Pediatric Ingrown Toenails: Causes, Symptoms & Treatments

Symptoms of an ingrown toenail can vary depending on patient age. Children below the ages of 3 or 4 years may not be verbally expressive enough to point out the painful toenail. Instead a parent or guardian will notice physical queues such as refusal to wear enclosed shoes or frequent pulling off of shoes in response to the painful toenail. As an ingrown toenail develops, localized redness, swelling and pain along the corner of the affected toenail will appear. If left untreated, drainage, pus and infection can build up at the site of the ingrown toenail. In severe cases, red streaks called cellulitis will appear.

• Congenital wide toenail —Some children are born with excessively wide toenails. This is usually inherited from one of the parents. The excessively wide toenail tends to incurvate overtime and can become ingrown.
  
  
• Tight or poor-fitting shoes —When children undergo rapid periods of growth, their shoes can become tight on their toes. This can lead to increased pressure along the corners of the toenail and allow it to curl into the skin on the side of the toe.
  
  
• Clipping the toenail too short —The toenail should be clipped straight across with a small rim of white. When a toenail is clipped too short, it can regrow into the side of the toe and become ingrown.
  
  
• Poor hygiene —Some young people do not clean their feet properly. When feet stay wet and dirty, fungus and bacteria will grow on the skin and around the nails. This can develop into a toenail infection called a paryonychia .
  

• At-home —There are a number of effective home treatments for ingrown toenails. Soaking in warm Epsom salt water can help to decrease inflammation and soreness. Topical antibiotic ointments can be locally effective in helping to resolve mild ingrown toenails. Also, clipping the incurvated portion of nail can offer temporary pain relief.
  
  
• In-office —When home treatments fail to improve an ingrown toenail, or if the toenail becomes infected, then patients should see a Board-certified podiatrist for definitive treatment. The treatment of choice for painful ingrown toenails is called a partial nail avulsion with chemical matrixectomy . This means a small portion of the toenail is removed under local anesthetic and a dilute acid, phenol, is applied to the nail bed. The application of phenol reduces the rate of recurrence to less than 10%. This procedure is performed in the office and can be done on the day of the initial appointment. The recovery is simple and satisfaction rates are very high with this procedure.
  
  
• Outpatient surgery —Patients below the age of 5 years rarely require partial nail avulsion, but when they do, it can be difficult to numb their toe in the office. Most children age 5 and younger are too strong to hold down and are too anxious to sit still for the 2 needle sticks that are required. When this happens, it is best to perform the toenail procedure as an outpatient surgery under light sedation. This can extend to some older children who have severe anxiety with needles. The procedure details are the same as in-office partial nail avulsion.