It essentially is a benign tumor, or lump that can technically occur anywhere on the body but are most prevalent on the hands, but also very common on the feet. It is basically a sac filled with fluid that arises from either a joint (space between two bones) or from a tendon (structure that attaches a muscle into bone). There is a theory that it is nothing more than the result of herniation of a tendon, or synovium which makes up a joint.
A dorsal ganglion cyst which occurs on top of the foot is the most common location in the foot.
These cysts are also known as bible cysts or sometimes Gideon cysts because years ago the recommended treatment was to smash the growth with a book in order to break it up and even the poorest of families owned a bible.
The growth is more common in women with 70 percent of ganglions occurring in people between 20-40 years of age. On rare occasions they have been known to occur in children younger than 10 years of age. About 4% of them occur on the feet.
Ganglions usually occur due to a weakness in the covering of a tendon or joint space. Everyday trauma such as motion of a tendon over a bony prominence or pressure from a shoe on a tendon or joint can cause a weakness in the covering with a subsequent swelling of liquid into a confined space thus causing the “lump” to form.
The growth may be moderately firm or soft, depending on the fluid content or whether the outer part of the sac bears calcification. The fluid itself is a colorless gel similar in appearance to k-y jelly. Pressure on the ganglion cyst itself rarely causes pain; any pain is from pressure to adjacent sites.
A diagnosis of a ganglion is usually made on clinical examination based on location of the growth and relevant history. An x-ray may be taken to rule out a bone spur as the aggravating factor behind the formation of the cyst. If there is any question as to the diagnosis an MRI or diagnostic ultrasound may be performed.
The picture below is that of a diagnostic ultrasound. The area in between the two blue arrows represents the tendon. Above the tendon is a black oval area (red arrow), which represents the ganglion. Since the cyst is made up of liquid it creates the least amount of “bounce” from the ultrasound waves and results in a black mass.
Once a mass is diagnosed as a ganglion cyst it may be left alone if it is not painful or causing problems with shoes. As stated previously sometimes these growths will spontaneously disappear. However, if there is any pain associated with the growth or the patient does not like the unsightly appearance, drainage is the simplest approach.
A large bore needle is inserted into the growth with local anesthesia and perhaps cortisone in an effort to burst and drain the growth. If the content of the ganglion is not too viscous this can be easily done; sometimes however, it is not possible to drain the cyst.
Once drained, a compression dressing is worn over the site for a period of time in an attempt to reduce recurrence. Having said that, there is a 70 percent recurrence rate with this form of treatment, but the upside is that the procedure can be repeated again since it is a relatively painless procedure.
If the growth is a source of irritation for the patient then surgical excision is necessary keeping in mind that there is even a recurrence rate with this form of treatment. The problem with surgical excision is that sometimes the cyst will burst while attempting to remove it. Although the sac will still be present it becomes difficult to determine where the “stalk” or origin of the cyst came from. It is important to remove this stalk in an effort to prevent recurrence.
Aside from the possibility of recurrence, surgical complications are limited with stiffness in the surgical area being a primary complaint.
Below is a picture of a ganglion cyst that has just been identified prior to removal. It is the round glistening lesion located in between the blue arrows. The next picture is that of the cyst after its removal. In this instance the cyst was removed intact.
Surgical excision is an outpatient procedure with a quick recovery time frame.
There really is no preventative care for these cysts due to their spontaneous nature. It is no longer recommended to try and break them up by smashing them with a book as this can cause additional trauma to the area. Warm heat compresses might make the cyst and surrounding area feel a little more comfortable but will not rid you of the growth.
Once a diagnosis of ganglion cyst is made and more potentially dangerous growths have been ruled out, you can just leave the growth alone unless it bothers you.
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