A ganglion is a soft tissue mass that most commonly occurs on the wrist in women between 25 and 45 years of age. They are also seen commonly on the foot.
A ganglion is a firm, rubbery mass that occurs on the top of the foot. On the foot, the most common area of involvement is in front of the ankle or on the outside of the ankle. A common characteristic of a ganglion is that they will enlarge and then shrink is size. They generally occur without any apparent cause. Ganglions arise spontaneously from a weakness in the soft tissue covering of a joint or tendon sheath. Ballooning out of the tissue occurs and it fills with a thick mucoid fluid. In many instances, ganglions are not painful until they reach a size that causes irritation from shoe pressure. On occasion they will compress a nearby skin nerve and cause tingling into the top of the toes. Tapping on the ganglion will often result in this same tingling sensation into the toes. Other common masses on the foot are giant cell tumors, fibromas and lipomas.
Diagnosis: The diagnosis is made by taking a through history of the clinical course of the condition. Physical exam will reveal a firm, rubbery mass that appears encapsulated and have a discreet boundary. They tend to be firmly adhered to the underlying deep tissues under the skin. A x-ray will reveal the shadow of the soft tissue swelling. On occasion there may be a small bone spur in the area of the ganglion. Spurring indicates a level of arthritis in the joint near the ganglion. A MRI or CT scan will clearly define the mass but is not necessary to make the diagnosis. If a ganglion were suspected within the deep structures of the foot a MRI would be useful to identify the size and extent of the mass.
Conservative Treatments : For people who have minor discomfort, less advanced conditions or are unable to undergo surgery, the symptoms may be treated conservatively (without surgery). This usually involves: Trimming or padding , Wearing supportive orthotics (individually fitted inserts) in shoes & other customized foot aids. Wearing shoes with a wider toe box. Unfortunately, conservative treatments provide only temporary relief of symptoms – they do not correct the deformity.
Surgical Treatments: When the deformity is painful or permanent, surgical correction is recommended to relieve pain, correct the problem and provide a stable, functional foot.
The mainstay of treatment for conditions like Ingrown toe nails, Ganglions etc is surgery.
Care After Surgery: Some swelling, stiffness and limited mobility can be expected following surgery, sometimes for as long as eight to twelve weeks.
Keeping the foot elevated above heart level and applying ice packs will help reduce swelling during the first few days after surgery. Many people can walk immediately afterward, although the podiatric surgeon may restrict any such activity for at least 24 hours.
Wearing a splint or surgical shoe for the first two or three weeks after surgery is recommended. The shoe protects the foot and helps properly disperse body weight. Stitches, if present, must be kept dry until removal – generally seven to ten days following surgery. While these are some of the most commonly prescribed treatments for digital disorders, others may be used. The podiatric surgeon will determine which treatment is likely to be the most successful in each case.
Possible Complications: Overall the surgical procedure is a safe one and without complications. However, as with any surgical procedure there are possible complications. The possible complications include infection, excessive swelling with delays in healing, damage to surrounding skin nerves or recurrence of the problem. It is important that during the period of time that the sutures are in place the foot be kept dry. Moisture will increase the risk of infection. Additionally it is important the patient stays off the foot and keeps it elevated during the first week to ten days following the surgery. Excessive swelling in the surgical site will lead to delays in the healing process and promote excessive scaring. Excessive movement at the surgical site may weaken the deep sutures and increase the risk of recurrence of the ganglion.