As a foot and ankle surgeon who specializes in runners and triathletes, the big question that someone has with a ganglion cyst is when it is actually necessary to do surgery. This article will explain why ganglion cysts become painful in runners, how you can treat it without surgery and when surgery is really necessary to remove the ganglion cyst from the foot.
A ganglion cyst is a fluid filled sac that extends from a joint capsule or tendon sheath. They most often occur in runners on the top of the foot, at the base of the big toe (or at the big toe joint), or around the ankle. But they can occur in other places. The most common location of a ganglion is actually in the wrist. Ganglions in the wrist may become bothersome in cyclists or triathletes who ride time-trial bikes. The repetitive motion of shifting on bar-end shifters can cause numbness in the hand if the ganglion cysts pushes on a nerve.
A ganglion cyst in the foot will start to become painful only when it gets compressed between the bones on the top of your foot and the shoe that you wear when you run. It can certainly become more painful if your laces are tight.
Ganglion cyst are not dangerous and they only need to be removed if they are painful and interfering with your shoes. Some patients will also want to remove the ganglion cyst just because it is unsightly and makes them uncomfortable with this ugly mass on their foot.
The standard self-treatments for ganglion cysts of the foot are as follows:
1. Wait to see if the cyst will go away on its own. Foot surgeons call this spontaneous resolution. Believe it or not this actually happens a large percentage of the time. Because of this, it is often best to wait and see if the ganglion cyst will slowly disappear and go away on its own.
2. Wear shoes that don’t push on the cyst and irritate it. This may see simple but many patients that I see have shoes that press directly on the soft tissue mass. If you wear sandals in the strap goes right across the mass it is more likely to hurt. Make sure that your shoes don’t push directly on the bump. This will definitely decrease the amount of pain that you have.
3. Apply pads around the ganglion cyst. Most of the pain that happens from a ganglion cyst is due to pressure from your shoes. You can never remove pressure but you can always put it somewhere else. You can purchase gel or felt pads at the pharmacy or grocery store that has a hole in them the whole should be about the size of the ganglion cyst. When you apply these paths on the top of the foot so that you can actually see the ganglion through the whole, you will transfer all of the pressure that was being applied to the ganglion cyst to the area around the ganglion cyst. This will decrease all of the pressure to the ganglion cyst and may make the pain go away. Keep in mind that you may only need this to work for a short period of time because the cyst might go away on its own.
4. Adjust your shoelaces by changing your lacing pattern. If you lace your shoes so that you skip one hole right at the location of the ganglion on the top of your foot, it will significantly decrease the amount of pressure and irritation to the ganglion. This may be enough to allow you to run without pain. If you are wearing cycling shoes that press on the ganglion, make sure that the strap that goes over the ganglion is loose. The goal is to simply decrease the amount of pressure from your shoes on top of the ganglion.
If none of these treatments work then you can see a foot surgeon who has an interest in sports medicine. It is important to see a surgeon who understands the activities that you participate in so that you can make sure you stay active.
One of the first treatments that any sports medicine foot and ankle surgeon will try is to drain the ganglion. A small amount of local anesthetic will be injected to make the area numb. A needle is then inserted into the ganglion in order to try to drain the fluid. At the same time, a small amount of steroid is injected into the ganglion to get it to stick together and shrink down and shrivel up and go away. This does not work all of the time but it is certainly worth a try because it is a quick fix when it works.
If you have had the ganglion drained and it continues to come back after you run a marathon or continue your training, you may want to consider surgery. Surgery is much more reliable treatment than draining the ganglion. The reason that you shouldn’t consider it initially is that it is more expensive and requires more downtime. You will have stitches in your foot for about 2 weeks after your surgery. You’ll have to avoid running swimming and cycling while you have stitches in. Depending upon the location of the ganglion you might have to avoid running biking and swimming for a couple of more weeks after your stitches are removed. This alone is usually a deterrent for runners and triathletes.
The only time you really must have a ganglion removed as if it is pushing on a nerve. This does happen sometimes in the foot in triathletes. Running shoes are easier to deal with than cycling shoes. Cycling shoes are unforgiving because they are very rigid and have straps that can’t be easily adjusted.
The unfortunate reality is that many ganglion cysts happened to pop up on the midfoot or the big toe joint right next to nerves. When the ganglion gets big enough to compress the nerve you get numbness tingling or burning pain in the foot or in the toes. This can produce permanent nerve damage if it isn’t treated. If you continue to have numbness tingling or burning whenever you run or ride your bike you should consider having the ganglion removed.
If you do decide to have the ganglion removed you want to time this so that it won’t disrupt your training. You should also make sure that you get a 2nd opinion and see at least 1 foot and ankle specialist who sees athletes. The last thing you want is to have your activities unnecessarily limited after surgery. It’s important to make sure that you keep the end goal in mind which is continuing to run bike and swim or enjoy whatever activities you choose.
Dr. Christopher Segler is a foot and ankle sports medicine specialist in San Francisco. His practice focuses on runners, triathletes and complicated reconstructive foot and ankle surgery cases. He lectures worldwide at medical conferences to audiences of podiatrists, sports medicine physicians and foot surgeons about complicated running injuries and his patented and published methods to speed up surgery and reduce pain after foot and ankle surgery. if you have a question about a ganglion you can call him directly at (415) 308-0833. You can also learn more about other sources of midfoot pain ankle sprain symptoms, causes and treatments at AnkleCenter.com.