As fewer children and teenagers wear sandals, doctors in China are reporting a sharp increase in ingrown toenails and nail fold infections (paronychia) among young people, with tight-fitting sports shoes identified as a major contributing factor.
The issue recently gained attention on Chinese social media after the topic “Why are fewer people wearing sandals?” began trending, with many users noting that most students now wear trainers and long trousers throughout the year, even during the hottest months.
Doctors at Hangzhou First People’s Hospital, affiliated with the Westlake University School of Medicine, said appointments for its paronychia clinic have been fully booked during the summer holidays. About 75% of patients are secondary school students, and almost all cases are linked to ingrown toenails.
One recent patient, a Form Three student identified only as Luo, endured severe pain in his big toe for more than six months while preparing for his high school entrance examination.
Despite recurring swelling and sharp pain while walking and running, he delayed treatment due to academic and sports commitments. He attempted to trim his toenail himself to ease the discomfort, but the condition worsened, causing persistent pain, swelling and discharge.
Doctors later diagnosed him with severe ingrown toenail-related paronychia. Instead of removing the nail, he underwent a conservative, non-surgical corrective treatment that gradually resolved the problem.
Deputy chief dermatologist Dr Zhong Jianbo said the clinic experiences a surge in similar cases every summer because many students ignore early symptoms during the school term and only seek medical attention during the holidays.
He explained that around 90% of paronychia cases are caused by ingrown toenails, while many parents mistakenly believe the condition can be treated simply by trimming the nail. Incorrect nail cutting can instead worsen the problem by disrupting normal nail growth.
According to Dr Zhong, the condition is caused by a combination of genetic factors and daily habits. Some children are born with toe or foot structures that make them more prone to ingrown nails.
However, lifestyle factors play an even greater role. Constantly wearing tight, narrow sports shoes, rarely exposing the feet to air, incorrect nail trimming and even sleeping with socks on can increase pressure on the toes and raise the risk of inflammation.
Doctors recommend choosing shoes with wide toe boxes, good ventilation and the correct fit, while encouraging children to wear open-toe sandals during hot weather whenever appropriate. Toenails should be trimmed straight across, leaving about one millimetre of the white edge intact instead of cutting the corners too short.
Parents are also advised to seek medical treatment promptly if children develop redness, swelling or pain around the toenails, rather than attempting home treatment, to prevent minor problems from developing into chronic conditions that affect walking and physical activity.
