Bursting Plantar Fascia Cysts?

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I have very little of the medical information on this particular patient,only what I have been told by the patient.

Patient is a keen runner and has been suffering from "rupturing cysts" in the plantar fascia. Her description is of a 2 week period of build up of pressure in the arch. When running downhill, there is a bursting sensation and the foot feels wet. Nothing is wet when the socks are removed but the patient can feel fluid in the arch of the foot.

Her orthopaedic surgeon has had MRIs which apparently has shown up some types of cysts on the plantar fascia. He has already done bilateral plantar fascia releases - not sure what exactly was done.

A very brief examination shows midfoot equinous bilaterally. No obvious swellings in the arch. There is no tenderness on palpation of the area of rupture. There is excessive pronation at and after midstance.

At the present moment, treatment is on hold until I have some type of diagnosis. However, I have not found anything on my searches here and on google. I wondered whether anyone had any ideas for differential diagnoses?

Many thanks in advance for any input

Regards,

Robin

 

Robin might be good to have a few pics (MRI slides). You might get some better info ?

 

Hi Mike,

I have no access to MRIs or to have them done. Same for radiographs. Reliant on reports passed on to me. I can see people have viewed this thread with little feedback. I suspect it is a combination of insufficient info and unusual presentation. Not surprised really, I was just hoping for the stroke of luck that someone else had come across something similar from my rather inept description!

Regards,

Robin

 

My guess is that when the fasciotomies were done perhaps the surgeon got a bit deep and interfered with one or more flexor tendon sheaths - as a result ganglion formation would likely occur. In this location it would be plausible that repetitive stress from running might burst these. Upon self-repair, the cycle would begin again.

Steve

 

Thanks for the suggestion Steve. Any suggestions for treatment apart from reducing the stress on the flexor tendons by accommodating the midfoot equinous?

Robin

 

Tx:
Well, my advice is to verify your Dx first.
If they are, in fact, ganglions, you always have the option of leaving them.
If you can identify where they are attached (which tendon sheath for instance) you can
possibly come up with biomechanical Tx.

Excision would depend on her symptoms. To be honest, I can't recall seeing a ganglion in this area -
which I assume from your description is plantar-central and deep. The tendon sheaths of all three tendons in this area are quite substantial.

Steve

 

Thanks Steve,

Going to get in touch with the orthopod who did the original fasciotomy and request further MRIs to get a better idea. Depends on whether the insurance company will pay out for them!
Will update when I have more info.

Regards,

Robin

 

In case anyone is still interested, the patient has been referred to foot ankle specialist for further investigation. Never managed to get more info on the MRIs. However, I found this interesting case study posted by Kevin Kirby on another thread for chronic exertional compartment syndrome. I have passed it on to the foot ankle surgeon who will be seeing the patient

Many thanks to Kevin

Robin

 

Hi Robin:
thanks for the followup.
Your description (other than a bursting sensation) does not really fit a compartment syndrome. These continue to be symptomatic with activity.
If you do happen to get an MRI result it would be interesting to hear what the findings were.
Steve