Why Does My Son’s Ingrown Toenail Keep Coming Back?
Recently, we had a mum bring her 14-year-old son in for the third time for the same problem: an ingrown toenail on the inside of his right big toe. So, you can guess what her biggest questions and frustrations were:
“Why does the ingrown nail keep coming back?
How can we stop it so I don’t have to keep bringing him back?”
Unfortunately, what mum didn’t realise was that it was the way her son was ‘trimming’ (read: picking) his toenails that had caused the nail to become ingrown all three times - and by this stage, he knew it, too.
1. The biggest cause of repeated ingrown toenails in kids is their cutting technique - or lack thereof
When we see one ingrown toenail after another in kids, the first thing we ask is how they’re trimming their toenails. Most often, they’ll tell us that they’re picking or pulling at the nails. When we do this and the nail is ripped off, we often don’t see the very end of the nail as we pull it off, and so we miss that a small spike or piece of nail is left behind - instead of being cut and filed in a clean and smooth line.
Our toenails are always growing - so the spike will keep growing with the nail. Except that the next day, we may squeeze our feet into our shoes, which pushes the skin surrounding the nail into the nail - and the spike. Before we know it, the spike has pierced the skin, and we have ourselves an ingrown toenail.
2. We can’t fix what we can’t see
For a number of people we see, especially if it’s their first ingrown toenail, they’ve already tried to cut down the side of the nail to try relieving the pain themselves. For some, this does give some temporary relief - until the nail keeps growing. But, for the majority, the problem lies in the fact that you can’t fix what you can’t see - and in most cases, you won’t be able to see that small, sharp nail spike without having the right podiatric tools, instruments, and experience to be able to feel it out.
3. The cost adds up
We have two main options when it comes to ingrown toenails:
- Remove the nail spicule as a one-off (conservative care)
- Remove the nail spicule and a small section of the nail, and apply a chemical that stops the small (problematic) edge of the nail from ever growing back (minor nail surgery)
Either option will help relieve the pain and symptoms at the time, but the two main differences are that (1) the one-off removal doesn’t guarantee that the ingrown nail won’t recur; and (2) the permanent removal is more expensive, because it’s a minor ‘surgical’ procedure that involves anaesthetic and dressings.
Don’t worry - the procedure is done in your regular treatment chair regardless of which one you have, but the surgical procedure is more technical, time-intensive, we need to take additional safety precautions as it’s more invasive.
What many people don’t realise when choosing option #1, is that even though the cost is lower, after you’ve been back to us to treat the same problem multiple times, the cost adds up to be the same - except that you still don’t have a permanent solution and you’ve spent much more time at appointments, and listening to your child complain about their toenail.
This third time, we did perform the second treatment option, called a partial nail avulsion, to permanently correct the problem. Mr. 14 played on his phone throughout the procedure, and mum “wished I’d just gotten it done the first time around”.
Once the nail heals, it looks very normal, here’s an example of before/after photos we took from another patient: