A ganglion is a cyst that forms on top of a joint, ligament, or tendon. The cyst is filled with fluid. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms such as pain, your doctor may recommend observation only to make sure that no unusual changes occur.
The procedure to remove a ganglion is called ganglion resection. The initial treatment of a ganglion is not surgical, but if pain becomes a problem, your orthopaedic foot and ankle specialist may recommend aspiration, a procedure to remove the cyst’s fluid through a needle. If the cyst returns, surgery to remove the ganglion might be an option.
A ganglion may cause pain. The enlargement of the ganglion may cause skin irritation or make it difficult to wear shoes. The ganglion may cause pressure on nerves and produce burning, tingling or numbness. For some patients, the appearance of a ganglion may not be acceptable.
Your doctor may recommend surgery if your symptoms are not relieved by non-surgical methods, or if the ganglion returns after aspiration.
If the ganglion is not causing any problems, then non-surgical treatment may be preferable because this avoids the risks associated with surgery.
Ganglion resection typically is an outpatient procedure and patients are able to go home the same day. You can be given a local or a general anesthetic. The choice depends partly on which you prefer, and partly on what your surgeon thinks is best. Often, local anesthesia is used in conjunction with IV sedation.
Usually open surgery is done, though in certain circumstances your surgeon may recommend arthroscopic surgery. The entire ganglion wall is removed and some surrounding tissue that may be the root of the ganglion is removed to prevent recurrence of the ganglion cyst. The cut made in the skin to resect the ganglion is at least as wide as the lump. The wound will be closed with sutures and covered with a dressing.
Your doctor will decide whether the foot and ankle requires immobilization in a cast or boot following surgery and also whether or not you can walk with full weight on the foot right away. If not, you may require crutches for a period of time.
There is some tenderness, discomfort, bruising and swelling after surgery. Pain medications, elevation and rest help during wound healing. The wound should be kept clean and dry. It usually will heal within two weeks.
You will have a scar instead of a ganglion. The skin around the scar may be permanently numb. You should avoid footwear rubbing against the scar.
Normal activities may be resumed two to six weeks after surgery.
RISKS AND COMPLICATIONS
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Complications from a ganglion resection are rare and seldom serious. Ganglion resection surgery can occasionally result in pain or scarring. Recurrence of the ganglion will happen in one out of five patients.
Would you recommend removal rather than aspiration?
Aspiration (removal of fluid through a needle) of the ganglion cyst and injection of steroid is less invasive than ganglion resection but there is a relatively high rate of recurrence. It is reasonable to simply observe the ganglion cyst if it is causing no problems or to have it aspirated and injected to see whether this is effective before considering surgery.
May I continue to exercise after surgery?
Depending on several factors, including the size and location of the wound, your doctor will advise you when it is safe to return to exercise. It is usually between two and six weeks after surgery.
Can this surgery make me worse?
This is possible but unlikely. Ganglion resection will result in a scar and there is a one in five chance of the ganglion coming back after the operation.
Will my foot be pain-free after surgery?
If you have foot pain that is not related to the ganglion then this may not be relieved by ganglion resection.
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