Ganglionic Cyst of the Foot and Ankle

Have you been told by your doctor that you have a ganglionic cyst on your foot or ankle? If so, what did they say it was and what are your treatment options? In this blog post, we will discuss what a ganglionic cyst is, how it’s treated, and what to expect after treatment. We hope this information helps you feel confident and empowered as you work with your doctor to find the best treatment plan for you.


What is a ganglion cyst?

A ganglion cyst is a fluid-filled lump that appears near joints and tendons. It is usually not painful and often disappears on its own. In the foot and ankle region, they can be painful because it could potentially hinder your ability to wear shoes comfortably depending on the location of the cyst. The most common location for a cyst to occur is on the top of the foot or front of the ankle. Cysts rarely form on the bottom of the foot (the most common soft tissue mass on the bottom of the foot is a plantar fibroma).

What causes a ganglion cyst?

Ganglion cysts develop as a result of micro-injury. Repetitive damage to the supporting capsular and ligamentous structures seems to cause fibroblasts to produce hyaluronic acid, which builds up in ganglion cysts.

How do you know if you have a ganglion cyst?

In most cases, a diagnosis can be based on a physical examination alone. The feel of a ganglionic cyst is fairly characteristic. It is normally spongy and should be freely mobile and not very adherent to adjacent soft tissues. The diagnosis can be confirmed through a variety of means including imaging studies (like an ultrasound or MRI) or biopsy.

An aspiration procedure can be helpful because it allows the doctor to visually inspect the fluid. If the fluid is thick, clear, or slightly blood-tinged it is most likely a ganglionic cyst. The aspirated fluid can be sent to a pathologist for confirmation of diagnosis.

What are the symptoms of a ganglion cyst?

Most ganglion cysts are asymptomatic, meaning they don’t cause any pain or other problems. However, some ganglion cysts can be painful, especially if they press on a nerve. Ganglion cysts can also limit your range of motion if they are located near a joint. If they are large enough, they may cause issues with shoe fit.

How are ganglion cysts treated?

The vast majority of ganglion cysts will resolve on their own over time. However, if the cyst is causing pain, limiting the range of motion, or affecting shoe fit, treatment may be necessary. Treatment options include aspiration, injection with a corticosteroid, or surgery.

Aspiration is a technique used to remove the fluid from the cyst. This can be a helpful technique because it immediately causes the cyst to decrease in size and a sample can be sent to the pathologist for confirmation of diagnosis.

The first step in the aspiration procedure is to numb the area with a local anesthetic (like Lidocaine). Once the area is numb, it is prepped with an antiseptic solution. A larger bore needle is then placed either with or without ultrasound guidance directly into the mass and the contents are drawn into the syringe. The needle is then removed and a light dressing is applied to the needle entry site.

Unfortunately, the recurrence rate with this technique is fairly high. A membrane surrounds the cyst which cannot be removed by a needle so new fluid will be created causing the cyst to get larger again. New attempts at aspirations can be performed, especially if the original aspiration offered a long-lasting effect. If multiple aspirations have been attempted or if it quickly comes back then surgery to remove the cyst can be considered.

Surgical excision of the mass can be more definitive because the surrounding cyst wall is removed at the time of surgery. As such, the recurrence rate is much lower with surgical excision. Surgery carries a greater risk for complications compared to aspiration but the recurrence rate is much lower so this option is much more definitive.

What is the long-term outlook for someone with a ganglion cyst?

The long-term outlook is generally very good for most people with ganglion cysts. Most ganglion cysts will resolve on their own over time and do not require any treatment. However, some ganglion cysts can be recurrent and may require multiple treatment modalities. Surgery is typically a last resort but can be very effective in treating recurrent ganglion cysts. All masses on the foot and ankle should be evaluated by your foot and ankle specialist to provide a diagnosis, ensure it is not malignant (cancerous) and come up with a treatment plan.