Ingrown Toenails

An ingrown toenail develops when the side of the nail, most often on the big toe, presses into or grows under the soft skin beside it. The skin becomes red, swollen and painful, and may become infected, producing discharge and a mound of moist, overgrown tissue at the nail edge.

In children and teenagers this is commonly related to curved or wide nails, tight shoes, sweaty feet, sport, or nails that have been cut too short or rounded at the corners. It can affect one or both sides of the nail and often keeps coming back once it has started.

Mild cases often settle with simple care at home: soaking the foot in warm salty water, keeping the area clean, wearing roomy shoes, and cutting the nail straight across rather than curving the corners. A short course of antibiotics may be needed if the toe is infected.

• Your child's surgeon may recommend a small procedure when:
• The problem keeps recurring despite good nail care
• Pain is stopping your child from wearing shoes or playing sport
• There is persistent infection or overgrown tissue at the nail edgeTreating an established ingrown toenail early prevents months of discomfort and repeated infections.

In children the procedure is usually performed under a short general anaesthetic as day surgery, with local anaesthetic to numb the toe afterwards. Older teenagers may sometimes have it done under local anaesthetic alone.

The most common operation is a wedge excision, in which the ingrowing strip of nail along the affected side is removed, together with the swollen tissue beside it. The nail root at that edge is then treated with a chemical or by cutting it away, so that the narrow strip does not grow back. The rest of the nail is left in place. A padded dressing is applied.

The toe can be sore for a few days and simple pain relief is helpful. Keep the foot raised where possible on the first day and wear open or loose footwear until the dressing comes off.

The dressing is usually changed after a day or two, after which the toe can be washed gently and covered with a light dressing until it has healed, which takes a few weeks. Some clear or slightly bloodstained ooze is normal in the first week. Your child can usually return to school within a few days and to sport once the toe is comfortable. Contact the team if there is spreading redness, increasing pain or fever.