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These are usually more common in older children and adolescents.

Clinical features

The edge where the nail meets the big toe is red, swollen, tender, and may be draining pus. The corner of the nail pushes against the cuticle or pulp of the toe, causing pain.

Cause

The edge of the nail (usually the outer edge) grows downwards into the pulp of the toe, instead of forwards. This produces an open wound which allows bacteria to enter, resulting in infection. It may be due to tightly fitting shoes, but can also be caused by cutting the nail by rounding the corners, instead of cutting directly across in a straight line.

Treatment

It will be easier for your child if he wears open shoes or sandals until the toe is healed. If he must wear closed shoes, put some protective padding over the toe. After a bath, when the nail is soft, gently push up the corner of the nail away from the cuticle, and try to wedge a small piece of cotton wool soaked in antiseptic solution into the crevice. Strap this around the toe. This method is usually only effective if the infection has not yet set in.

If this treatment does not lead to improvement of the infection within several days, you should see your doctor who will discuss with you the options of antibiotic treatment, and/or surgical removal of part of the nail. This procedure is called a wedge resection. Under local anaesthetic a wedge of the nail and nailbed is cut out, to allow the nail to regrow normally. Daily dressings must be applied for a week after a wedge resection. Most cases of ingrowing toenail will respond to treatment without the need for surgery.

See your doctor if your child has a sore, red toe in which one corner of the nail is growing down into the skin.

Prevention

Cut toenails straight across rather than rounding the corners. Make sure your child wears shoes that fit properly.

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