A ganglion is a firm, rubbery mass that can occur anywhere on the foot. The most common area of involvement is in front of the ankle or on the outside of the ankle. A regular characteristic of a ganglion is that it would enlarge and then shrink in size.

Ganglions tend to arise spontaneously from a weakness in the soft tissue covering of a joint or tendon sheath. Ballooning out of the tissue occurs, and it fills with a thick sticky, clear, thick, jelly-like (mucoid) fluid. In many instances, ganglions are not painful until they reach a size that causes irritation from shoe pressure. On occasion they will compress a nearby skin nerve and cause tingling into the top of the toes. Tapping on the ganglion will often result in this same tingling sensation into the toes.

What causes a Ganglion?

The cause is not known although increased activity or trauma may contribute. Another perspective is that a ganglion may form because of a flaw in the joint capsule or tendon sheath that permits the joint tissue to protrude outwards.

Will it get worse?

Generally, ganglions tend to get bigger with time but are not necessarily painful.

Symptoms

• Swelling (it may alter in size or could fluctuate)

• Pain

• Discomfort in shoes

• Difficulty in walking

Diagnosis

The diagnosis is made by taking a thorough history of the clinical course of the condition. Physical exam will reveal a firm, rubbery mass that appears encapsulated and have a discreet boundary. They tend to be firmly adhered to the underlying deep tissues under the skin. An x-ray will reveal the shadow of the soft tissue swelling. On occasion there may be a small bone spur in the area of the ganglion. Spurring indicates a level of arthritis in the joint near the ganglion. A MRI or CT scan will clearly define the mass, but is not necessary to make the diagnosis. If a ganglion is suspected within the deep structures of the foot, a MRI would be useful to identify the size and extent of the mass.

What will a doctor/podiatrist do?

• Monitor the ganglion

• Consider draining the ganglion

• Advise on surgery

Draining the fluid from the ganglion can reduce the prominence. However, because the expanded tissue is still present and connected to the capsule / sheath, it is likely that the ganglion will fill with fluid again.

What will happen if I leave this alone?

It may remain static or get larger, causing discomfort.

Treatment

Small ganglions that are not symptomatic or painful usually require no treatment. A non-surgical form of treatment is termed “needling”. This involves numbing the area with a local anaesthetic. Once the area is numb, a large gauge needle is placed into the ganglion. Aspiration (removal) of ganglion fluid is then attempted; however, because of the thickness of the fluid, it is often difficult to draw it out. The ganglion is then punctured with the needle several times. A steroid medication may then be placed into the mass and a snug bandage applied. This treatment has a 70% recurrence rate. The ultimate treatment for a ganglion is surgical excision.

How does surgery correct the deformity?

The ganglion needs to be carefully dissected from the surrounding soft tissue, and the connecting tunnel (stalk) identified and removed. Care needs to be taken not to damage any of the normal tissues.

Are there a lot of complications?

There are risks and complications with all operations and these should be discussed in detail with your specialist. A thorough examination of your foot and general health is important so that these complications can be minimised.

Although every effort is made to reduce complications, these can occur. In addition to the general complications that can occur with foot surgery, there are some specific risks associated with this surgery:

• Damage can be done to adjacent soft tissues (nerve, blood vessel, and tendons).

• You may get discomfort in other parts of your foot during the recovery period. This generally settles.

• There is always a possibility that the ganglion may return.

When will I be able to walk again and wear shoes?

In the majority of cases, you will be able to walk with the aid of crutches within 2-4 days, but you will remain somewhat limited for the first 2 weeks.

Recovery is usually quite quick, although it does depend on the size and location. If you have a ganglion on the sole of the foot or require a cast, you may not be able to walk on the foot for 3 weeks.

Your feet mirror your general health . . . cherish them!