What Causes Ingrown Toenails In Kids And How To Treat It?

Onychocryptosis or ingrown toenails in kids is a common nail disorder where instead of growing outwards, the toenail begins to grow into the skin surrounding the nail.

Since this ingrowth cuts the skin, the affected area can get infected and inflamed, causing pain and discomfort severe enough to impact a child’s daily activities. However, if the condition is detected early, you can manage ingrown toenails at home. According to the National Institutes of Health (NIH), 20 out of 100 people who visit a doctor for foot problems have an ingrown toenail.

Read this post to know more about the causes of ingrown toenails and the various treatment options available to tackle the condition.

Signs Of An Ingrown Toenail

There are four stages of an ingrown nail, and the signs vary according to the stage (1).

Stage 1:

• Reddening and inflammation at the sides of the nail.
• Folded toenail that does not cross the nail bed.
• Pain when pressure is applied on the nail.

Stage 2:

• The folding of the nail exceeds 3mm from the nail bed.
• Pain and fluid on the sides of the nail
• Sensitivity around the toenail
• Serum drainage and infection might also occur.

Stage 3:

• Pain worsens with swelling of the skin around the nail.
• The nail folds further, and if not treated at this stage, can result in deformation of the nail.

Stage 4:

• The nail folds on both sides.
• The skin around the nail swells.
• Pain increases and causes difficulty in walking (1).

Possible Causes Of Ingrown Toenails In Children

Although anyone could develop this condition, ingrown toenails are commonly observed in teenagers. Some of the possible causes include:

1. Tight footwear: Wearing footwear that compresses the big toe towards the second toe can compress the nail and cause pressure between the nail and the lateral nail fold, possibly leading to ingrowth of that nail.

2. Improper trimming: Nails should be cut across, not rounded; also, they should not be trimmed too short, as this could expose the underneath soft tissue.

3. Nail infections: Fungal nail Infections can thicken the toenail, and this could break off the nail spicules (small spikes on the outer nail margin), which could result in an ingrown nail.
   

   Image: Shutterstock

4. Excessive sweating: This could be a cause of ingrown nails among teenagers. Excess sweating near the toenails could make the skin around the nail tender, making it easy for the nail to penetrate.

6. Abnormalities in nail formation: Any abnormalities in the formation of the nail bed, thick nail folds, etc., could also cause the nail to grow inwards.
7. Other causes: In some cases, ingrown nails are also found to be a result of intrauterine trauma, sports where kicking is involved, or genetics (2).

An anonymous blogger and a mother of two boys shares about her son’s encounter with an ingrown toenail, “After fifteen pounding hours of soccer camp last week, regularly playing soccer in the cul-de-sac and three games of 3v3 soccer on Monday night, little T.Puzzle has developed an infected, ingrown toenail. Now, I’ve never had one, so I can’t say for sure how painful it is. Even after our trip to the podiatrist and screams of fear and pain from him as the aggravating piece of toenail was cut away, he asked me if he could play soccer when we got home (ⅰ).’’

Home Remedies For An Ingrown Toenail In Children

If the ingrown toenail is in the initial stages, you can consider treating it at home. However, it must be noted that there is no scientific backing to prove their effectiveness.

1. Soak your child’s toes in lukewarm water mixed with Epsom salt for 15 minutes and pat the toe dry with a towel. Anecdotal evidence suggests that repeating this for several days can help reduce infection and inflammation of the infected area.
   

   Image: Shutterstock

2. You can also consider using an antibiotic ointment to reduce the infection.

3. If your child is diagnosed with fungal infections, you could also use an over-the-counter antifungal cream (3), but do check with your doctor before trying this.

If these home remedies do not clear the ingrown nail, take your child to the doctor.

When To See A Doctor

Take your child to the doctor or a podiatrist if:

• The toe is swollen and inflamed
• Pus pockets have formed near the nail or on the toe
• There is repeated ingrowth of the nail
• Your child has developed a fever
• The pain is unbearable

The doctor would conduct a physical examination of the nail and determine the depth of the ingrown nail. If your child’s toenail is infected, then your doctor might request an X-ray for proper evaluation.

The treatment will be based on the diagnosis.

Treatment Of Ingrown Toenails In Children

The treatment options for ingrown toenail may vary according to the stage of the ingrown nail. Mild swelling, with no pus or drainage, can be treated with nonsurgical treatments. However, if there is swelling with signs of infection, and the ingrown nail has grown deep into the skin, then you might need surgical removal of the nail.

Sometimes, your child’s doctor might also prescribe antibiotics or antifungals to cure bacterial or fungal nail infections in children.

