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Fibroma or ganglion cyst on the bottom of the foot?

I have a pea-sized lump on the bottom of the arch of my left foot, which my doctor believes may be a ganglion cyst in the plantar fascia. It swells to a larger size after I walk or run on it. I've had it for about six weeks, and it's tender to the touch; it gets irritated and painful when I run or take long walks on it. I've tried conservative treatments like ice, stretching, a night splint, and I'm in the process of getting new orthotics. My doctor is now considering cortisone injections or surgery. I've been a regular runner for over 20 years and a marathoner for the past 10. I've been told that ganglion cysts often recur, and I am very troubled by the thought that I may not be able to run consistently again, or for long distances. What are the various treatments and procedures for this injury, and what are the success rates? I would also like to know what the recovery times are like.

Jamie Linden

Chapel Hill, NC

I've been in practice for 15 years, including two years as a foot and ankle surgery resident, and I have never seen a ganglion on the ligament in the arch. While it is possible, it is very unlikely. What I believe this is, most likely, is a fibroma. The only treatment is excision and you never perform that unless they hurt consistently. First, ask your doctor is (s)he was using the term cyst as a term you would understand, even though it is really a fibroma. If the answer is still a cyst on the ligament, get an MRI to confirm that it really is a cyst, get it drained, and you may do very well. If it is a fibroma (as I suspect), get your orthotics modified to fit the lump without pressing into it. Otherwise, leave it alone until it drives you nuts; surgery is the only way to get rid of it and recurrence is indeed high.

Gene S. Mirkin, DPM, FACFAS

Kensington, MD

I assume from what your physician told you that the growth is not in the skin but under it. Pea sized lesions in the skin would include things like the common wart. There are a number of treatments for skin lesions that would not interfere with running. If the growth had to be removed it would not keep you from running for very long. A lesion under the skin is a little more problematic and is most likely a plantar fibroma, inclusion cyst, or ganglion cyst. If the lump is under the inside of your arch along the plantar fascia, it probably is a plantar fibroma, the most common lump we see on the bottom of the foot. It develops as a fibrous little growth and is relatively dense in consistency, whereas a ganglion cyst develops as a fluid filled sac and is usually softer and more mobile. It comes from the lining of tendons and joints, and is less likely to be under your arch. The inclusion cyst comes from something foreign under the skin, usually after a puncture wound. All of the above are not cancerous and have trauma as a factor in their development.

The fibroma unfortunately may grow and does have a tendency to return. The majority do not return, but the surgery could sideline you for several weeks. Injection of steroid into the lump is a common and effective treatment for both the fibroma and ganglion. I would recommend this as the first step. The injections will often soften the fibroma, or make a fibroma or ganglion shrink. (An inclusion cyst would require removal. Surgery would be simple and effective.) Surgery for the fibroma or ganglion is usually effective, and I too would not anticipate it would bring an end to your running career.

Richard A. Bronfman, DPM

Little Rock, AR

A fibroma is the more likely diagnosis, as a fluid-dilled cyst (ganglion) is rarely painful. You ought to have a diagnostic ultrasound to identify for certain which type of lesion it is, how big it is, and where it is attached before you can begin to assess treatment options or get discouraged about time before a return to running. If the groeth is solid and painful, surgical removal is usually very successful and has minimal disability.

David M. Davidson, DPM

Williamsville, NY
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Title Annotation:THE CLINIC
Author:Linden, Jamie; Mirkin, Gene S.; Bronfman, Richard A.; Davidson, David M.
Publication:Running & FitNews
Geographic Code:1USA
Date:Sep 1, 2007
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