Ingrown toenail is a common condition that may cause significant pain, functional impairment, and recurrent disease. Although conservative management is appropriate for mild cases, moderate-to-severe or recurrent ingrown toenails are commonly treated surgically under local anesthesia. However, pain associated with the digital nerve block and procedure-related anxiety may negatively affect the patient experience. Virtual reality (VR) has emerged as a promising non-pharmacological intervention for reducing pain and anxiety during a variety of medical procedures by providing an immersive distraction. Nevertheless, evidence regarding its use during ingrown toenail surgery remains limited. The primary objective of this study is to evaluate the effect of VR on procedure-related pain intensity and anxiety in adults undergoing outpatient ingrown toenail surgery under local anesthesia compared with standard care. Secondary objectives include assessing the effects of VR on physiological arousal parameters, patient satisfaction, and safety.

Inclusion Criteria:

• Adults aged 18-65 years.
• Patients presenting to the Dermatology Outpatient Clinic of Ankara Bilkent City Hospital with ingrown toenails who are scheduled for surgical treatment based on the severity and recurrence of the condition.
• Ability to provide written informed consent.

Exclusion Criteria:

• Inability to read, understand, or sign the informed consent form.
• Active infection, including infection at the surgical site.
• History of epilepsy or seizures of any etiology
• Hearing impairment or requirement for a hearing aid that would interfere with the VR intervention or study instructions. 6. Presence of a cardiac pacemaker or any implanted medical device.
• History of neurological disorders (e.g., migraine).
• Inability to understand or speak Turkish.
• Active psychiatric disorder, use of anxiolytic or antidepressant medication that may influence anxiety assessment, panic disorder, or claustrophobia.
• Visual impairment preventing the use of the VR device.
• Cardiac or metabolic disorders that may affect heart rate.
• History of vertigo.
• Cervical spine disorders involving the head or neck region.
• Known anemia, history of methemoglobinemia, or glucose-6-phosphate dehydrogenase (G6PD) deficiency.
• Known allergy to local anesthetics.
• Previous ingrown toenail surgery.