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Hello all,

I have a patient who was wearing ill fitting shoes about a year ago, he says the crease on the shoes upper pushed against his little toe and created a blister just proximal to the proximal nail fold.
Since then he has this blister that builds up when he wears his normal shoes - he has to lance the blister, but two to three weeks later the blister is back again.

Looking at the site - which is a raised blister about 3mm x 3mm by 1mm height - there is no evidence of flakiness, redness etc, ie. fungal or bacterial infection. When I lance the blister there is transparent exudate that has a gel like consistency. The patient seems to think there is one area of the blister where the pain is coming from- as there is some pain when I press the area.

I said I would get back to him about how to treat this problem... does anyone have any ideas?

Many thanks

 

Mucoid Cyst arising from the dipj?

 

thanks very much for that, i have looked this up and it seems to correlate well with the patients presentation. Next time i see him i am going to draw a sample from the 'blister' and if hyaluronic acid....well ...i will know. thanks again.

 

This is most likely a myxoid cyst, Peter. the diagnostic is the sticky gel. This is synovial fluid tracking from a joint - most probably the proximal IPJ. Surgery is the treatment of choice as the tract along which the synovial fluid reaches the cyst needs to obliterated, otherwise the cyst will probably reccur.

 

Aren't mucoid and myxoid the same thing? Peter described the lesion next to the nail plate, as such wouldn't this be coming from the DIPJ as I mentioned.

 

think they are the same thing... :
In the literature, they have been referred to as cystomata, myxomatous cutaneous cysts, myxomatous degenerative cysts, periarticular fibromas, synovial lesions of the skin, periungual ganglions, mucous cysts, myxoid cysts, synovial cysts, dorsal cysts, nail cysts, cystic nodules, digital mucoid cysts, digital myxoid cysts, and digital mucinous pseudocysts (emedicine).

the fluid was definitively of a gelatinous consistency, so not a normal blister. will refer to surgery I think. Thanks again.

I dont really need to take a sample of the fluid...or do i??

 

Agree with George. Highly unlikely to be anything other than a muoid cyst given the description.

I generally give the patients two options:
i) live with it (as my mum does with hers)
ii) DIPJ arthroplasty with ellipse of the lesion. Never seen one associated with the PIPJ.

Most go for the surgery. I've done quite a few of these without seeing any complications including recurrence.
No sample of fluid required. Infact it's easier to remove these surgically when they haven't burst or been aspirated.

Ryan

 

hi,

great, thanks for that. Have advised on compressive therapy with cordran tape, and soaking the foot in epsom salt with warm/hot water as a first - however don't have much faith in that to be honest - suggested surgical referral if no improvement.

thanks for the replies

Peter