Premier Podiatry

Ganglions

A ganglion is rather like a balloon that can arise under the skin. Joints have a structure around them known as the joint capsule which helps to keep the joint in position. The inside of the capsule is lined with a special tissue called synovium which produces the fluid that lubricates the joint (synovial fluid). Rather like joints, many tendons have a sheath around them so that they can move freely under the skin. This is also lined with synovium which produces synovial fluid to allow free movement.

If a weak point arises in the capsule or sheath, a bubble is formed (rather like the weak point on a bike wheel inner tube). Generally, there is a small connecting tunnel (stalk) between the bubble (the ganglion) and the joint capsule or tendon sheath. The ganglion is usually full of synovial fluid.

Ganglions can occur anywhere on the foot.

What causes a ganglion?

The cause is not known although increased activity or trauma may contribute.

Will it get worse?

Generally, ganglions tend to get bigger with time but are not necessarily painful.

What are the common symptoms?

• Swelling (it may alter in size or be fluctuant)
• Pain
• Difficulty in shoes
• Difficulty in walking

How is it recognised?

Clinical examination and a detailed history allow diagnosis. Sometimes, pressing a pen torch onto the area will light up the fluid. X-rays help to evaluate the underlying bone and joint for any associated arthritis / bony prominence.

What can I do to reduce the pain?

• Wear good fitting shoes
• Wear a protective pad if necessary
• See a podiatrist

What will a podiatrist do?

If you experience symptoms:

• Monitor the ganglion
• Consider draining (aspirating) the ganglion
• Advise on surgery

Draining the fluid from the ganglion can reduce the prominence. However, because the expanded tissue is still present and connected to the capsule / sheath, it is likely that the ganglion will fill with fluid again.

Will this cure the problem?

The conservative treatments are unlikely to resolve the problem in the long term.

What will happen if I leave this alone?

It may remain static or get larger causing discomfort.

How can I cure the deformity?

The only effective way of removing the ganglion is to have an operation.

How does the operation correct the deformity?

The ganglion needs to be carefully dissected from the surrounding soft tissue and the connecting tunnel (stalk) identified and removed. Care needs to be taken not to damage any of the normal tissues, especially blood vessels and nerves.

I have heard it is very painful.

The nature of surgery means that there will be pain and swelling, usually worse the night after surgery. However, with modern anaesthetic techniques and pain killers, this can be well controlled. The level of pain experienced varies greatly from patient to patient with some experiencing no significant discomfort. Whilst this type of operation rarely causes significant discomfort, much depends on the size and location of the ganglion.

Will I have to have a general anaesthetic (be asleep)?

Not if you did not want one. Many of these procedures are performed perfectly safely under local anaesthetic (you are awake). Some patients worry that they may feel pain during the operation but it would not be possible to perform the operation if this were the case.

Will I have to stay in hospital?

No. As long as you were medically fit and have adequate home support, many patients are able to have this type of operation performed as day surgery and go home.

Will I have to have a plaster cast?

Generally not. However, bigger ganglions or ones that are on the sole of the foot may require a cast and you may not be able to walk on the foot for 3 weeks.

Are there a lot of complications?

There are risks and complications with all operations and these should be discussed in detail with your specialist. A thorough examination of your foot and general health is important so that these complications can be minimised.

Although every effort is made to reduce complications, these can occur. In addition to the general complications that can occur with foot surgery, there are some specific risks with ganglion surgery:

• Damage to adjacent soft tissues (nerve, blood vessel, tendon)
• You may get discomfort in other parts of your foot during the recovery period. This generally settles.
• There is always a possibility that the ganglion may return.

When will I be able to walk again and wear shoes?

In the majority of cases, you will able to walk with the aid of crutches within 2-4 days but you will remain somewhat limited for the first 2 weeks.

Recovery is usually quite quick although it does depend on the size and location. If you have a ganglion on the sole of the foot or require a cast, you may not be able to walk on the foot for 3 weeks.

When will I be able to drive again?

When you feel able to perform an emergency stop. This is generally between 2-4 weeks post operatively but you should always check with your insurance company first.

When will I be able to return to work?

If you are able to get a lift and have a job that is not active and you can elevate your foot, you may be able to return after a few days. Generally, patients return to work between 1-4 weeks depending on the type of job, activity levels and response to surgery.

When will I be able to return to sport?

Although the healing process continues for up to 1 year, you should be able to return to impact type activity at around 2-6 weeks. This will depend on the size and location of the ganglion and how you respond to surgery.