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Ganglion Cyst or Fibroma?

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.

Ron Mueller

Brooklyn, NY

I've been in practice for multiple decades, 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 if (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

A fibroma is indeed the more likely diagnosis, as a fluid-filled 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 growth 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
Publication:Running & FitNews
Article Type:Column
Geographic Code:1USA
Date:Mar 1, 2017
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