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Foot & Ankle Surgery

Ganglion of the Foot or Ankle

A ganglion is perhaps the most common soft tissue growth found in the foot or ankle.  Ganglions are not cancerous.

The growth is a gel-filled cyst that typically forms off of a joint lining or tendon sheath.  The location is typically on the top of the forefoot or midfoot, but can also occur around the ankle.  A similar condition can occur on the top of the toe at the last toe joint just behind the toenail – these are called mucinous cysts.

The cause of the ganglion is usually simple wear and tear on a particular tendon or joint.  In the case of a mucinous cyst, there may be some degenerative joint disease (arthritis) in the last joint of the involved toe.

Ganglions are usually not painful, unless:

They a big enough to be irritated by shoe pressure

They are pressing against a nearby nerve

The joint or tendon of origin of the ganglion (or mucinous cyst) is inflamed (arthritis or tendonitis)

The diagnosis of a ganglion (or mucinous cyst) can typically be made by examination only – how it feels on exam and where it is located.  While radiographs (x-rays) are occasionally ordered, they typically are not need to make a diagnosis.  Instead, radiographs are occasionally used to check the bones and joints for other possibilities.  MRI exams are used even more rarely.  The MRI might be used for surgical planning with deeper ganglions or to check for other possibilities if the diagnosis is in question.

Ganglions (and mucinous cysts) can enlarge and regress spontaneously.  In a few cases, they can resolve on their own.

Self care for a ganglion or mucinous cyst:

  • Avoid shoe pressure irritation of the mass.
    • Use padding to take pressure off the mass.  Felt “horse-shoe” padding can be purchased.
    • Re-lace your shoes to avoid pressure on the mass, if the mass lies under an eyelet of your shoe.
    • Make sure the toe box of your shoe is roomy enough.
  • Use ice on the painful area for 15-20 minutes, at least 2-3 times per day – especially in the evening.  Fill a styrofoam or paper cup with water and freeze it. Peel back the leading edge of the cup before application. Massage the affected area for 5-10 minutes.  CAUTION: AVOID USING ICE WITH CIRCULATION OR SENSATION PROBLEMS.
  • Compress the area.  You may wrap the affected area with Coflex (a self-adherent elastic bandage material thinner than an ace wrap).  Coflex can be purchased.
  • Do not try to puncture the cyst and drain it yourself, as there is a risk of creating a serious infection.

 

Doctor-assisted care for a ganglion or mucinous cyst:

Aspiration / injection

The doctor can draw off the gel fluid from the cyst with a syringe and needle (aspiration).  This is typically combined with injecting the mass with a small amount of cortisone.  In some cases, an alternative injection material, called a sclerosing agent, might be discussed.   The success rate with this type of intervention is perhaps 50%.  In some cases, the can be a recurrence of the within 2 weeks – 6 months.

After this type of intervention, it is helpful to keep the area compressed with Coflex for 1-2 weeks.  Coflex can be purchased.

The risks of cortisone injections for ganglion include, but are not limited to: increased pain for 24-72 hours following the injection, skin depigmentation at the injection site, weakening of adjacent cartilage, ligament, or tendon structures with potential rupture, and infection.  Systemic side effects of this type of injection are extremely rare.

Surgical excision 

The surgery involves removal of the mass and a small amount of the tissue of origin.  In cases of a mucinous cyst, a portion of the associated joint may be removed (called an arthroplasty).  Typically the mass is sent to the pathology department for verification of the diagnosis.

The anesthesia administered is typically either, local anesthesia alone, or local anesthesia with intravenous sedation by an anesthetist.  The surgery is performed on an outpatient basis.

You are allowed to walk on your foot after surgery in a post-operative shoe.  Although you can walk on your foot after surgery, complete rest and elevation is encouraged for the first two weeks following surgery.

Sutures are typically removed at two weeks after the surgery, at which time, you are typically allowed to resume bathing and resume your regular footwear – as tolerated.  Recovery (resolution of swelling, tenderness, and stiffness) is complete within 2-4 months most individuals.

The surgery is typically a success, but the recurrence rate is about 10%.  Risks include, but are not limited to: recurrence, infection, arthritis, tendonitis, tendon injury, nerve entrapment, prolonged recovery, delayed incision healing, painful or unsightly scar, incomplete relief of pain, no relief of pain, worsened pain, recurrent pain, impaired function, and loss of toes or foot.