More Conditions

ganglion cyst

What is a Ganglion Cyst?

A ganglion cyst is a fluid filled mass than can occur in any area of the body including the foot and ankle. They usually form around joints or tendons.

What Are The Symptoms Of A Ganglion Cyst?

  • Raised mass or “ball” just under the skin
  • Can be soft or hard to the touch
  • Can be painful when irritated
  • Causes burning or numbness if pressing against a nerve
  • Can grow slowly or quickly
  • Usually a single mass, but can be multiple
  • Can come and go if accidentally “popped” and refills

What Are The causes Of a Ganglion Cyst?

With repetitive trauma to the soft tissue of a joint (capsule) or the wrap around tendons (sheath) these structures can become damaged. The damage can lead to an irritation of the tissue and extra growth of the tissue. The area will fill with the natural fluid that is already within these structures. The extra tissue will then expand and “balloon” underneath the skin and become visible. If the cyst continues to become irritated, it con continue to enlarge and become more painful.

How Is A Ganglion Cyst Diagnosed?

Diagnosis is achieved by the clinical examination and ultrasound imaging of the patient. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and the cyst. Diagnostic ultrasound of the cyst will be performed in the office to examine the source of the cyst its size and will be reviewed with the patient. Aspiration of the cyst fluid for analysis may be needed to confirm the diagnosis.

How Is A Ganglion Cyst Treated?

A ganglion cyst does not have to be treated if it is not painful and does not impede the use of shoes. Ganglion cysts are benign lesions that are not harmful to the body and do not become cancer.

When they are painful, unsightly, or make it difficult to use certain shoes, they can be treated with aspiration or surgical removal.

Aspiration Of a Ganglion Cyst:

Aspiration of a cyst is the removal of the fluid through a syringe and needle. All the fluid from the cyst will be drained. The fluid is then sent to a lab for analysis to confirm the diagnosis.

  • In Office Procedure
  • Local Anesthesia
  • Painless
  • Ultrasound Guidance used for Precision
  • Needle is placed into the cyst
  • Fluid is drained using a syringe
  • High recurrence rate
Surgical Removal of a Ganglion Cyst:

Surgical removal of the cyst is the gold standard treatment for painful and recurring cysts that have failed aspiration attempts.

  • Performed in an operating room under light sedation
  • The entire cyst and its damaged tissue is removed
  • The “stalk” where the cyst originated from is closed to reduce recurrence
  • Immediate walking in a special shoe and activity begins in 2 weeks
  • Very low recurrence rate

Metatarsalgia (Ball of Foot Pain)

What is Metatarsalgia?

There are 5 long bones behind each toe called the metatarsals. They are named in order from the big toe to the 5th toe as the 1st,2nd,3rd,4th, and 5th metatarsals. They act to support the weight of the body through the arch. At the level of the “ball” of the foot are the “heads” of the metatarsals, where they are round and larger than the narrow long shaft of the bone that leads to the wider square “base” at its end. These bones angle downwards towards the ball of the foot, placing all the pressure from the ground at the level of the ball of the foot.

Metatarsalgia is a term that could define many different problems at this level of the foot.

What are the Symptoms of Metatarsalgia?

  • Pain under the ball of the foot
  • Bruising feeling
  • Numbness
  • Pain when pushing off the ground
  • Painful Callus formation

What Causes Metatarsalgia?

  • Excessive exercise with demands on the ball of the foot
  • Walking long distances in poor shoes
  • Stress fracture of the metatarsal
  • Untreated fracture of the metatarsal
  • Hyper-flexion of the toe joint
  • A metatarsal that is too long
  • A short 1st metatarsal
  • Barefoot running
  • Bunions
  • Hammer Toes
  • Morton’s Neuroma
  • Plantar Plate Tear
  • Toe Sprain

How is Metatarsalgia Diagnosed?

Diagnosis is achieved by the clinical examination and x-rays of the patient. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and evaluating their gait. Digital radiographs (x-rays) of the feet will be obtained in the office and reviewed with the patient. A specialized CT scan of the foot may be obtained to evaluate the metatarsal bones in 3D to aid in diagnosis.

How is Metatarsalgia Treated?

Treatment of metatarsalgia depends on identifying the root cause and source of the problem. The goal of the initial treatment is to reduce the symptoms and support the area of pain.

  • Ice therapy
  • Anti-inflammatory medications
  • Rest
  • Supportive shoes
  • Walking Boot
  • Padding
  • Custom Molded Orthotics
  • Physical Therapy

Plantar Plate Tear

What is a Plantar Plate Tear?

On the bottom of the ball of the foot at the level of each lesser toe, there is a thick and strong ligament called the plantar plate. It attaches to the base of the bone of the toe (phalanx) and the long bone of the foot (metatarsal) across the joint. It’s job is to secure the toe in a straight position within the joint, and relocate the toe when it bends in normal walking. The ligament is named for its shape like a plate.

