Ingrown Toenails in Children

What is an ingrown toenail?

An ingrown toenail occurs when the nail grows down and cuts into the skin of the toe which leads to the toe becoming red, swollen, painful and inflamed. This is most commonly found in the big toe and either one or both sides can be affected.

What causes an ingrown toenail?

• poorly fitting shoes
• improper nail cutting
• nail injuries

Prevention / treatment of ingrown toenails

• correctly fitted shoes and changing of socks daily and after sports
• correct cutting of nails – nails should be cut straight across not rounded; nails should also not be cut too short
• twice daily washing with soap and water, then thorough drying of feet, using a foot moisturiser if skin is dry

Why treat an ingrown toenail?

If left untreated, the toe can become infected and the infection can then spread to the rest of the toe causing pain when walking, discharge of pus and an unpleasant smell. Treatment does not always involve an operation; in some cases, good foot care (as outlined above) may be sufficient.

The operation

The operation performed will depend on how ingrown the nail is, whether one side is affected or both and whether infection is present. The surgeon will discuss the most appropriate operation for your child in clinic. This may include:

• partial nail avulsion (also called wedge resection) – removing part of the toenail
• total nail avulsion (also called Zadek’s procedure) - removing the whole toenail and nail bed

During a wedge resection, a medication called ‘phenol’ may be applied which destroys the nailbed. Your surgeon will discuss this with you.

During Zadek’s procedure, the nail bed is also removed and therefore the nail will never grow back. After a wedge resection the nail will be smaller but the nail bed will remain.

Before admission to hospital

Preoperative assessment:

You will be asked to complete a ‘health screening questionnaire’ when your child is added to the waiting list; this will usually be completed over the telephone.

Purchasing suitable painkillers:

It is important that you purchase some children’s pain killers such as Paracetamol (e.g. Calpol) and Ibuprofen before admission to hospital so that you have these available at home after discharge.

If your child becomes unwell:

If your child has a cold, cough or illness such as chicken pox the operation will

need to be postponed to avoid complications. Please telephone us. (The telephone number is at the end of this leaflet).

Starvation Plan:

Your child will not be able to eat and drink before the operation. Specific advice

about this will be given in the letter of confirmation.

Clothing:

Your child will return from the operation with a dressing over their toe; ensure you bring appropriate open toe footwear for use on the journey home.

After the operation

• Once fully awake, your child will be able to have a drink and something to eat.
• Painkillers will be given as needed, usually Paracetamol and/or Ibuprofen.
• Unless your child has an underling condition which requires monitoring after anaesthesia, he/she will go home on the same day as the operation.
• If your child needs to stay in hospital overnight, we will provide a bed for a parent/carer to stay too if required.
• After the operation there may be some swelling; this may take a few weeks to completely disappear.
• Your child will have a dressing on the affected toe. Instructions will be given as to when and who (yourself or a practice nurse at your GP surgery) will remove the dressing.

What are the complications of a nail avulsion?

The most common complications from this operation are recurrence of the ingrowing toenail. Less common complications include infection and bleeding.

Discharge advice

• Your child’s wound should be kept clean and dry; avoid baths for five days after the operation.
• Children may find some physical activities uncomfortable such as PE at school and bicycle riding, so these should be avoided for one to two weeks.
• Paracetamol (Calpol) and/or Ibuprofen (Brufen) should be given to prevent pain. Please follow the instructions on the bottle.
• You will be informed at discharge when your child’s dressing needs to be removed. Often this can be undertaken at home and if not, an appointment should be booked with your practice nurse at your GP surgery.
• Occasionally a wound can become infected. If your child’s wound becomes red or there is increased tenderness, contact your GP.

Follow up

There is usually no required for follow up at the hospital. Please see your practice nurse or GP if concerns arise.

Contacts

Nurse specialist (Monday to Friday 08:00 to 18:00): 01223 586973

The ward / clinic you were on.