You may think of ganglion cysts as things that sprout up on the hand or wrist, and they often are. However, they are known to crop up on the foot as well, and may cause some difficulties, especially if you’re into wearing shoes (which most of us are, really).
Ganglion cysts are bumps that occur under your skin and are filled with a rubbery or jelly-like substance. They tend to occur at the top of the foot or near the ankle, and may spring up as a result of some injury or trauma (such as dropping the collected works of William Shakespeare on your foot, or twisting or otherwise stressing out your foot), or may seem to have no cause whatsoever (or at least, no cause that you can recall). They tend to sprout because the tissue (called a sheath) that covers a joint or tendon becomes weak or damaged and leaks fluid.
The most obvious (and sometimes only) symptom of a ganglion cyst is the cyst itself: a lump or bump that resides under the skin, often on the top of the foot or near the ankle. The cyst may also have other accompanying symptoms, such as tingling or burning sensations in the tops of the toes, particularly when the cyst is bumped or tapped (this occurs when the cyst presses against a nerve). You may also experience a dull ache if the cyst is putting pressure on a tendon or joint in the foot. Depending on where it’s located, the cyst may also make it difficult to wear shoes, which may make the skin around the cyst irritated or raw.
Because they’re fairly common soft tissue problems, your podiatrist has likely seen a ganglion cyst before. However, in order to make a good diagnosis (like a good podiatrist should), he or she will likely examine your foot visually, and may shine a light into the cyst to evaluate it. Your podiatrist may press or move the cyst about a little under your skin. It should have a nice, distinct outline, and will likely seem connected to the deeper tissue layers, although it should move freely under the skin. In order to be sure the lump is benign, your podiatrist may take a sample of the fluid inside the cyst. Occasionally, he or she may use X-rays or other imaging methods (such as an MRI or CT scan) in order to get a good look at the cyst, and to check for possible bone spurs inside of it.
Treating cysts can be tricky, since they do tend to come back (kind of like that tin of peanut brittle you’ve regifted four times). However, they also may go away on their own. If the cyst doesn’t interfere with your shoe wearing or other activities, your podiatrist may decide that the best treatment is to monitor it for a week or two to see if it shows any sign of diminishing or growing larger. You may also be able to switch your shoe- wearing habits or use padding to make your feet more comfortable while you wait for the cyst to go away.
If a more proactive treatment method seems suitable, your podiatrist may try draining the cyst with a needle (called “aspiration” or “needling”) and then injecting a steroid into the area to prevent further swelling. Afterward, your podiatrist may wrap a bandage snugly around the area to try to prevent the reformation of the cyst. This treatment may work sometimes, but in a little over two thirds of cases, the cyst tends to come back.
If more conservative treatments fail, your podiatrist may suggest removing the cyst surgically. This usually involves cutting the mass from the soft tissues that surround it (taking care to avoid nerves that may be nearby), finding and disconnecting the “tail” that connects the cyst with the tissue sheath from which it sprung, and stitching the whole thing back up. Recovery may involve wearing a cast or splint to reduce movement (which may cause the cyst to form again) and generally takes several weeks, depending on how much cutting was needed to remove the cyst. Surgery has a much better success rate than other treatment methods, although cysts, the annoying things that they are, may still come back, even after surgical excision. In that case, it’s back to the drawing board.