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Ganglion Cyst

What Is a Ganglion Cyst?

A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means “knot” and is used to describe the knot-like mass or lump that forms below the surface of the skin.

Ganglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot – usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger, and may even disappear completely, only to return later.

Causes

Although the exact cause of ganglion cysts is unknown, they may arise from trauma – whether a single event or repetitive micro-trauma.

Symptoms

A ganglion cyst is associated with one or more of the following symptoms:

A noticeable lump – often this is the only symptom experienced

Tingling or burning, if the cyst is touching a nerve

Dull pain or ache – which may indicate the cyst is pressing against a tendon or joint. Difficulty wearing shoes due to irritation between the lump and the shoe

Diagnosis

To diagnose a ganglion cyst, the foot and ankle surgeon will perform a thorough examination of the foot. The lump will be visually apparent and, when pressed in a certain way, it should move freely underneath the skin. Sometimes the surgeon will shine a light through the cyst or remove a small amount of fluid from the cyst for evaluation. Your doctor may take an x-ray, and in some cases additional imaging studies may be ordered.

Non-Surgical Treatment

There are various options for treating a ganglion cyst on the foot:

Monitoring, but no treatment. If the cyst causes no pain and does not interfere with walking, the surgeon may decide it is best to carefully watch the cyst over a period of time.

Shoe modifications. Wearing shoes that do not rub the cyst or cause irritation may be advised. In addition, placing a pad inside the shoe may help reduce pressure against the cyst.

Aspiration and injection. This technique involves draining the fluid and then injecting a steroid medication into the mass. More than one session may be needed. Although this approach is successful in some cases, in many others the cyst returns.

When is Surgery Needed?

When other treatment options fail or are not appropriate, the cyst may need to be surgically removed. While the recurrence rate associated with surgery is much lower than that experienced with aspiration and injection therapy, there are nevertheless cases in which the ganglion cyst returns.

Ganglion cysts of the foot are benign, fluid-filled, soft-tissue masses that attach to tendon sheaths or joint capsules. The fluid tends to be thick, sticky, clear, and jelly-like. It is similar to synovial fluid, which lubricates the joints and tendons.

Most ganglion cysts appear on the wrist, but a significant number also occur in the foot, usually the top. The term ganglion means “knot,” which describes these irregular, multi-walled, mobile masses underneath the skin.

The most distinguishing feature of ganglions is their location around joints and tendons, although in rare cases they may found in bones or tendons.

The development of ganglion cysts may be rapid, or it may occur over many years.

They may shrink, enlarge, or even disappear and reappear. The majority of them disappear within two years. Although not generally painful themselves, ganglion cysts may cause symptoms due to their proximity to other structures. They can be found in any age group, and women are three times more likely than men to suffer from them.

Symptoms of a Ganglion Cyst on the Foot

The first symptom will be a lump on the foot. The lump is most commonly on the top of the foot, but it can be located near any joint or tendon, and it may vary in size.

Other symptoms may include:

Burning sensation (indicating the cyst is pressing against a nerve)

Pain (indicating the cyst is pressing on a nerve, joint, or tendon)

Limitation of motion (the cyst is pressing against a joint or tendon)

Skin irritation above the ganglion

Wearing shoes is painful due to the size of the cyst. Ganglion cysts are often painless and harmless, but as with any growth, you should have yours checked by your physician to rule out more serious issues.

What Causes Ganglion Cysts?

The exact cause of ganglion cysts is still unknown. The most prevalent theory involves trauma to the affected area, which may result from a single, direct incident or from chronic overuse. This results in inflammation of the associated connective tissues, which then degenerate or liquefy into “ganglionic jelly.” The remaining connective tissue forms the cystic capsule to enclose this fluid, thus creating the ganglion cyst.

Diagnosing a Ganglion Cyst on the Foot

Your doctor will ask about the history of the lump and perform a physical exam. The diagnosis may be based on appearance and feel. Sometimes a light shone through the lump can indicate whether the fluid is more liquid or solid, which further helps with the diagnosis. Additional testing may include analysis of the ganglionic fluid, x-rays and/or ultrasound.

