Pediatric Ingrown Toenails: A Practical Treatment Algorithm

Ingrown toenails are common in the pediatric population, particularly among adolescents, and often present unique diagnostic and therapeutic challenges due to anatomical differences, compliance issues, and the impact of anesthesia. Despite a range of conservative and surgical options, there is no clear consensus on optimal management in children.

To propose a practical treatment algorithm for pediatric ingrown toenails, stratified by severity and age group, and grounded in current literature and the authors' clinical experience.

A comprehensive review of the literature was conducted focusing on conservative and surgical treatments for pediatric ingrown toenails. Treatment efficacy, recurrence rates, and age-related considerations were analyzed and synthesized into a clinical decision-making algorithm.

Conservative measures (taping, cotton pledgets, and nail bracing) demonstrated variable success, with recurrence rates ranging from 5% to 23%. Surgical approaches, such as hypertrophic tissue removal and chemical matricectomy, demonstrate greater long-term efficacy, particularly in moderate to severe cases. In children younger than 10 years, soft tissue-focused procedures are preferred to avoid permanent narrowing of the plate or nail distortion. Pain control, anesthesia strategy, and patient compliance significantly affect outcomes.

Management of pediatric ingrown toenails should be individualized based on severity and age. A thorough assessment of the child's foot structure and gait, which may contribute to recurrence or suboptimal outcomes, should be performed as an adjunct procedure.