Ingrown Toenails

Early signs can be treated by wearing wider or open-toed footwear, using the correct nail-trimming technique and finding ways to allow the nail to grow out from beneath the skin. Daily warm water soaks with antiseptics and massage of the toe can be helpful. If infection occurs, antibiotics may be required. If it occurs repeatedly, your child may need surgery.

Your child cannot eat for 6 hours before the procedure. Your child can drink water for up to 2 hours before the operation. The Day Surgery Unit will instruct you the day before surgery to confirm fasting times. It is useful to bring your child’s favourite toy along on the day.

The anaesthetist will meet you and your child prior to the procedure.  They will discuss the anaesthetic with you and take you through to the operating theatre.  Your child will be anaesthetised using a face mask and then you will be taken to a waiting area.  Once your child is asleep a drip is inserted often in the hand or arm, but occasionally it may need to be sited in the leg.  

Ingrown toenails can be repaired under local (rather than general) anaesthetic. It is injected at the base of the toe to numb it. However, injection of the anaesthetic is painful. We can discuss if this would be appropriate for your child.

Local anaesthetic is injected at the base of the toe to numb it. On the side of the ingrown toenail, the nail, nailbed and nail matrix is excised 3mm from its edge. That part of the nail will not regrow so that repeated ingrown toenail is prevented. The toe is dressed with Vaseline-infused gauze, a 2cm wide bandage and a 4cm wide bandage. The whole operation takes around 20 minutes.

On completion of the operation your child will be taken to the recovery area. Children often initially appear distressed and a little confused upon waking up but will quickly settle down once you are with them and if offered a drink or something to eat. Full recovery usually takes about 2-3 hours after which you can go home.

In general, your child may eat a normal diet after surgery. Vomiting is common on the day of surgery. It is temporary, and usually due to the anaesthetic and pain-relief medications that are used. If vomiting occurs, start with clear liquids and add solids slowly for the first day.

The local anaesthetic will keep your child comfortable for 6-12 hours. Children’s paracetamol should be given for pain relief for 48 hours. After that use paracetamol only if needed. Some children need additional medication such as ibuprofen or celecoxib. Opiate (morphine-type) medications may also be required for a day or two. Paracetamol and ibuprofen can be given at the same time and work well together. Follow the dosages recommended on the packaging or by the anaesthetist. Never give more than has been prescribed.

• Activity: Keep the foot elevated for the first 24 hours. Your child can walk to the bathroom but other than that, should be seated with the foot up. After 24 hours, your child can walk around again but should take it slowly at first. Sport is best avoided for 4 weeks after surgery.
• School: Your children may return to day care or school when comfortable.
• Wound care: One day after surgery, the outer bandage can be removed. Five days after surgery, all of the dressings can be removed and replaced with a fabric bandaid. No creams or ointments are required. Your child should wear open-toed shoes for 4 weeks. It will take 6 weeks for the toe to look normal again.
• Bathing/showering: The toe should be soaked in a warm bath or showered daily, dried and dressed with a fabric bandaid.
• Stool softeners and laxatives: May be needed to help regular stooling after surgery, especially if opiates are needed for pain.

Call the doctor’s office if:

• You see any signs of infection: redness along the incision site, increased swelling, discharge
• Your child’s pain gets worse or is not relieved by pain killers
• There is bleeding from the incision that does not stop with elevation
• Your child has an abnormal temperature
• Vomiting continues on the day after surgery
• If you have any other concerns

I will review your child 4-6 weeks after the surgery to ensure healing of the wound. For patients from rural areas this may be deferred to your local General Practitioner or Paediatrician. Please ring soon after the operation to arrange a convenient time.

This is a common operation with a low complication rate. The vast majority of children who have this operation recover well and have no serious complications of surgery. However, complications can occur. Some of the recognised ones include:

Bleeding
If your child mobilises excessively and does not keep the foot elevated for the first 24 hours, bleeding from the wound is common. This will show as a blood-stained dressing. The bleeding will usually stop if the foot is elevated.

Infection
There is a 1-2% risk of wound infection after surgery. The wound will appear red, be tender to touch and may discharge pus or blood. If this occurs, a course of antibiotics may be required, and you should contact me or present to your General Practitioner or Local Hospital as soon as possible.

Recurrence
There is a 5-10% chance of recurrence. This can usually be addressed by modifying footwear and nail-cutting technique. Occasionally re-operation is required.

If you have any questions, please do not hesitate to contact us.

Ph: 02 8307 0977
Fax: 02 8088 7420
Email: info@drgideonsandler.com

Please refer to the following resource for more information:

1. Ingrown Toenails
   The Hospital for Sick Children