|Patient presents with painful swollen big toe joint|
|Side View of the Swollen Right Big Toe Joint|
|Non Swollen, yet prominent, uninvolved left big toe joint|
|MRI showing Probable Ganglion Cyst not involving the Joint|
|MRI Image of the Sideview of the Big Toe Joint|
I will follow her in two weeks. Ganglions may resorb, but some have to be surgically removed. I would inject 3 plus times with cortisone before considering surgery. She will need some form of orthotic device designed for her shoes to prevent pressure. The biomechanics of her foot is of a plantarflexed first ray which sticks out like a sore thumb and gets easily bruised. This bruising over time can lead to the gradual development of a cyst.
Carleen first felt symptoms 3 months ago, but does not recall bruising her foot. It is probably her biomechanics coupled with unpadded shoes, or the normal stress of activity, that causes the tissue to be initially traumatized. Ganglions are normally produced by normal joint or tendon fluid, that due to a weak spot in the lining of the joint or tendon sheath, allows the fluid to begin to seep out of the joint/tendon and into the surrounding tissue. The body attempts to wall off the fluid, but the hernia formed causes a gradual cyst formation. The biggest cyst of this type is called a Baker's Cyst off the back of the knee joint. Hopefully, with Carleen, we will be able to prevent surgery.