CHILDREN usually make great patients. They are always curious about their feet and as long as you engage with them and make them feel relaxed, they will never be scared to come back for a follow-up visit.

This is a technique I have to employ, especially when dealing with a child who has ingrown toenails.

One of the most common conditions children come to my office for is an ingrown toenail or onychocryptosis. Of course, adults also get this problem but it tends to be more common in children and young adults due to their activities and lifestyle.

Sports, where the nails may be continually traumatised, like in football, ballet or kick-boxing, will make you more vulnerable to developing this condition. Footwear is another common issue. Poorly fitting shoes where the toes are bunched up may cause the nails to curl in.

Bad nail care, including cutting the nails too short, broken nails, and traumatised nails may cause ingrown toenails. In rare cases, predisposition such as abnormally shaped nail beds and nail deformities may also lead to this condition.

A true ingrown toenail is caused by actual penetration of the flesh by the nail. They can occur on any toe but is most commonly found on the big toe. The area will usually be painful and inflamed. There may also be pus, bleeding and overgrowth of skin and flesh around the toe. Diagnosis is made on clinical examination.

Treatment

The treatment of an ingrown toenail depends on its severity. A very mild case should be trimmed back by a podiatrist. Saltwater or Epsom salt footbaths are useful in reducing the chance of bacterial infection.

The problem is, as the nail grows back it will most likely ingrown again so the problem will need regular maintenance. Often, these patients will request or be advised to have nail surgery to get rid of the condition permanently.

If an ingrown nail is severe, the only option for treatment is surgical intervention. Under local anaesthetic, we remove the section of nail that is penetrating the flesh and kill the section of the nail bed that it is growing from. This means there should be no recurrence of the problem. This procedure is called a partial nail avulsion. It is very rare that the whole nail will need to be removed.

The aesthetic of the toe is very important as patients wish to wear open-toed shoes without feeling self-conscious. If an ingrown toenail is left untreated, infection and ulceration may occur.

The main points to observe to prevent ingrown toenails are:

• Trim your nails carefully, don’t leave sharp corners, and don’t cut them too short.

• Wear shoes that fit properly and do not squeeze the toes. This also applies to socks, tights and any other hosiery.

• If you have nails that curl into the sides, make sure they are cut by a podiatrist every three months.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974-6339), Kingston (978-8392), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.