Saturday, February 4, 2012
Many patients present to my office with lumps on their foot that either appeared suddenly or gradually grew. These are normally ganglion cysts, formed by fluid leaking from tendons or joints. They are totally benign, and occasionally have to be surgically removed. But most patients are told to ice massage them in a circular manner 2 times per day to see if they can break them done. Before any thought of surgery, the ganglions should be drained in an office setting, one or two times. If the ganglions are not superficial, then cortisone can be injected after the draining to further increase the chance that they will not return. If you do get them drained, you need to spend one month with a compression wrap and extra padding over the ganglion to help prevent it from refilling up again. Here is an example of a ganglion from a recent patient. Like some patients, this patient also had a ganglion on his wrist that did need surgery. Ganglion patients can get other ganglions.
These benign lumps are not attached to the skin, are soft to pressure, and can only be documented on MRI or ultrasound. X-rays should be negative. Since ganglion cysts can develop from herniations in the ligaments of an arthritic joint, X-rays may show boney changes under the ganglion. If you can use ice massage to shrink them, routine ice massage 2 to 3 times per week may help keep them from coming back.