Spraining or tearing with direct trauma or repetitive trauma over time can damage the plantar plate.  It usually occurs at the 2nd toe joint.  It is sometimes referred to as pre-dislocation syndrome.

What are the Symptoms of a Plantar Plate Tear?

  • Pain in the ball of the foot
  • Pain when bending the toe up or down
  • Deviation of the toe towards another toe
  • Elevation of the toe
  • Leads to the formation of a Hammer Toe
  • Pain with walking and activity
  • Swelling in the ball of the foot
  • Pain in high heel shoes

What Are The Causes of A Plantar Plate Tear?

The plantar plate ligament can sprain, partially tear, or rupture. These can occur with repetitive micro-trauma over time or direct trauma to the structure. It is usually caused by a negative mechanical influence on the joint. Poor anatomy of the foot can also lead to plantar plate tears.

  • High Arched foot type
  • Long Metatarsal
  • Bunions
  • Hammer Toes
  • Hyper upwards flexion of the toe
  • High impact sports
  • High heel shoes

How is a Plantar Plate Tear Diagnosed?

Diagnosis is achieved by the clinical examination and x-rays of the patient. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and evaluating their gait. Digital radiographs (x-rays) of the feet will be obtained in the office and reviewed with the patient. A specialized CT scan of the foot may be obtained to evaluate the metatarsal bones in 3D to aid in diagnosis. Diagnostic Ultrasound of the ligament will be performed to directly evaluate the ligament and will be reviewed with the patient. An MRI may be ordered to further evaluate the ligament.

How Is A Plantar Plate Tear Treated?

Early diagnosis and treatment of a plantar plate tear is paramount. It can take several weeks and months for a plantar plate to heal depending on the amount of damage to the ligament. Those with a plantar plate tear need to be patient during the healing process. Cortisone injections are NOT recommended.

The plantar plate is difficult to heal because:
  • It has poor blood supply
  • Its location on the bottom of the foot is under constant strain
  • There is repetitive bending of the toe, stretching the ligament when walking
Treatment with No Deformity of the Toe:
  • Ice Therapy
  • Anti- inflammatory medications
  • Rest
  • Splinting / Taping the toe in a downwards position
  • Stiff soled shoes
  • Custom Molded Orthotics
  • Physical Therapy
Treatment with Deformity of the Toe:

Sinus Tarsi Syndrome

What is Sinus Tarsi Syndrome?

The Sinus Tarsi is a small cavity below the ankle located on the outside of the foot, just below and in front of the ankle bone. The cavity is between the ankle bone (talus) and the heel bone (calcaneus). It has a direct connection to the joint below the ankle that allows the foot to move inwards and outwards, called the Subtalar Joint.

There are important ligaments, nerves, capsule, and fat that are within the sinus tarsi. These structures can become injured following repetitive strain, trauma to the subtlar joint or a foot deformity like a flat foot (pes planus). When this occurs the joint and sinus tarsi can become inflamed and irritated, leading to pain when walking. This is called Sinus Tarsi Syndrome.

What are the Symptoms of Sinus Tarsi Syndrome?

  • Pain over the outside of the ankle
  • Swelling over the outside of the Ankle
  • Tenderness over the outside of the Ankle.
  • Symptoms are typically worse in the morning
  • Pain and Stiffness that slowly improves as the patient warms up.
  • Symptoms may also be aggravated during walking or running especially on slopes or uneven surfaces.
  • Arthritis of the Subtalar Joint

What Causes Sinus Tarsi Syndrome?

Sinus tarsi syndrome usually occurs following an ankle sprain or due to the repetitive strain associated with walking or running on an excessively pronated (flat) foot.

  • Poor flexibilit
  • Inappropriate training
  • Poor foot biomechanics
  • Inappropriate footwear
  • Muscle weakness
  • Ankle Sprains
  • Foot Sprains
  • Flat Feet

How is Sinus Tarsi Syndrome Diagnosed?

Diagnosis is achieved by the clinical examination and x-rays of the patient. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and evaluating their gait. Digital radiographs (x-rays) of the feet will be obtained in the office and reviewed with the patient. A specialized CT scan of the foot may be obtained to evaluate the Subtalar Joint and the Sinus Tarsi in 3D to aid in diagnosis.

How is Sinus Tarsi Syndrome Treated?

Treatment in Early Stages:
  • Rest, Ice, Compression, Elevation
  • Anti-Inflammatory Medications
  • Supportive Athletic Shoes
  • Physical Therapy
  • Custom Molded Orthotics
  • Cortisone Injection into the Sinus Tarsi
  • Walking Boot
Treatment In Chronic Stages:

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