Ingrown toenails

My son has had considerable pain with an ingrown toenail. Do you have any suggestions about what can be done for this?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Ingrown toenails are a common problem. They occur when the end or side of the nail begins to grow into the skin of the toe. This growth causes swelling at the site where the nail is intruding in the skin. Then infection may start shortly thereafter due the feet harboring bacteria that invade the site.

The best thing that can be done about ingrown toenails is to keep them from happening in the first place. However, even the most attended to nails can eventually become ingrown. Therefore, all one can do is to be as diligent as possible and hope for the best. Here are some tips to avoid ingrown nails in children and teenagers:

  1. Try to trim the nails no shorter than the edge of the toes. Most nails become ingrown at the edge of the end of the nail. Therefore, if the end remains close to the end of the toe, it will have little chance to become ingrown at that spot.
  2. Cut the nail straight across at the top but round the two corners to conform with the shape of the toe.
  3. If you notice the nail starting to become ingrown, try gently lifting the edge to trim it back.
  4. If there is pus present, consult your physician.

There is controversy as to whether poorly fitting shoes cause ingrown toenails or not. One thing seems certain; they can certainly aggravate an already ingrown nail making it worse. So, assuring good fitting shoes that do not allow for the big toes to be compressed is a smart idea.

Once the ingrown nail has been clearly established, it is usually difficult to rectify the situation without having your health care provider remove the ingrown portion of the toenail. One thing to try prior to this is to give the toe a good, long soak in warm water. This may soften up the skin and nail enough to allow it to be clipped back.

If it is determined that a portion of the nail must be removed, it may be done in the office using local anesthetic. Usually, some numbing medicine (lidocaine) is injected at the base of the toe. The nail is pulled out from under the skin and cut back enough to allow for the skin to heal before the toenail begins to grow back over that spot. Some physicians will clip the nail back to the nail bed to keep the nail from ever growing over that spot again. This is usually not necessary unless ingrown nails in that particular toe seem to be recurrent. Most of the time, removal of the portion of ingrown toenail is enough to relieve any infection that has taken hold. However, topical or oral antibiotics may be needed if the infection is more involved.

It is often difficult as a parent to be the toenail police. So, you have your work cut out for you. I would try the warm soaks to the foot both to relieve some of the pain but also to allow for possible cutting back of that nail. If this does not seem to relieve the problem, your son ought to seen by his physician to have that nail cut back. Having it cut back is definitely not the most fun in the world, but like the lion with thorn in his foot, the relief from this procedure can be immense.

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