The x-rays and ultrasound may show damage to surrounding structures (tendons, joints, bones, etc.); furthermore, the ultrasound is often diagnostic for ganglions. Should these tests be inconclusive, an MRI may be ordered. Once diagnosed, a treatment plan can be created.

Ganglion Cyst Foot Treatment

Treatment of the ganglion is dependent on the symptoms you are experiencing. If you are not in pain and the cyst is small, your doctor may prefer merely to monitor the situation. If there is pain, limitation of motion, or difficulty wearing shoes, however, some treatment may be necessary.

The simplest form of treatment is aspiration (or drainage) of the ganglion. Usually the area is numbed with local anesthetic, after which a large-gauge needle is introduced to remove the fluid. Often a corticosteroid, and sometimes

Hyalauroindase (a dissolving enzyme), is injected after the drainage to reduce the likelihood of recurrence. While aspiration is immediately curative, ganglion cysts do have a high rate of recurrence.

If the aspiration technique doesn’t work, surgery may be performed to excise the cyst. Depending on the size and location, this procedure may be done in the office or the hospital. It requires local anesthesia, sutures, bandaging, and possibly splinting, again depending on the size and location of the cyst. Post-operatively, rest and reduction of activities may be required. The benefit of the excision procedure is that it has a significantly higher success rate in preventing recurrence, although complications such as joint stiffness, scar formation, and infection are possible.

Home remedies seem to have little effect on ganglion cysts. Heat may reduce the size of the cyst, but only temporarily. Many home remedies can cause more harm than good, such as “Bible Therapy,” which involves taking a heavy object such as a book and smashing the cyst. Needless to say, such therapy can create complications.

Risks of Ganglion Cysts

Here are some risks of ganglion cysts or their treatments:

Infection

Reaction to corticosteroid

Recurrence

Excision: 5 to 15 percent of the time

Aspiration: 50 to 70 percent of the time

Scar at excision site

Reduction of range of motion

Damage to vessels or nerves after injection or excision

What is a Ganglion cyst of the foot?

This is a tumor which is benign, swelling or lump that technically can occurs anyplace on the body but are usually most prevailing on the hands, and is also very common on the feet. The term comes from the word ‘ganglion’ translated to ‘knot’ recounting the lump of cells which is knotted and grow beneath the surface of the skin of the foot.

A ganglion cyst is basically a sac which is filled with fluid that arises from either a joint (space between two bones) or from a tendon (structure which attaches a muscle into a bone). Inside this cyst is a substance which is sticky, thick, clear, jellylike as well as colorless. Contingent on the size, cysts can feel spongy or firm.

Ganglion cysts do vary in size, may get larger or smaller as well as may even vanish totally, only to return later. They can make wearing shoes very difficult.

Ganglion Cyst Foot Symptoms

A ganglion cyst is normally associated with one or more of the following symptoms:

A noticeable lump – often this is the only symptom which is experienced.

It is typically soft, somewhere from 1 cm to 3 cm in width as well as it will not move.

Swelling can appear slowly or develop suddenly, can reduce in size, and can even disappear altogether, just to return at a later time.

A majority of these cysts do cause some amount of pain, frequently following an repetitive or acute trauma, but as many as 35% have no symptoms, except for cosmetic appearance.

The pain is usually nonstop, aching as well as made worse by joint motion.

When the cyst is linked to a tendon, you can feel a sensation of weakness in the affected foot.

If the cyst is touching a nerve there will be a sensation of tingling or burning.

There can be difficulty wearing shoes because of irritation between the lump and the shoe.

Ganglion Cyst Foot Treatment

Whether or not you have any symptoms, medical evaluation of a ganglion cyst is a positive option. The primary care physician can make certain that it is indeed a ganglion cyst, and help you choose the best plan of action.

