Have you recently noticed a lump on the bottom of your foot? Or is it just some swelling due to bumping your foot? I have had a surprising number of patients lately suffering from cysts and fibromas so I wanted to share some information with you that I hope is helpful.
If you have a lump or unexplained swelling, it’s very important to get a proper evaluation because there is a chance that it may be a soft tissue mass. The good news is that, most of the time, soft tissue masses are benign in the foot and ankle. Two such common masses are ganglion cysts and plantar fibromas.
What are ganglion cysts?
Ganglion cysts are fluid-filled sacs composed of synovial fluid from a tendon sheath or joint. The exact cause of these cysts is unknown but they are generally associated with the friction of a tendon or repetitive micro-trauma from a joint. They are more commonly seen in females between the ages of 20 and 40.
Clinically these cysts tend to be found on the top of the foot and are well-circumscribed fluid-filled masses with surrounding skin that is freely moveable. Ganglion cysts are generally asymptomatic unless they are pressing on a tendon or nerve. A clinical test performed to help diagnose a ganglion cyst is called the transillumination test. This test utilizes a penlight to shine light through the mass. If the whole mass lights up, then it is positive for a cyst. An ultrasound or MRI can also be used for diagnosis.
Ganglion cysts used to have the nickname “bible cysts”
Believe it or not, treatment used to involve hitting the cyst with a bible to “pop” it. Though an effective form of therapy (gives new meaning to the term “bible thumping”), we try far less abusive, not to mention less painful ways to treat ganglion cysts. For smaller, asymptomatic cysts we suggest compressive therapy. If the cyst is large enough, we simply use an ultrasound to identify the cyst, numb up the area and aspirate the strawberry-colored gelatinous fluid. A cortisone injection is frequently given after aspiration to minimize inflammation. Keep in mind that these cysts have a very high re-occurrence rate, so they may come back. If the cyst does continue to reoccur, then we surgically excise it.
What are plantar fibromas?
Plantar fibromas are made up of fibrous tissue. Like ganglion cysts, the exact etiology of what causes plantar fibromas is also unknown. Often they can be associated with a strain to the plantar fascia. There’s also a strong correlation to multiple medical conditions such as epilepsy, diabetes, thyroid disorders, alcoholism, and liver cirrhosis.
Patients on medications like Dilantin, glucosamine, and/or chondroitin, and large doses of vitamin C have a higher incidence of developing these soft-tissue masses. Plantar fibromas are commonly found along the bottom of the foot within the plantar fascia. They are slow-growing lesions that are usually asymptomatic. However, as nodules grow in size, they can become more painful when bearing weight. An MRI can be beneficial for identification and extent.
Are there treatments for plantar fibromas?
Yes, and they are similar to the basic treatments we have for plantar fasciitis. This includes stretching, anti-inflammatories, padding, cortisone injections, and orthotics. There is also a “miracle” cream called “transdermal Verapamil” which can be applied daily. Verapamil in its oral form is used to treat high blood pressure and arrhythmias. In the topical form, it mysteriously shrinks plantar fibromas over time (don’t worry – it won’t affect your blood pressure). The only problem is that many pharmacies do not carry this cream. Rest assured, we know where to find it.
If the plantar fibromas continue to be bothersome, then surgical excise may be warranted. A localized excision can be performed on a single lesion with minimal recovery. But if multiple lesions are present or single lesion excision did not work, then sometimes an entire plantar fasciotomy may be needed.
Ganglion cysts and plantar fibromas are the most common soft tissue masses of the foot and ankle and are benign. However, there are other soft tissue masses that exist and there is always an inherent risk of malignancy, which is extremely serious. Therefore, it’s always best to have all the lumps and bumps on your feet evaluated by trained professionals. Between “bible cysts” and miracle creams, the doctors at University Foot and Ankle Institute will not only diagnose but effectively treat all your foot ailments.
Choose University Foot and Ankle Institute for your Lumps and Bumps!
If you are experiencing problems with your feet or ankles we are here to help. Our nationally recognized podiatrists and foot and ankle specialists offer the most advanced foot and ankle care along with the highest success rates in the nation. We are leaders in the field of research and treatment of all foot and ankle conditions.
For more information or to schedule a consultation in the greater Los Angeles area, please call (877) 736-6001 or make an appointment now.
University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia.
When not tending to patients at University Foot and Ankle Institute, Dr. Jafary utilizes his surgical expertise assisting those less fortunate. As a member of the Yucatan Crippled Children Foundation, he has traveled to Mexico several times and performed hundreds of limb correction surgeries on children with disabling foot and ankle disorders. Dr. Jafary also participates in Podiatry Overseas, which takes him to underserved countries to treat patients with lower extremity deformities.
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