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Ganglion Cysts
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 thorough history of the clinical course
of the condition. Physical exam will reveal a firm, rubbery mass that
appears encapsulated and will 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. Treatment Small
ganglions that are not symptomatic or painful usually require no
treatment. A non-surgical form of treatment is termed "needling". This
involves numbing the area with a local anesthesia. Once the area is
numb a large gauge needle is placed into the ganglion. Aspiration of
ganglion fluid is attempted, however, because of the thickness of the
fluid it is often difficult to draw the fluid out. The ganglion is then
punctured with the needle several times. A steroid medication may then
be placed into the mass and a snug bandage applied. This treatment has
a 70% recurrence rate. The definitive treatment for a ganglion is
surgical excision. (See surgical excision of a ganglion)
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