Lumps on the Top of the Toes and Foot

Ganglion Cyst

Ganglion cyst can appear as a large or small lump on the top of the foot. The most common area of involvement is at the front of the ankle. These masses can pop up at any time without notice and can potentially be painful. Ganglions are typically due to a weakening of the soft tissue that covers a joint space or tendon. The tissue creates a pocket and becomes filled with a gelatinous joint fluid. The pain can occur when the mass becomes large enough or presses up against a nerve.

Diagnosis of the mass is typically done by physical exam, imaging, and biopsy. During the physical exam the podiatrist will check the location, size, feel, and symptoms of the mass. This is done with palpation and percussion of the mass and its surrounding areas. X-rays are used in order to determine the possible causes of the ganglion. Bone spurring is a result of arthritis and ganglions can appear about these joint spaces. Ultrasound is very helpful in diagnosis soft tissue masses as well and can be done in the office. An MRI may be used for confirmation of the mass and this type of imaging is also helpful for surgical planning.

Treatment of the mass conservatively is done by draining the lesion. A small amount of anesthetic is placed adjacent to the mass so that the skin is numb. A larger needle is then placed into the numb area and the mass is aspirated. The material that was aspirated is then sent to a pathology lab where its contents will be analyzed and identified. Cortisone injection into the same area will hep to reduce inflammation and help decrease reoccurrence. Unfortunately there is a 70% recurrence rate with aspiration. Removal of the cyst surgically can also fail with reoccurrence but at a lower rate.

Mucous Cyst

Mucous cysts are lumps that are seen at the top ends of the toes. The area where this mass typically appears is at the distal interphalangeal joint. This is the toe joint that is located at the ends of the toes. The exact cause of the mucous cyst is unclear but theories include a defect in the soft tissue surrounding the joint and thickening of the tissue involved. These lesions are most common in women and can appear in the 40th through 70th decades. Aspiration of the lesion is a conservative option but care must be taken to not have any infections occur. Excision of arthritic bone and also the lesion has the best long term results. Recurrence still may occur with the two previous options. Injection of the lesion with steroids may help but again reoccurrence will be high. If redness and swelling develops after any of these treatment options it is very important to treat the infection quickly to avoid complications. Infection of the joint and the bone may occur if the soft tissue infection is not treated properly.

Hammer toe with callus

Crooked toes are a very common issue among feet of all ages. The contracted toes are typically a result of poor foot posture and trauma. Poor foot posture such as flat feet or high arched feet can cause the feet to pull on tendons abnormally. This abnormal tension can lead to contraction and prolonged contraction can lead to a fixed deformity. Trauma such as a toe fracture can cause a toe to look bumpy. This is an acute circumstance and can be dealt with fairly quickly in the office. The doctor will numb up the toe and place the toe back into place. He/She will also splint the toe so that the toe does not go back to its incorrect position. The more common cause is from the poor foot posture. Conservative measures include custom inserts, stretching, padding, and strapping.

Orthotics are crucial to helping this problem since they have the ability to place the foot into a proper position. This proper position reduces the strain to the foot which in turn reduces contracture of the digits. The orthotic can be combined with strapping and padding to help reduce the deformity even more and reduce symptoms. The most common complaint for this problem is pain on the tops of the toes because the contracted toes are pressed against the inside of the shoes. The shoes can therefore be changed to accommodate for the deformity and help with the symptoms.

Surgical options include releasing the tendons that are causing the contracture and if necessary removing some bone. Tendon release is a very minimally invasive option that can be done in the office under local anesthesia. The removal of bone is only in cases of debilitating pain and also a rigid deformity. If the doctor during the exam cannot reduce the deformity then a rigid boney contracture exists. This problem requires surgery since a simple tendon release will not change the structure of the toe.

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