Lower Extremity Ganglion Cysts

How Lower Extremity Ganglion Cysts Present

Lower extremity ganglion cysts typically present as round or oval swellings, often located near joints or tendons of the foot or ankle. These cysts may vary in size, sometimes causing discomfort with pressure or movement, and can be painful or painless. They can be firm or soft to the touch and may fluctuate in size over time. Rarely, they may compress nearby structures, leading to symptoms like tingling or weakness.

Anatomy

Ganglion cysts originate from the joint capsule or tendon sheath, containing thick, gel-like fluid. They typically form near joints or tendons, with the most common locations being in the hands and feet. These cysts may arise from joint trauma or degenerative changes, presenting as sometimes painful, round swellings often connected to nearby structures.

Scheme of the anatomy

FIG 1 • Upper Extremity Ganglion Cyst Demonstrating Presentation in Relation to Tendon Sheath 

1. Ganglion cyst arising from dorsal scapholunate joint. B. Ganglion cyst arising from flexor sheath.

Symptoms of Lower Extremity Ganglion Cyst

Lower extremity ganglion cysts commonly manifest as soft swellings near the foot or ankle joints or tendons. As mentioned before, they may cause discomfort with pressure or movement and occasionally compress nearby structures, leading to tingling or weakness. In some instances they are painful, in other occasions they are completely asymptomatic until shoe gear is applied or when certain activities are performed. Symptoms vary depending on cyst size and location but typically include localized swelling and occasional discomfort.

Diagnostic Methods for Foot Ganglion Cysts

Physical examination, assessment of cyst size, and mobility

During a physical examination, a healthcare provider assesses a lower extremity ganglion cyst by palpating the affected area, noting its size, consistency, and mobility. They may apply gentle pressure to evaluate tenderness and observe any changes in the cyst’s size or shape with movement. The assessment also involves checking for signs of compression on nearby structures, such as nerves or blood vessels, which can cause symptoms like tingling or weakness as previously mentioned. 

During examination, transillumination (shining light through the cyst), helps assess its contents and structure, confirming it as fluid-filled. This aids in distinguishing it from other lesions. It’s a valuable diagnostic technique for evaluating cyst size, consistency, and mobility, aiding healthcare providers in treatment decisions.

The examinations mentioned previously help determine the extent of the cyst, guiding decisions on further diagnostic imaging and helping guide treatment options.

Imaging tests to evaluate the cyst and surrounding structures 

Imaging tests, such as ultrasound, MRI, and less commonly, CT scans, are used to evaluate lower extremity ganglion cysts and surrounding structures. These tests provide detailed images of the cyst’s size, location, and relationship to nearby bones, tendons, and nerves, aiding in diagnosis and treatment planning.

How Are Ganglion Cysts Treated?

Can ganglion cysts resolve on their own?

Yes, ganglion cysts can sometimes resolve on their own without intervention. This spontaneous resolution may occur due to changes in pressure within the cyst, natural reabsorption of fluid, or changes in activity level. However, resolution is not guaranteed, and cysts may persist or recur over time. Monitoring by a healthcare provider is often recommended to track changes in size and symptoms.

Can they be treated without medical intervention?

Yes, some ganglion cysts may resolve without medical intervention, especially if they are small and cause no symptoms. However, medical treatment may be needed for larger, symptomatic cysts or ones that are noted to be rapidly growing.

What is the surgical treatment to address the cyst? 

The surgical treatment to address a ganglion cyst is called an excision. During this procedure, the cyst and its surrounding tissue are removed surgically. This is typically performed under local anesthesia on an outpatient basis. The goal of excision is to completely remove the cyst, reducing the chance of recurrence and relieving any associated symptoms.

Rehabilitation and Recovery

Post-treatment care following surgical excision of a ganglion cyst includes:

• –Wound care: Keep the surgical site clean and dry, following any specific instructions provided by the healthcare provider.
• –Activity restrictions: Avoid heavy lifting or strenuous activities for the specified recovery period to allow proper healing.
• –Pain management: Take prescribed medications as directed to manage any discomfort.
• –Follow-up appointments: Attend scheduled follow-up visits with the healthcare provider to monitor healing and address any concerns.
• –Rehabilitation: Depending on the location and extent of surgery, physical therapy or exercises may be recommended to regain strength and mobility.
• –Watch for signs of infection: Monitor for symptoms such as increased pain, redness, swelling, or drainage from the surgical site, and contact the healthcare provider if any occur.

Adhering to post-treatment care instructions can help promote optimal healing and reduce the risk of complications.

Managing recurrence

Managing the recurrence of a ganglion cyst involves monitoring changes, consulting a healthcare provider if it returns, considering imaging for assessment, discussing treatment options, possibly modifying activities, and attending regular follow-up appointments.

Frequently Asked Questions

What are operative vs. non-operative treatment recurrence rates?

There is a range of recurrence rates suggested in different studies however it is generally accepted that ganglion cysts after aspiration and steroid injection, can recur in a range from 30% to 80%. Factors influencing success include cyst location, size, and healthcare provider skill. Multiple treatments may be needed. 

Surgical excision typically has lower recurrence rates (around 10-20%) but depends on various factors, including the ones mentioned above along with the addition of the used surgical technique, post-operative care and patient compliance.

Can ganglion cysts become malignant?

Ganglion cysts are typically benign, meaning they are non-cancerous. Malignant transformation of a ganglion cyst into a cancerous lesion is extremely rare. However, if there are concerning features such as rapid growth, changes in appearance, or unusual symptoms, further evaluation by a healthcare provider may be warranted to rule out any malignancy or other serious conditions including other soft tissue masses/tumors.

Can lower extremity ganglion cysts come back after treatment? 

Yes, as mentioned above, lower extremity ganglion cysts can potentially recur after treatment, especially if the underlying cause or contributing factors are not fully addressed. Recurrence rates vary depending on factors such as the size and location of the cyst, the effectiveness of the treatment, and individual characteristics. Monitoring for any changes and promptly seeking medical attention if symptoms reappear can help manage recurrence effectively.

Are there activities that increase the risks of developing ganglion cysts?

Activities involving repetitive stress or trauma to the lower extremities, such as running or jumping, increase the risk of developing ganglion cysts in that area. These cysts can also result from underlying joint or tendon conditions exacerbated by such activities. Certain shoe gear, especially tight ones, can also be a common culprit. 

How long is the recovery period after ganglion cyst removal?

The recovery period after ganglion cyst removal varies based on factors such as cyst size, location, surgical technique, the type of suturing technique used, and even the type of suture material used. Typically, recovery takes a couple of weeks to a month. Patients may need to limit activities and follow post-operative care instructions until sutures are removed and healing is complete. Special protective shoe gear or a boot may be prescribed during the healing course. 

Are there risks of ganglion cyst aspiration or surgery?

Both ganglion cyst aspiration and surgical excision pose potential risks. Although rare, aspiration risks include infection at the puncture site, damage to nearby structures like nerves or blood vessels, and the possibility of cyst recurrence. Similarly, surgical excision risks encompass infection, nerve or blood vessel damage, scarring, and cyst recurrence. However, with proper technique and image guidance, these risks are incredibly rare, and healthcare providers can help patients navigate the decision-making process regarding the most appropriate treatment option.