FOOT GANGLION (Synovial Hernia; Synovial Cyst) |
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General Information
DEFINITION--A small, usually hard nodule lying directly over a tendon or a joint capsule on the top or bottom of the foot. Occasionally the nodule may become quite large. Sometimes a foot ganglion may regress and disappear altogether, only to reappear later.
BODY PARTS INVOLVED
Top or sole of the foot.
Tendon sheath (a thin membranous covering to any tendon).
Any of many joint spaces in the foot.
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SIGNS & SYMPTOMS
Hard lump over a tendon or joint capsule in the foot. The nodule "yields" to heavy pressure because it is not solid.
No pain usually, but overuse of the foot may cause mild pain and aching.
Tenderness if the lump is pressed hard.
Discomfort with extremes of motion (flexing or extending) and with repetition of the exercise that produced the ganglion.
CAUSES
Mild or chronic sprains in a foot joint, causing weakness of the joint capsule.
Defect in the fibrous sheath of the joint or tendon, permitting part of the underlying synovium (thin membrane that lines the tendon sheath) to protrude through. Irritation of the protruding synovium causes it to fill with fluid. Continued irritation makes it enlarge and harden, forming the ganglion.
RISK INCREASES WITH
Repeated injury, especially mild sprains. Foot ganglions frequently occur in runners, jumpers, skiiers and participants in contact sports.
Inadequate warmup prior to practice or competition.
Poor muscle strength or conditioning.
If surgery is necessary, surgical risk increases with smoking, poor nutrition, alcoholism, and recent or chronic illness.
HOW TO PREVENT
Build your strength in a long-term conditioning program appropriate for your sport.
Warmup before practice or competition.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care for diagnosis and possible injections of local anesthetic or corticosteroids.
Surgery (usually). Surgery will be conducted under general or local anesthesia in an outpatient surgical facility or hospital operating room.
DIAGNOSTIC MEASURES
Your own observation of signs and symptoms.
Medical history and physical examination by a doctor.
X-rays of the area.
POSSIBLE COMPLICATIONS
After surgery:
Excessive bleeding.
Surgical-wound infection.
Recurrence if surgical removal is incomplete.
Calcification of ganglion (rare).
PROBABLE OUTCOMEGanglions sometimes disappear spontaneously, only to recur later. Surgery is usually necessary. After surgery, allow about 3 weeks for recovery if no complications occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This condition develops gradually.
CONTINUING CARE
IMMEDIATELY AFTER SURGERY:
The affected area is usually immobilized in a splint for 1 to 2 weeks following surgery.
If the wound bleeds during the first 24 hours after surgery, press a clean tissue or cloth to it for 10 minutes.
A hard ridge should form along the incision. As it heals, the ridge will recede gradually.
Use an electric heating pad, a heat lamp, or a warm compress to relieve incisional pain.
Bathe and shower as usual. You may wash the incision gently with mild unscented soap.
Between baths, keep the wound dry with a bandage for the first 2 or 3 days after surgery. If a bandage gets wet, change it promptly.
Apply non-prescription antibiotic ointment to the wound before applying new bandages.
Wrap the foot with an elasticized bandage until healing is complete.
AFTER THE INCISION HAS HEALED:
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
You may apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
MEDICATION
Your doctor may prescribe pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need.
You may use non-prescription drugs, such as acetaminophen, for minor pain.
ACTIVITY
Return to work and normal activity as soon as possible. This reduces postoperative depression and irritability, which are common.
Avoid vigorous exercise for 3 weeks after surgery.
Resume driving when healing is complete.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a foot ganglion.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms. Drugs used in treatment may produce side effects.
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