Ganglions: Soft Tissue Masses often seen in the Foot



Patient presents with painful swollen big toe joint

  Patient Carleen presented to my office yesterday with a swollen big toe joint. These first two photos show how swollen the area looked. Compare the swollen right big toe joint with the uninvolved left big toe joint seen in the third photo.



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

After getting the MRI imaging, I drained the cyst of 5 ml of bloody fluid and sent it to the lab. The lab did not identify any bacteria. Hooray!! Carleen was started on icing and contrast bathing to reduce the swelling (minimum of 3 daily of the combination). She was given a hapad arch support to transfer weight into the arch and dancer's pad to float the painful toe. See the padding used in the following post link.

http://www.drblakeshealingsole.com/2010/09/sesamoid-fractures-advice-when-not.html

 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.