A ganglion cyst will not need any emergency treatment unless there is substantial trauma. A check by either the primary physician or a doctor who specializes in treating bones and joints known as an orthopedist ought to be sufficient.

A careful examination by the doctor is usually all that is required in order to make a diagnosis of a ganglion cyst.

The physician can get additional verification by taking a syringe and drawing out a portion of the fluid inside the cyst – needle aspiration – or by using an ultrasound. An ultrasound is a method of imaging involving the use of sound waves, and this can aid in evaluating the bump to seeing it is fluid-filled or solid.

Ultrasound can identify as well if there is a blood vessel or artery involvement within the lump. Benefits of ultrasound exposure are that it is widely accessible, it is fast, it is low-cost as well as it is a reliable method of imaging.

X-rays with ganglion diagnosis is not needed.

Your primary care physician may refer you to a surgeon if the bump is solid or if the bump involves an artery.

Magnetic resonance imaging or MRI can be use and is suitable for ganglions. One drawback to this diagnostic tool is that it is quite expensive.

Facts on Medical treatment of cysts include:

Most ganglion cysts (38%-58%) can go away without any treatment at all.

Various treatments have been proposed over the years. One is advising those with cysts that have no symptoms not to worry, using a needle to take out the cyst’s contents (aspiration), or surgery.

The treatment rest on the severity of the ganglion cysts to the foot. If the cyst does not hurt and does not interfere with the patient’s ability to walk or perform other regular activities with the foot, the physician may ask the patient to keep checking back until the cyst disappears.

Patients that are susceptible to ganglion cysts can be asked to wear shoes which are prescribed by the doctor, or at least pads for anti-pressure that can line regular shoes.

If the cyst perseveres, an aspiration may be implemented. The cyst is drained of the fluid inside and a medication consisting of a steroid is injected back into the cyst in order to help reduce inflammation and prevent subsequent refilling.

Currently, an additional substance known as hyaluronidase was presented as a ‘partner’ to the steroids. Hyaluronidase is an enzyme which is already in wide use in the management of some kinds of arthritis. Investigation has established that when joined with steroids, it increased the cure rate of ganglion cysts 57% to 89%. The cyst will heal with only one visit, but in numerous cases, the cysts did reappear.

If all treatment options fail, surgery can be used to remove the cyst. When cysts are detached by surgery, they rarely recur, but there are cases where they do.

Ganglion Cyst Foot Surgery

If an individual is suffering from problems using the foot or considerable pain or if the treatment options have not worked, the physician may make a referral to a surgeon to eliminate the cyst.

With the majority of the cases, the surgery is performed as an outpatient meaning the individual will go home on the same day after the surgery.

During Surgery:

Normally, a local or regional numbing agent is used to deaden any pain in the area to be operated on.

The specialist will then make a cut into the skin over the cyst. The incision size is determined by the cyst size.

The cyst as well as the stalk which fastens the cyst to the tendon or joint, together with a portion of the tissue in the surrounding area will be removed.

The surgeon then stitches and bandages the area.

After Surgery:

The limb operated on needs to be kept in an elevated position for at least 48 hours in order to help to reduce swelling. There may be some discomfort, tenderness and swelling for 2 to 6 weeks.

The physician will endorse analgesics, for instance acetaminophen (Tylenol) or non-steroidal drugs for inflammation or NSAIDs, for instance ibuprofen (Motrin, Advil) or naproxen (Anprosyn, Aleve) for relief of pain.

Change bandages as instructed.

Dependent on the cyst location, the doctor may mention in the meantime using a brace or a splint to help with minimizing post-operative pain. But, in many cases, using the limb as quickly after surgery is advised.

As the area heals, it is important to monitor for symptoms of infection, such as discharge, redness, or swelling

Unfortunately, there is no assurance that a ganglion cyst will not return, even with surgery. And also, as with every type of surgery, there are some hazards to be thought about. Although rare, injury to tendons, blood vessels or nerves may occur. These can cause weakness, restricted motion, or numbness.