Ganglion cyst on the bottom of foot from trauma in an accident

by Jennifer P
(Augusta Maine)

My husband was in an accident Dec of 09. He was driving a tractor trailer loaded with tree length wood. A women crossed the center line trying to avoid her when the truck rolled over. Trying to brake to stop on impact he took alot of force through his feet. He woke up face down in the passenger side of the truck.. They have surgically tryed to aspirate it twice with no luck. It is so large that he is having a hard time walking and his toes are turned up because he can not put pressure on it.We went to a specialist in Portland ME and he said he has never seen anything like that in his 30 years. They are in both feet but the right is much worse. Our foot MD In Augusta ME said his team will be able to take it out but cutting through the bone on the top of his foot to get to it. Evidently because of the nerves and muscle it is easier to go through the top vs the bottom. The MRI's show that it is growing into the surrounding muscle and tissue ect. This is 100% workers Comp and they agree after years of fighting finally.. MY husband is only 45 and I want him to have the best. I worry about the damage and complications after. I can not find anything on the internet relating to this type of surgery...None of the MD's doing this have ever done this before either...Though they "make" it sound easy.... I would love your imput or be able to get a resource of a MD who has done this... Thank you, Jennifer

I have copies of MRI's for review....

RESPONSE

Hi Jennifer,

I am sure in the information you have found regarding ganglion cysts, every source will mention the fact that there is a better than fair chance of recurrence. That is the risk you take when you consent to having a ganglion surgically removed.

Having said that, based on your narrative, the risk/reward ratio favors your husband because he is in so much pain walking on it and previously attempted drainage of the cyst has not been successful.

The key to reducing the recurrence of a ganglion cyst is being able to dissect down to the root or stalk of the cyst and being able to excise the stalk. Anything short of that is subject to failure.

I know the cyst is located on the bottom of the foot and of course the common mantra in foot surgery is to avoid incisions on the bottom of the foot because of the potential chance of residual scarring of the incision which in itself may be painful to walk on.

So apparently in the way it is growing your doctor feels it is better to go through the top of the foot and through bone.

I am assuming he is talking about one of the metatarsal bones which are the long bones behind the toes.

Since visibility and being able to dissect to the base of the ganglion are so paramount, I am not so sure that going through the top of the foot and disrupting bone(s) is the best approach since I do not know if that will give them the best exposure to the base of the cyst. Of course they have examined your husband and seen the MRI; I have not.

On the surface at least I would think going through the bottom of the foot and taking the special precautions necessary when making this type of incision (scarring), would seem to be the better approach for any growth occurring on the bottom of the foot.

The main issue with going through bone is that they are going to have to saw through the bone and using a power saw to cut bone increases the chances of bursting the cyst, which then makes it impossible to properly excise the cyst.

I can only be of limited help here for the reasons I have previously stated. If there is real doubt on your part about the anticipated surgery, then why not get a second opinion in a bigger medical market like Boston for example. Barring any medical issues your husband may have, this would typically be an outpatient procedure, so it could be done any where.

Marc Mitnick DPM
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