (25.0%), Winograd (15.0 %), and banding (26.1%) groups (p=0.472). No significant differences were observed in the postoperative infection rates between the two methods (p=0.571).
Conclusion: The nail brace method offers faster recovery, shorter return-to-work durations, and lower postoperative pain, making it a less invasive alternative to the Winograd technique, which has longer recovery times. Despite these differences, both methods show similar recurrence rates, highlighting the need for treatment selection based on patient characteristics and preferences. Further studies with larger samples are required to assess long-term outcomes.

Keywords

Ingrown toenail nail brace, Winograd technique, recurrence, postoperative pain

References

• Huang S, Wang J, Chen Z, Kang Y. Surgical interventions for ingrown toenail. Foot Ankle Surg. 2024;30(3):181-190. doi:10.1016/j.fas.2023.12. 003
• Di Chiacchio N, Di Chiacchio NG. Best way to treat an ingrown toenail. Dermatol Clin. 2015;33(2):277-282. doi:10.1016/j.det.2014.12.009
• Borges APP, Pelafsky VPC, Miot LDB, Miot HA. Quality of life with ingrown toenails: a cross-sectional study. Dermatol Surg. 2017;43(5):751-753. doi:10.1097/DSS.0000000000000954
• Exley V, Jones K, Watson J, Backhouse M. A survey of the treatment and management of ingrown toenails by UK podiatrists: a cross-sectional survey. J Foot Ankle Res. 2024;17(2):e12017. doi:10.1002/jfa2.12017
• Wang HH, Yang TH, Liu CW, Tsai TY, Huang YC. Efficacy of nail braces for acute and chronic ingrown toenails: a prospective study. Dermatol Surg. 2020;46(2):258-266. doi:10.1097/DSS.0000000000001905
• Pamuk Ç. Winograd surgery can be performed under partial digital block in patients with ingrown toenails. Foot Ankle Surg. 2022;28(6):785-788. doi:10.1016/j.fas.2021.11.002
• Kaya E, Coşkun T. Comparison of Winograde and vandenbos surgical techniques according to Heifetz stage in the treatment of ingrown toenails. J Contemporary Med. 2022;12(6):930-936. doi:10.16899/jcm. 1175187
• Heifetz CJ. Ingrown toe-nail: a clinical study. Am J Surg. 1937;38(2):298-315. doi:10.1016/S0002-9610(37)90439-2
• Arica IE, Bostanci S, Kocyigit P, Arica DA. Clinical and sociodemographic characteristics of patients with ingrown nails. J Am Podiatr Med Assoc. 2019;109(3):201-206. doi:10.7547/17-023
• Zaraa I, Dorbani I, Hawilo A, Mokni M, Ben Osman A. Segmental phenolization for the treatment of ingrown toenails: technique report, follow up of 146 patients, and review of the literature. Dermatol Online J. 2013;19(6):18560. doi:10.5070/D3196018560
• Talwar A, Puri N. A study on the surgical treatment of ingrowing toe nail with nail excision with chemical matricectomy versus nail excision alone. Group. 2013;1(1):6. doi:10.7241/ourd.20131.06
• Terrill AJ, Green KJ, Salerno A, Butterworth PA. Risk factors for infection following ingrowing toenail surgery: a retrospective cohort study. J Foot Ankle Res. 2020;13(1):48. doi:10.1186/s13047-020-00414-y
• Mousavi SR, Khoshnevice J. A new surgical technique for ingrown toenail. ISRN Surg. 2012;2012:438915. doi:10.5402/2012/438915
• Khunger N, Kandhari R. Ingrown toenails. Indian J Dermatol Venereol Leprol. 2012;78(3):279-289. doi:10.4103/0378-6323.95442
• Exley V, Jones K, O'Carroll G, Watson J, Backhouse M. A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms. J Foot Ankle Res. 2023;16(1):35. doi:10.1186/s13047-023-00631-1
• Karaca N, Dereli T. Treatment of ingrown toenail with proximolateral matrix partial excision and matrix phenolization. Ann Fam Med. 2012; 10(6):556-559. doi:10.1370/afm.1406
• Haneke E. Controversies in the treatment of ingrown nails. Dermatol Res Pract. 2012;2012:783924. doi:10.1155/2012/783924
• Barreiros H, Matos D, Goulão J, et al. Using 80% trichloroacetic acid in the treatment of ingrown toenails. An Bras Dermatol. 2013;88(6):889-893. doi:10.1590/abd1806-4841.20132296
• Kayalar M, Bal E, Toros T, et al. Results of partial matrixectomy for chronic ingrown toenail. Foot Ankle Int. 2011;32(9):888-895. doi:10.3113/FAI.2011.0888
• Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. Cochrane Database Syst Rev. 2012; 2012(4):Cd001541. doi:10.1002/14651858.CD001541.pub3
• Guler O, Tuna H, Mahirogullari M, et al. Nail braces as an alternative treatment for ingrown toenails: results from a comparison with the Winograd technique. J Foot Ankle Surg. 2015;54(4):620-624. doi:10.1053/ j.jfas.2015.04.013