Ganglion Cysts

Ganglion cysts are little bags of a syrup-like substance resembling a mixture between Vaseline and KY jelly. Ganglion cyst usually develop from tendon sheath or from a joint capsule.

A tendon sheath is the “tunnel” that a tendon passes through. The sheath is very thin. If the sheath get a weak spot, it bubbles out. I like to compare this to a football. The leather pigskin that surrounds the foot is tough and strong, but if there is a defect in the stitching, the air bladder on the inside will bubble out. This is somewhat how a ganglion forms. However, the bubble fills up with a viscous-like fluid.

The same thing happens in a joint capsule. When to bones come together, that forms a joint. Almost every joint in the human body has a joint capsule that surrounds the joint. The joint capsule holds in joint fluid to insure the joint is moist and provides a smooth slick surface for the bones to move against one another. If the joint capsule get a weak spot like the tendon sheath, then an out-pocketing can form and you get a bubble filled with a clear jelly like substance.

Ganglion cysts usually cause pain by putting pressure on something next to it.

If the ganglion is close to a nerve, then you may have nerve pain, like numbness, tingling or shooting pains.

If the ganglion is close to a tendon or joint, you may get a dull pain or ache.

Most of the time, ganglion cysts are relatively asymptomatic when barefoot, but when you put on a pair of tight shoes, the cyst causes pain on the adjacent structures.

When we evaluate your cyst, we look for a few key features to make sure it is actually a ganglion.

First, the skin overlying the cyst is usually not stuck to the cyst and moves freely.

Second, the cyst is does not typically cause skin discoloration, unless there has been friction inside the shoe.

Thirdly, we can turn off the lights in the treatment room and shine a flashlight by the lesion and the whole lesion should light up. If the lesion is solid and not fluid filled, this will not occur.

Fourthly, we can use a needle to draw out some of the jelly-like substance.

Lastly, advanced imaging studies like an MRI can give us a better idea how big the cyst is and what is inside of it.

Treatment

1. Nothing. Sometimes the cysts will bust on their own. Back in the old days, people used to hit them with a Bible to rupture the cyst.

2. Shoe modification – sometimes wider or deeper shoes are needed to avoid putting pressure on the cyst.

3. Aspiration and injection – Most often, we can use a needle to draw out all of the jelly like substance, then inject a steroid in shrink the size of the cyst. This is usually done on the 1st visit.

4. Surgery – If the previously mentioned techniques were performed without any success and the cyst keeps coming back, then we suggest excision of the cyst. This is the most definitive treatment and is very successful.

If you have a ganglion cyst, and you want to have it evaluated, please visit Dr. Kory Williams or Dr. Eric Silvers at AdvancedFoot & Ankle Center in McKinney, TX and Prosper, TX for an evaluation and treatment.

Have a nice day!

~Dr. Kory Williams