Nonsurgical treatments for ingrown toenails

1. Taping

: In this method, an elastic strip of tape that is 15 to 25mm wide and 5cm long is used. One end of the tape is fixed to the side where the ingrown nail is formed, while the other end is pulled tight and taken around the toe and attached to the other end of the toe.

It is advised to change the tape daily until the ingrown tail is exposed, which usually takes up to four to eight weeks.

If there is sweat and pus, then it could interfere with the sticking of the tape, so you should clean the toe area before applying the tape. Your doctor might also prescribe antibiotics simultaneously to reduce the infection (4).

2. Packing: This method could be a little aggressive but is said to provide quick relief. So, it is best to estimate if your child could take the pain before trying it. In the packing method, a wisp of cotton is inserted in the corner of the nail fold to prevent it from further folding. You can soak the cotton in disinfectant and change it daily.

Once your child is no longer experiencing pain (and the nail is not digging into the skin anymore), you can stick the cotton in the same position with glue and leave it for a week.

3. Nail braces: These are mechanical devices that exert force and open up the curved nail. These nail braces come with two tips that should be placed on either edge of the ingrown nail. There is a plate in the center with a screw, as you start tightening the screw, the center plate exerts force in the nail, thus straightening it (5).

Image: IStock

These nonsurgical techniques are helpful during the first and second stages of ingrown toenails when there is less inflammation and no pus discharge. But, if your child’s ingrown nail is in the third or fourth stage, then your doctor might recommend surgical intervention.

Quick fact

It is recommended that parents should not try to dig the nail out or cut it off by themselves as it carries a high risk of infection (10).

Surgical procedures for ingrown toenail include

4. Avulsion of the entire nail:

Here, the entire nail bed is removed, giving time for the inflammation and the swelling to subside before the new nail grows back.

5. Wedge excision of a nail edge: In this method, soft tissue around the corner of the ingrown nail is removed, and the folded nail is straightened.

6. Chemical nail avulsion: Chemicals such as phenol sodium hydroxide are used to dissolve the bond between the nail and the nail tissue, and then the entire nail is removed.

7. Laser nail avulsion: Using a carbon dioxide laser, the ingrown nail is removed (6).

After the surgical procedure, post-operative care is necessary to speed up the recovery and healing process and includes:

• Resting and minimizing physical activity
• Follow the prescribe wound care
• Ask your child to wear open-toed and loose-fitting footwear post the surgery
• Clean the wound regularly and change the dressing. This might prevent the bandage or dressing from sticking to the wound.

According to a study performed on the surgical methods on children, wedge excision was found effective (7). However, Your child’s doctor will determine the type of surgical method after examining the toenail.

Can You Prevent An Ingrown Toenail?

Image: IStock

With simple precautions and care, you might be able to prevent ingrowth of toenails or their repeated occurrence. Here is how:

• Always cut your child’s toenails straight across, and never leave any sharp edges.
• Encourage them to wear loose-fitting footwear that gives the toes ample space to breathe and does not put pressure on them.
• Teach your children proper foot hygiene so that they do not catch infections.
• Whenever you notice any curvature in the nail, use a small strip of dental floss to elevate the tip and clip it off.
• If your child has excessive perspiration in the feet, then make sure they wash their socks and change them from time to time.

Quick fact

Tell your children to keep their feet clean and dry at all times to prevent ingrown nails (11).

Complications of Ingrown Toenails

When treated in time, an ingrown toenail may not cause any serious complications. However, if left untreated, it could lead to severe infection, which can spread to the bone. In children with diabetes, ingrown toenails can cause infections that do not heal quickly.

Infographic: A Step-By-Step Guide To Cutting A Child’s Nails

It is essential to know the right way to cut your child’s nails to reduce the chances of ingrown nails. We bring you this infographic on how to cut your child’s nails to prevent ingrown nails. Save it for future reference.

Illustration: Momjunction Design Team

Watch this concise 3D animation video that demonstrates effective home remedies for treating and removing an ingrown toenail. Obtain clear and easy-to-follow instructions for optimal home care and surgical extraction.

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Dr. Thulja TrikamjeeMD

Dr. Thulja Trikamjee is a specialist pediatrician and allergist at the University of Cape Town Lung Institute. She is associated with the World Allergy Organization (WAO) and the European Academy of Allergy and Clinical Immunology (EAACI).

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Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College.

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Ghazia ShahMSc, MA, BEd

Ghazia is a scientist-turned-writer with three years of research experience in Cancer Biology. She did her masters degree in Biotechnology at the University of Kashmir and bachelors in Education at the same university. Ghazia then delved deeper into the science of language with a masters in English.

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