What is an ingrown toenail?
Ingrown toenails are a common, painful condition that frequently affects children and adolescents. It occurs when skin on the side of a nail grows over the edge of the nail, or when the nail itself grows into the skin.
This condition is usually very painful and can be associated with infection of the toe. Some ingrown toenails are chronic, with repeated episodes of pain and infection.
What causes ingrown toenails in children?
Ingrown toenails can develop in children for many reasons. Two major causes are poorly fitting school shoes and improperly trimmed nails.
- Footwear and Socks: Shoes that are too tight or narrow press on the sides of the nail and encourage it to press in against the adjacent skin. Even too-tight school socks or tights can push the child’s nail into the skin of the toe. With little feet that are growing fast, it’s very important to regularly check the fit of the shoes and socks.
- Incorrect nail cutting technique: Nails that are trimmed down into the corners, cut too short or picked at, chewed or peeled off are also more likely to become ingrown.
- Trauma: such as stubbing a toe, or having one stepped on can cause the toenail to penetrate the surrounding skin. Sports that require restrictive footwear (eg. ballet, ice-skating, soccer etc) can also cause trauma to the nail.
- Family trait: In some cases, the condition is inherited and the toenail grows in a curved shape, making the child predisposed to ingrown nails.
- Sweaty, teenage feet: Warm, moist skin is softer and the nail is more easily able to penetrate soft skin especially with pressure from tight school shoes.
- Acne medication: Teenagers that have been prescribed acne medication (eg. accutane, retinoids) may be at higher risk of developing ingrown toenails during their course of treatment.
What are the signs and symptoms of an ingrown toenail?
The big toe is most commonly affected in children. These are the most common symptoms of ingrown toenails:
- Pain when any pressure is placed on the toe, especially inside an enclosed shoe
- Redness of the skin surrounding the nail
- Localized swelling and inflammation
- Overgrowth of skin (proud flesh) at the side of the nail
- Discharge or drainage, including blood or pus
- Throbbing pain in the toe
How are ingrown toenails treated in children?
Treatment for an ingrown toenail will depend upon the severity of the ingrown nail and whether this is the first episode or if it is a recurring problem with the nail.
If this is the first episode, we will treat the nail with a simple procedure called a ‘partial nail avulsion’, where a small piece of the nail is gently removed and a sterile dressing is applied. This procedure can usually be performed comfortably in children, without the use of a local anaesthetic. If the ingrown toenail cannot be comfortably removed, we will administer a local anaesthetic to completely numb the toe, so that no pain is experienced during the procedure.
If your child is experiencing repeated episodes of ingrown toenails, there are two treatment options available at Foot Health Clinic that you can consider:
- This painless procedure involves applying a fine tensioned wire to the nail to gently lift the edge of the nail away from the skin. The nail brace is left in place for a few months until the nail has settled. This treatment option offers rapid relief and requires no needles.
- Called a ‘partial nail avulsion with matrixectomy’. This is a permanent surgical correction that involves removing the piece of nail that is growing in, then applying a chemical (phenol) to the root of the nail to stop that piece of the nail from growing back. This procedure is performed under local anaesthetic in our rooms with the toe completely numb.
What should I do if my child has an ingrown toenail?
If your child has an ingrown toenail follow these simple care instructions until you visit your Podiatrist:
- Bathe the toe in warm, salty water twice daily;
- Apply betadine antiseptic solution to the toe and cover with a clean dressing. We recommend Cutiplast Sterile dressings.
- Wear an open toe shoe or sandal so there is no pressure on the nail.
Infected ingrown nails should be treated as soon as they develop. In many cases, treatment by your podiatrist may simply involve clearing the side of the nail with a sterile instrument, draining any pus and applying a sterile dressing. Antibiotics are almost never required to treat ingrown toenails in children. Once your podiatrist has cleared the nail from pushing into the skin, the infection will settle rapidly with the pain, swelling and discharge resolving within days, much like removing a splinter from the skin.
How can I prevent ingrown toenails in the future?
There are some simple steps you can take to prevent the development of ingrown toenails:
- Cut nails straight across without tapering down into the corners. This is probably the most important factor in preventing ingrown toenails. Avoid cutting the nails too short, leave them a little longer than usual.
- Avoid wearing shoes or socks that are too tight or narrow.
- Keep feet clean to prevent the ingrown nail from becoming infected.
At Foot Health 4 Kids, we offer a range of solutions for the treatment of ingrown toenails, from advice on correct nail cutting techniques to nail bracing and ingrown toenail surgery. If your child has ingrown toenails, don’t hesitate to contact us for professional care, gentle treatment and expert advice.