LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Ganglions

What exactly is a “ganglion”?

A ganglion is a sac filled with a jellylike fluid that originates usually from a tendon sheath or an underlying joint capsule. The word “ganglion” means “knot” and is used to describe the knot-like mass or lump that forms below the surface of the skin. 

Women are more likely to get ganglion cysts than men. They most commonly appear in women aged 20-40. You can get ganglions virtually anywhere near a tendon or joint. They are most common around your wrist but can often be seen on the top of the foot, the front of the ankle, or virtually anywhere in the foot or ankle. The don’t have to be “superficial” and easily visible, they can be deeper inside the foot and not easily seen or felt.

It is a benign lump, not a malignant lump or cancer.

What causes a ganglion?

Usually the cause is not known. Occasionally they can appear following an injury or repetitive injury to the joint or area.

What are the symptoms? 

People usually complain of a lump or swelling often on their foot or ankle, commonly seen on the top of the foot. Wearing shoes can rub on the lump and make them uncomfortable. On occasion the ganglion can be in close proximity to a small nerve. If the nerve gets compressed then patients can complain of numbness or discomfort in the area of skin the nerve supplies. With some ganglions, deeper under the skin for example they can cause a general ache or pain around a joint.

Ganglions

How is the condition diagnosed? 

Clinical examination is often enough to diagnose this condition. X-Rays can be taken that may show underlying joint arthritis, but this is not typical. If the diagnosis is uncertain then an ultrasound or MRI scan can be done.

Can the problem get worse?

Symptoms from a ganglion are usually tolerated for a long time because the lump can appear and disappear and appear again. It can also gradually enlarge, making shoe-wearing difficult and cause a generalised foot ache.

How do you treat a ganglion?

3 options are possible:

  1. Leave it alone, find more comfortable shoes, take pain relief as needed.
  2. Opt for an needle aspiration in the clinic, this will get rid of the lump immediately but unfortunately it can recur in over 20% of patients and may need further surgery
  3. Surgical excision. This is done as a day-case procedure through a small incision. There are small risks including infection (1%), damage to nerves close to the ganglion (5%) or recurrence (around 5-10%).

Deciding whether surgery is necessary

Many patients are simply seeking advice on managing a problem. If the lump is not really causing a large problem then you can leave it alone because they can disappear in some cases. If you have had an aspiration and it recurs then surgery is a good option. The surgery can then be discussed with your surgeon.

  • Chelsea & Westminster Hospital NHS
  • The Lister Hospital, Chelsea
  • Fortius Clinic
  • Bupa Cromwell Road