foot problem: advice please

I'm not a foot surgeon, but I would advise avoiding surgery as much as possible and using it as an absolute last resort – it can cause more problems than it solves. Surgery should be reserved for major deformaties and injuries in which other measures just won't be effective enough.

Having been sidelined by a foot/leg injury before, I know how frustrating it can be. Hope you feel better and get out this summer.

bumping this to the top to see if it gets some more responses,
thanks,

Billy

"bumping this to the top to see if it gets some more responses,"

Why not cut to the chase and PM Jennifer Mitol? She's about the only one here who actually knows a lot about issues like this.

I certainly would like to hear from Jennifer, but there may also be some hikers out there that have had this particular issue… That's why…

billy

Hey Billy,

well, you're right. There are only a few things you can do about synovial cysts – one of the most common and effective home remedies (and no, I'm not making this up) is to smack it really hard with a book to smash it. Obviously, there is the possibility of associated injury, but otherwise it's pretty darned effective (especially if there is a bony prominence under the cyst).

You can continue to have it aspirated, but I'm kind of surprised that they didn't put some corticosteroid or something in there as well to keep it away. That's usually the standard of care.

As far as having it excised, yeah, try to avoid it if you can but it's really not that big of a deal. You'd be out maybe a week -10 days?? The surgery is not TOO much more complicated than simply having a skin tag or a wart removed, usually it's done arthroscopically.

Thanks Jennifer…
"You can continue to have it aspirated, but I'm kind of surprised that they didn't put some corticosteroid or something in there as well to keep it away."
Well the doc says he does not use corticosteroid for these and I am not a big fan of it as I have read that steroids can weaken the soft tissues and cause the area to be prone to injury.

Right now I'm afraid to put it in a boot and do miles. Afraid it will swell up and make things worse… and harder for the surgeon to repair if I go that way.

Do you have any idea if hiking and swelling it back up would make things worse? It's right above the big toe joint and there is a large tendon there that goes out onto the big toe.. and veins too. Just doing some yard work there was slight abrasion on the cyst bump so I'm thinking a boot and miles are out.

Feel like I'm kinda in limbo here… great early hiking season in the Sierra and I'm stuck on the couch :(

Billy

all a cyst is is a fluid filled sac, in your case involving the synovial lining of the joint. Yes, constant friction and what not can make it worse, and there have been a few studies that demonstrate a possible increased risk for OA of the offending joint.

Without seeing your foot and knowing exactly what's going on – can you just splint that joint? Wear stiff-soled shoes? Put a huge bit of moleskin around the cyst (with the cyst poking through, the moleskin around it – kind of like one of those bunion pads, but to go over the cyst instead of a bunion?

The good news is that cysts are pretty benign, they usually don't cause too much damage, and are relatively easy to deal with. If you have to have it cut out because none of these things are working, then don't worry too much about it…it's not an awful surgery (of course, I'm saying this without seeing your foot and without knowing the extent of your particular cyst – so take my words for what they are worth – generalizations, and not much more).

Thanks for the suggestions Jennifer. I'll try some of that…

Doctors know stuff in the office environment, but don't relate very well the out on the trail situations… your suggestions are good ones to try…

billy

Jennifer, does Billy's toe cyst sound about the same as a Baker's Cyst in the knee joint? I am all too familiar with that.

As long as you can keep the joint "stock" and natural, you are OK. As soon as you have had any joint surgery or injury there, then there is a good chance that a little fluid pocket will form. As long as it stays there, it is sort of OK. However, if it gets some insult, like a sharp blow, the fluid sac may burst and leak its fluid downward. Then you can get some serious inflammation, pain, and swelling where it ends up. In the case of a knee, it does this in the upper part of the calf muscle. In the case of a toe, it depends on how you orient your toe.

According to the three or four physicians who have treated me for Baker's Cyst at the knee, about all you can do is to take OTC anti-inflammatory drugs, elevate it as often as possible, and hope for the best. That has nearly always fixed me up within a week or ten days. Toes might be different.

For a while, they kept thinking that I might have some blood clot or something. Modern medical imaging and ultrasound eliminated that possibility.

–B.G.–

Bob… I looked it up on the web and it does sound similar to synovial cyst… though the underlying cause seems different…

billy

A Baker's cyst is a great example how LOCATION is the main issue with cysts. The cyst is the same – a fluid filled sac, in the case of a Baker's cyst caused by bunching up of synovial tissue on the backside of the knee then fibrosing – but it's the location that determines whether or not it's going to be a problem.

There are A LOT of very, very sensitive things behind your knee, which is why it's relatively problematic to remove the cyst and why we usually just leave them alone. But it's also why they'd be looking for blood clots and all that stuff – you can feel your pulse behind your knee (if you know where to look), and sometimes that cyst can push against important things.

But overall a cyst is relatively benign – it's just a question of where it is and if it pushes on something important that matters.

Hi again Jennifer,
In your response you reference my synovial cyst being joint related. That may be. but it also may be that it is a rupture in the tendon sheath, the tendon that goes over the top of that big toe joint and on out the toe. I believe the offending item was a can of soup dropped onto the top of that toe joint… (It hurt/stung like hell) could have ruptured the tendon sheath allowing synovial fluid to escape. Would that make any difference in your advice? Treatment? Recovery?

thanks,
Billy

Billy,

Yes, it MAY make it more complicated, but honestly, a ruptured tendon sheath is messy business with or without a cyst. That's kind of a whole different ballgame, and that would be your main problem, rather than the cyst.

Did you have any imaging that showed a ruptured sheath? If not, and you can actually move your toe, then most likely it's just a collection of fluid (that absolutely can come from a contusion such as you described) and honestly, if it is OUTSIDE the joint capsule then the surgery to remove it is even easier.

Of course, thanks for realizing that I'm saying these things without actually examining your foot.

Jennifer

No imaging. Not only can I move my toe, there is no reduction in movement and there is no pain. I'm just afraid to put the swelling in a boot and make it worse.

Thanks for your comments. I do understand that you are not actually looking at the foot and don't worry, I'm no fool, I will take all advice/comments with a grain of salt and be responsible for my own actions/decision… I would not hold you liable for any of your comments.

billy