Alliance Foot & Ankle: Questions?

Alliance Foot & Ankle: Questions?

Ganglion Cyst

What is a ganglion?       

Ganglion Cysts are a benign fluid-filled lump (cyst) that can occur in many areas of the body, but is most common on the hands and feet.  They typically arise over a joint or tendon.  Although the exact causes are not known, a ganglion likely occurs due to a weakness in the covering of the tendon or joint space. Direct injury or everyday minor trauma can potentially be a cause.  Motions of a tendon over a bony prominence or pressure from a shoe on a tendon or joint are examples of minor trauma.  Weakness in the covering with a subsequent swelling of liquid into a confined space causes the lump to form.  The growth is usually very firm but may be somewhat soft, depending on the fluid content.  The fluid itself is usually similar in appearance to a thick clear jelly.

Diagnosis

A diagnosis of ganglion cyst is usually made on clinical examination based on location of the growth and pertinent history.  An x-ray may be taken to rule out a bone spur as the aggravating factor behind the formation of the cyst.  If there is any question as to the extent of the growth, an MRI may be ordered for a more detailed evaluation.

Treatment 

Proper treatment is based on pain, size, location and aggravating factors. Once a mass is diagnosed as a ganglion cyst it may be left alone, untreated, if it is not painful or causing problems with shoes. Occasionally these growths will spontaneously disappear.  Cysts can be drained by needle aspiration followed by a cortisone injection in an effort to prevent the cyst from filling again.  Once drained, a compression dressing is worn over the site for a period of time in an attempt to reduce recurrence.  Over half of the cysts will refill with this form of treatment, but the upside is that the procedure can be repeated again if needed.  If the growth is a source of pain or irritation and drawing fluid out (aspiration) has failed, then surgical excision may be necessary. Although surgical excision reduces the chance for recurrence ganglions will sometimes come back.  Surgical excision is an outpatient procedure.   Crutches and non-weight bearing are not usually needed.   A surgical shoe is usually worn for 2 to 3 weeks during the time that the incision is healing.  There really is no preventative care for ganglion cysts due to their spontaneous nature.

It is important to be evaluated by a foot and ankle specialist to ensure proper diagnosis.  More information can be found on our website, alaskapodiatry.com.

Alliance Foot & Ankle: Questions?

Alliance Foot & Ankle: Questions?

Questions?

Please feel free to post a comment or question, we will be happy to answer it.

Hammer Toes

Thanks to Randy for posting a question, hope this helps.

A hammertoe is a contracture—or bending—of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. Common symptoms of hammertoes include:

• Pain or irritation of the affected toe when wearing shoes.

• Corns (a buildup of callus skin) on the top, side, or end of the toe, or between two toes. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.

• Calluses (another type of skin buildup) on the bottom of the toe or on the ball of the foot.

Corns and calluses can be painful and make it difficult to find a comfortable shoe. Even without corns and calluses, hammertoes can cause pain because the joint itself may become dislocated or arthritic.

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment. Corns are more likely to develop as time goes on—and corns never really go away, even after trimming. In more severe cases of hammertoe, open sores may form.  Because of the progressive nature of hammertoes, they should receive early attention.

Causes of Hammertoes 

The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.  Hammertoes are often aggravated by shoes that don’t fit properly—for example, shoes that crowd the toes. In some cases, ill-fitting shoes can actually cause the contracture that defines hammertoe. For example, a hammertoe may develop if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is caused by some kind of trauma, such as a previously broken toe.

Treatment:

Non-Surgical Approaches

There are a variety of treatment options for hammertoe. The treatment your  foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.

A number of non-surgical measures can be undertaken:

• Trimming and padding corns and calluses. 

• Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels—conditions that can force your toe against the front of the shoe.

• Orthotic devices. A custom or OTC orthotic device placed in your shoe may help control the muscle/tendon imbalance.

• Medications

When Is Surgery Needed?

In some cases, often when the hammertoe has become more rigid, surgery is needed to relieve the pain and discomfort caused by the deformity.  Your surgeon will discuss the options and select a plan tailored to your needs.  Among other concerns, he or she will take into consideration the type of shoes you want to wear, the number of toes involved, your activity level, your age, and the severity of the hammertoe.

One type of surgical procedure performed to correct a hammertoe is called arthroplasty. In this procedure, the surgeon removes a small section of the bone from the affected joint.  Another surgical option is an arthrodesis.  Arthrodesis is a procedure that involves fusing a small joint in the toe to straighten it. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing.

It is possible that a patient may require other procedures, as well— especially when the hammertoe condition is severe. Some of these procedures include tendon/muscle rebalancing or lengthening, small tendon transfers, or relocation of surrounding joints.  Often patients with hammertoes have bunions or other foot deformities corrected at the same time. The length of the recovery period will vary, depending on the procedure or procedures performed.  For more information please visit our website alaskapodiatry.com.