Ingrown Toenails in Children

An ingrown toenail (onychocryptosis) occurs when the edge or corner of a toenail grows into the soft flesh surrounding it. This common condition can affect people of all ages, including children. While sometimes just a minor irritation, an ingrown toenail can become painful, inflamed, and potentially infected if not managed correctly. Understanding the signs, causes, and proper care is important for parents in Singapore to help keep their children’s feet comfortable and healthy

Children may not always complain directly about toe pain. Look out for both visible signs and subtle behavioural cues:

• Visible Signs:
  • Redness: Along the side of the toenail where it meets the skin.
  • Swelling: Puffiness or swelling of the skin next to the nail edge.
  • Tenderness/Pain: The area may be sore when touched or when pressure is applied (like from shoes or blankets).
  • Fluid or Pus: Yellowish fluid or pus draining from the area indicates infection.
  • Overgrowing Skin: Sometimes the skin may start to grow over the nail edge.
• Subtle Pain Cues & Behavioural Changes:
  • Limping: Or walking awkwardly to avoid pressure on the toe.
  • Hesitation During Play: Avoiding running, jumping, or activities they usually enjoy.
  • Footwear Issues: Suddenly refusing to wear certain shoes (especially closed-toe ones) or frequently trying to take shoes off.
  • Flinching: Wincing when the toe is accidentally bumped or when putting on socks/shoes.
  • Vague Complaints: Mentioning a “sore,” “funny feeling,” or “owie” on their toe without being specific.

Several factors can contribute to ingrown toenails in children:

• Improper Nail Trimming: This is a very common cause. Cutting nails too short, rounding the corners, or tearing/picking at nails can encourage the edge to grow into the skin.
• Tight or Ill-Fitting Footwear: Shoes or socks that are too tight, narrow, or short can crowd the toes and force the nail into the surrounding skin. This is especially relevant as children’s feet grow quickly.
• Trauma/Injury: Stubbing the toe, dropping something on it, or repetitive impact from activities (like kicking a ball) can damage the nail or nail bed, altering growth.
• Nail Shape: Some children naturally have nails that are more curved (pincer nails) or wider, making them more prone to becoming ingrown.
• Genetics: A predisposition for ingrown toenails can sometimes run in families.

Poor Foot Hygiene: Although less common as a primary cause, sweaty feet can soften the skin, making it easier for the nail to penetrate.

• Infection (Paronychia): Bacteria can easily enter the broken skin, causing increased pain, redness, swelling, warmth, and pus formation. Untreated infections can sometimes spread.
• Chronic Pain and Discomfort: Making wearing shoes and participating in activities difficult.
• Hypergranulation Tissue: Excessive growth of reddish, fleshy tissue over the nail edge, which can bleed easily.

A podiatrist at Fine Podiatry Clinic can usually diagnose an ingrown toenail based on:

• Visual Examination: Carefully inspecting the toe, nail, and surrounding skin for redness, swelling, signs of infection, and the position of the nail edge relative to the skin fold.
• Patient History: Discussing the child’s symptoms (including subtle cues observed by parents), duration, previous occurrences, nail trimming habits, footwear, and activities.
• Assessing for Infection: Checking for signs like pus, increased warmth, and significant swelling.

Imaging like X-rays is typically not needed unless a bone infection or underlying bone spur is suspected, which is rare.

Treatment depends on the severity of the ingrown toenail and whether infection is present. Parents should avoid aggressive “bathroom surgery” or attempting to dig out the nail themselves, as this can worsen the problem and increase infection risk.

• Non-Surgical Treatments (Professional Care): For mild to moderate cases without significant infection:
  • Correct Nail Trimming/Spicule Removal: A podiatrist can often carefully trim the nail edge correctly or remove the small spike (spicule) of nail digging into the skin, providing immediate relief. This requires skill and sterile instruments.
  • Packing/Taping: Techniques like gently packing sterile cotton under the nail edge or taping the skin away from the nail may be used to help guide nail growth.
  • Antibiotic Ointment: May be recommended if there’s minor irritation or risk of infection.
  • Foot Soaking Advice: Warm salt water soaks may sometimes be suggested to help reduce inflammation (guidance should be sought from the podiatrist, especially if infection is suspected).
  • Oral Antibiotics (If Infected): If signs of infection are present, the podiatrist may recommend seeing a doctor for assessment and potential prescription of oral antibiotics.

Note: Early professional intervention often leads to quicker resolution and prevents complications.

Helping prevent ingrown toenails involves careful nail care and proper footwear:

• Correct Nail Trimming: Cut toenails straight across, not curved down at the sides. Avoid cutting them too short; the edge should be roughly level with the top of the toe. Use clean, appropriate nail clippers. Gently file any sharp corners if needed.
• Well-Fitting Footwear: Ensure shoes and socks are not too tight. Check shoe size frequently, as children’s feet grow fast. Choose shoes with a wide enough toe box to allow toes to move freely.
• Good Foot Hygiene: Keep feet clean and dry. Change socks daily, especially if feet get sweaty.
• Protect Feet: Encourage wearing appropriate footwear during sports to prevent trauma.
• Avoid Picking/Tearing Nails: Teach children not to tear or pick at their toenails.