From the Guidelines
A ganglion cyst on the metatarsophalangeal (MTP) joint of the foot should be initially managed with conservative treatment, including rest, avoiding tight footwear, and over-the-counter pain relievers, with surgical intervention considered only if conservative management fails, as there is no direct evidence in the provided studies to support a specific treatment approach for ganglion cysts on the MTP joint. The provided studies primarily focus on the management of foot ulcers in patients with diabetes, with recommendations for offloading interventions, surgical procedures, and footwear guidance 1. However, the study from 2001 mentions that ultrasound can detect ganglion cysts, among other conditions, which may be useful in diagnosing a ganglion cyst on the MTP joint 1. Key considerations for managing a ganglion cyst on the MTP joint include:
- Conservative management with rest, ice, and pain relievers for mild cases
- Aspiration or surgical excision for persistent or recurrent cysts
- Avoiding tight footwear and using appropriate footwear to reduce pressure on the cyst
- Considering surgical intervention, such as joint arthroplasty or metatarsal head resection, if conservative management fails and the cyst is causing significant symptoms or interfering with walking, although these procedures are typically recommended for foot ulcers rather than ganglion cysts. It is essential to prioritize the patient's quality of life, morbidity, and mortality when making treatment decisions, and to consider the potential risks and benefits of each treatment approach.
From the Research
Ganglion Cyst on Foot MTP
- A ganglion cyst is a benign soft tissue swelling filled with hyaluronic acid and other mucopolysaccharides, which can occur on the foot, particularly around the metatarsophalangeal (MTP) joint 2.
- The development of a ganglion cyst is suspected to be caused by repeated mechanical stress, with the lesion being constantly under pressure due to weight-bearing activities 2.
- Symptoms of ganglion cysts can include swelling, pain, weakness, or paraesthesia, with the two main concerns being the cosmetic appearance and the fear of future malignant growth 3.
Treatment Options
- Treatment options for ganglion cysts can be either conservative or surgical, with nonsurgical treatment being largely ineffective in treating the condition 3.
- Aspiration and steroid injection can reduce the volume of the cyst, but the effect may wane off over time, with the majority of patients having a smaller cyst at the same site after 6 months 4.
- Surgical excision has been shown to have a higher success rate and lower recurrence rate compared to aspiration and steroid injection, with a success rate of 92.5% and a recurrence rate of 7.5% in one study 5.
Recurrence Rates
- The recurrence rate for ganglion cysts can vary depending on the treatment option, with aspiration alone showing the highest recurrence rate (78.1%), followed by aspiration and steroid injection (62%), steroid injection alone (37.5%), and surgical excision (17.6%) 6.
- The overall pooled recurrence rate across 8 studies was 29.5%, with the most common complication being paraesthesia, reported in 14/261 (5.4%) patients 6.
Management of Foot and Ankle Ganglia
- A scoping review of the management of foot and ankle ganglia found that a variety of conservative and surgical treatment strategies are reported, showing good outcomes, but there is a lack of high-quality research currently regarding the treatment of foot and ankle ganglia 6.
- Further research is required to determine the associations between time to treatment, ganglion location, and extent of surgical resection and recurrence rate 6.