Q: I have a ganglia cyst on the second toe of my left foot. My doctor says surgery is the only method of removal. I’m hoping you have an alternative treatment.
A: A ganglion cyst is a non-cancerous fluid-filled palpable lesion that commonly affects the joints or tendons of the hand or wrist; however, cysts can also appear on the ankles and feet and less commonly in other joints such as the base of the fingers on the palm side of the hand, outside of the knee, and top of the foot, as well. They vary in size from very small to about an inch in diameter and can be pain-free or relentlessly painful when they press on a nearby nerve or restrict joint movement.. A physician can generally identify a ganglion by visually examining and palpating the lesion, or may choose to order an ultrasound, or MRI to rule out arthritis, a tumor, or other cysts. An ultrasound can help evaluate whether the lesion is fluid-filled or solid and can also determine whether an artery or blood vessel is causing the lump. Ganglions are seldom found in children and are more common in women between the ages of 20 and 40 than in men of any age.
The cause for a cyst to appear remains elusive. Trauma may trigger joint tissue to break down and form small cysts that join into a larger, more noticeable mass; however, more than not, a flaw in the joint capsule or tendon sheath that allows joint tissue to bulge can be the reason. Symptoms may include weakness or tingling of the area, pain that is made worse by moving the joint , numbness, and occasional swelling.
Treatment options will depend on whether the cyst is causing pain or problems with joint restriction. Without symptoms, a wait and watch approach is likely at the top of the list unless the individual is self-conscious and wants it removed for cosmetic reasons. In the instance of minor pain, over-the-counter Aleve, Motrin or Advil might be preferred. When the cyst is on a foot, loosening the laces, changing the shoe style or wearing wider shoes may be appropriate or aspiration with a needle inserted into the cyst to drain the fluid is more than not the preferred procedure. When other treatments fail to work, surgery to remove the cyst and stalk that attaches it to the tendon or joint may be appropriate. Arthroscopic surgery is becoming more common for this and numerous other procedures, simply because there is a smaller scar and shorter healing time. Keep in mind, however, that even once a cyst is surgically removed, it can recur. In summary, most do well with aspiration. If the cyst is on the top of the foot, there should be no problem having an office-surgical procedure.
Years ago when a cyst appeared on a wrist, care included heat, poultices, topical plaster or one old wife’s tale which was to place the hand and lower arm on a table or hard surface with the ganglion facing up. Another individual used the family bible to strike the cyst, shattering it. End of story! That’s why older individuals may refer to a ganglion as a bible cyst. We now know that all of these remedies and the blow to the body part can do more harm than good and is definitely not recommended, nor is self-aspiration that can lead to infection.
Because your cyst is in what must be an awkward place and because it likely affects every step you take, you may need to make a decision for treatment. Ask your primary care physician or orthopedic specialist if he or she performs arthroscopic repair which should allow for faster recuperation and if this is an option. Otherwise, wearing sandals or different shoes is likely your best bet.
