A ganglion is a cyst that forms on top of a joint, ligament, or tendon. The cyst is filled with fluid. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms such as pain, your doctor may recommend observation only to make sure that no unusual changes occur.
The procedure to remove a ganglion is called ganglion resection. The initial treatment of a ganglion is not surgical, but if pain becomes a problem, your foot and ankle orthopedic surgeon may recommend aspiration, a procedure to remove the cyst’s fluid through a needle. If the cyst returns, surgery to remove the ganglion might be an option.
A ganglion may cause pain. The enlargement of the ganglion may cause skin irritation or make it difficult to wear shoes. The ganglion may cause pressure on nerves and produce burning, tingling, or numbness. For some patients, the appearance of a ganglion may not be acceptable.
If the ganglion is not causing any problems, non-surgical treatment may be preferable. Your doctor may recommend surgery if your symptoms are not relieved by non-surgical methods, or if the ganglion returns after aspiration.
Ganglion resection typically is an outpatient procedure and patients are able to go home the same day. You can be given a local or a general anesthetic. The choice depends partly on which you prefer, and partly on what your surgeon thinks is best. Often, local anesthesia is used in conjunction with IV sedation.
Usually open surgery is done, though in certain circumstances your surgeon may recommend arthroscopic surgery.
The doctor can draw off the gel fluid from the cyst with a syringe and needle (aspiration). This is typically combined with injecting the mass with a small amount of cortisone. In some cases, an alternative injection material, called a sclerosing agent, might be discussed. The success rate with this type of intervention is perhaps 50%. In some cases, the can be a recurrence of the within 2 weeks – 6 months.
After this type of intervention, it is helpful to keep the area compressed with Coflex for 1-2 weeks. Coflex can be purchased.
The risks of cortisone injections for ganglion include, but are not limited to: increased pain for 24-72 hours following the injection, skin depigmentation at the injection site, weakening of adjacent cartilage, ligament, or tendon structures with potential rupture, and infection. Systemic side effects of this type of injection are extremely rare.
The surgery involves removal of the mass and a small amount of the tissue of origin. In cases of a mucinous cyst, a portion of the associated joint may be removed (called an arthroplasty). Typically the mass is sent to the pathology department for verification of the diagnosis.
The anesthesia administered is typically either, local anesthesia alone, or local anesthesia with intravenous sedation by an anesthetist. The surgery is performed on an outpatient basis.
You are allowed to walk on your foot after surgery in a post-operative shoe. Although you can walk on your foot after surgery, complete rest and elevation is encouraged for the first two weeks following surgery.
Sutures are typically removed at two weeks after the surgery, at which time, you are typically allowed to resume bathing and resume your regular footwear – as tolerated. Recovery (resolution of swelling, tenderness, and stiffness) is complete within 2-4 months most individuals.
The surgery is typically a success, but the recurrence rate is about 10%. Risks include, but are not limited to: recurrence, infection, arthritis, tendonitis, tendon injury, nerve entrapment, prolonged recovery, delayed incision healing, painful or unsightly scar, incomplete relief of pain, no relief of pain, worsened pain, recurrent pain, impaired function, and loss of toes or foot.
Your doctor will decide whether the foot and ankle requires immobilization in a cast or boot following surgery and also whether or not you can walk with full weight on the foot right away. If not, you may require crutches for a period of time.
There is some tenderness, discomfort, bruising, and swelling after surgery. Pain medications, elevation and rest help during wound healing. The wound should be kept clean and dry. It usually will heal within two weeks.
You will have a scar instead of a ganglion. The skin around the scar may be permanently numb. You should avoid footwear rubbing against the scar.
Normal activities may be resumed 2-6 weeks after surgery.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Complications from a ganglion resection are rare and seldom serious. Ganglion resection surgery can occasionally result in pain or scarring. Recurrence of the ganglion will happen in 1 out of 5 patients.