The patient was a 2-year-old male who was brought in by his parents with complaint of irritability and pain on crawling and manifested by crying excessively. He was otherwise well with unremarkable past medical history and milestones were up to date. Examination revealed bilateral ingrown hallux nails which elicited tenderness on palpation. The infant underwent wedge excision and sharp matricectomy under general anaesthesia and was discharged the following day for regular wound dressings. He showed satisfactory recovery with subsequent reviews in the orthopaedic clinic revealing no early recurrence (Figure 1).

Ingrown toe nails are more common in older children and adults [1]. Much has been documented on the therapy but little on the pathoanatomy causing the condition. Baran et al has reported malalignment of the nail apparatus as an aetiology in their analysis of thirty patients. In this condition, the nail plate is deviated lateral to the longitudinal axis of the distal phalanx. Correction of this deformity, a congenital malalignment, is suggested to avert subsequent ingrowing and hemionychogryphosis which is one of its long term sequale [1]. Other theories of causation suggest improper cutting of nails in convex fashion and presence of paronychia as a result of sucking. More scientific early explanations including Lathrops theory suggest that it results from imbalance between the borders of the nail and cuticle due to incurving of the medial borders resulting from inherited architecture [2], [3]. Treatment includes conservative treatment for patients with mild lateral deviation of the nail plate with follow up podiatry examination to detect complications [4]. Surgical realignment is often required for individuals with either marked nail plate deviation or disabling sequelae.

Infantile ingrown toe nails are a rare condition but patients require adequate recognition and treatment to avert discomfort as a result of this morbidity.

Keywords: Hallux, Ingrown toe nails, Wedge excision

1. Baran R, Bureau H. Congenital malalignment of the big toe-nail as a cause of ingrowing toe-nail in infancy: Pathology and treatment (a study of thirty cases). Clin Exp Dermatol 1983 Nov;8(6):619–23.   [CrossRef]   [PubMed]    
2. Bailie FB, Evans DM. Ingrowing toenails in infancy. Br Med J 1978 Sep 9;2(6139):737–8.   [CrossRef]   [PubMed]    
3. Lathrop RG. Ingrowing toenails: Causes and treatment. Cutis 1977 Jul;20(1):119–22.   [PubMed]    
4. Grassbaugh JA, Mosca VS. Congenital ingrown toenail of the hallux. J Pediatr Orthop 2007 Dec;27(8):886–9.   [CrossRef]   [PubMed]