A ganglion is a benign soft tissue lump filled with jelly like fluid.
They usually arise from a joint or tendon sheath.
They vary in size and location on the foot which determines the symptoms.
They can disappear and then return.
They are commonly seen on the top of the foot.
What is the cause?
They may develop due to minor or repetitive trauma which causes inflammation in a joint or tendon sheath.
This results in inflammation and fluid production leading to accumulation and ganglion formation.
Ganglions in the foot are often associated with joint arthritis
A “one way valve” mechanism has been suggested with fluid coming out of a joint but not able to move back in.
What are the symptoms?
- Development of a lump which may cause rubbing and pressure in footwear
- Burning or nerve pain due to the ganglion pressing on nearby nerves. This is made worse in enclosed shoes.
- Dull ache due to pressure on nearby tissues
How is it diagnosed?
- Ultrasound can confirm it is a cystic ganglion and may show from where it is arising
- Xrays are useful if arthritis or spurs are suspected
What is the non-surgical treatment?
- Pain relief
- Shoe modification to reduce rubbing
- Off the shelf orthotics to support the arch if there is associated arthritis in the middle of the foot
- Injection to aspirate ( drain ) the ganglion and then inject steroid
- Successful in 40-50% of cases
When is surgery considered?
- Very large ganglions
- Multiloculated ganglions- these are like soap bubbles with multiple small pockets. These are difficult to aspirate and likely to be unsuccessful with aspiration
- Failure of aspiration and steroid
What is the surgical treatment?
Surgery involves excision of the ganglion and removal removing the “one way valve”.
Addressing tendon pathology or joint arthritis may be required.
What does the rehabilitation involve?
- Day surgery
- 7-10 days elevation of the foot to ensure wound healing
- A post op shoe or boot may be required
- Full weightbearing
- At 2 weeks begin a gradual return to normal activities
- By 6 weeks managing normal activities
- 3 months for swelling resolution
How long will I be off work?
At 2 weeks once the wound has healed you can return to normal duties at work provided you can wear your normal shoes.
In some cases swelling may restrict certain shoes and prolong the time off work.
When can I drive?
You cannot drive for 2 weeks.
What are the risks of the procedure?
General risks of surgery
- Wound healing problems
- Incomplete symptom resolution
- Blood clots to the leg
- Anaesthetic problems
Specific risks for ganglion excision
- Recurrence – 10% risk
- May require revision surgery
- Nerve injury- nerves often moved out of the way during surgery which can result in altered sensation and in rare cases persistent nerve pain.
If you have any questions please contact Mr Curry’s rooms on (03) 9928 6560