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Pt -

45yr female. Moderately active. No significant med. Hx.
Supinated rigid foot type. RCSP - 0 degrees BF, NCSP - 2degrees inv. BF. Arch height - 30mm BF. +++ WB and pressure on 1st met head. <10 degrees DF at AJ with knee flexed + extended.

1 yr ago she had painful/tender lump appear over base of 5th met. approx. 15mm wide, long, high. Rx. GP syringed out fluid and gave a cortisone injection - had been good until 1/12 ago.

1/12 ago Pt noticed bump reappeared in same region along with tenderness.

My Dx and Rx -

1. occurring because of increased WB on lateral foot and bone spur formation (explaned that bursa and inflammation = "squishy" stuff) on base of 5th met.
2. Tight Peroneol muscles - so pulling on insertion point (causing inflammation and tenderness).

I prescribed muscle stretching of calf and peroneal muscles, icing and use of antiflamm. gel on base of 5th met. Referred to physio for deep tissue massage of peroneal muscle + tendon. Possible long term Rx - orthotic therapy to reduce WB on base of 5th and disperse WB forces over entire foot opposed to just heel, base of 5th met and met heads.

What would YOU diagnose and do for this Pt?

 

Podski,

With this history I would diagnose it as a ganglionic cyst.
The treatment would be the same as the GP. I would want to see if this fluid is a gel. If it is, then it is definately a ganglionic cyst. The injection of a long acting corticosteroid is recommended after the drainage. If it recurs, then consider surgical resection.
One tip when doing the surgery, use atraumatic pickups and use curved scissors to bluntly dissect it (If you puncture it, you will never excise the entire cyst). Track it to the tendon or capsule where it originate from. Once in a while there is an exostosis at this point that needs to be reduced. If you puncture it, you will never excise the entire cyst.

Regards,

Stanley

 

I have come accross a similar thing on a 16 year old girl who does tap and jazz dancing. She has Tailor's bunions and has a squishy, painful lump over the right lat base of 5th MPJ. Unsure if was a bursa/ganlion and why it was there.

 

base of 5th mpj???? i think this is likely to be a classic bursa/bursitis. it's there to redce shearing stress.

 

i would diagnose bursitis (depending on other clinical observations). may some form of insertional tendinopathy of p brevis. could send for mri/u/s scan.

rx = rearfoot valgus post with possible footwear modification to reduce direct pressure.

 

if this is a ganglion then i'm not sure surgery would be particulalry useful. high incidence of recurrence.

 

Lance,

I do surgery for a ganglion if the drainage and injection fail after attempting it twice. I find if done properly, the surgical results are worthwhile. What would you do conservatively, and what are your results?
What's your recurrence rate with surgery?

Regards,

Stanley

 

Maybe it is Plantar Fibroma.
Regards,
Carol B.

 

Could be a fibroma if the patient is a poor historian.

Regards,

Stanley