Soft Tissue Surgery
Ganglion
Ganglions are a relatively common and present as a smooth swelling beneath the skin that cannot be compressed. Ganglions arise from either a tendon sheath or a joint. Within these structures is synovial fluid; a thick jelly like substance (the “oil” of joints and tendons). Ganglions occur when there is a weakness of either structure. This weakness leads to expansion of the joint capsule or tendon sheath which is filled with the synovial fluid. If the ganglion is not causing too many problems, it may be advisable to monitor it. Other treatments include draining. Draining the ganglion is not always successful and commonly the tendon sheath or joint capsule repairs itself and refills. Surgery involves excising the ganglion and attempting to repair the weakness. However, it is important to know that even following surgery there is a recurrence rate of ~30%.
Bursa
A bursa is a superficial fluid filled sac. There are two types of bursas: anatomical and adventitious. Anatomical bursas are meant to be there and are often between tendons and joints. Adventitious bursas form when an area of skin is exposed to excessive friction or a joint becomes prominent and rubs on your footwear, which is the case with bunion deformities. Adventitious bursas are the ones that often cause problems in the foot and ankle. The treatment for a bursa is the same as for a ganglion but in addition, any bony deformity or prominence that is causing the bursa may need to be reduced.
Plantar Fibroma
A plantar fibroma is a fibrous nodule in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet and may be singular or multiple. Generally, it is a benign (non-cancerous) condition with a very low incidence of malignancy. Over time, the fibroma may increase in size but may never produce any problems. Problems experienced include pressure from footwear and discomfort within the lesion itself. Definitive causes for this condition have not been clearly identified.
Treatment can include insoles to cushion the lesion as well as steroid injections into or around the lesion. If these treatments fail and the lesion is painful enough surgical management may be required.
Plantar fibroma surgery involves excision of the fibroma and part of the normal plantar fascia. The reason for this is that if any of the abnormal fibroma cells remain, there is an increased chance of recurrence. The plantar fascia is an important structure in the foot and acts as a beam, preventing collapse of the arch. Following removal of the fibroma you may notice a reduction in the height of the arch, as well as some discomfort on the outside of the foot. Following this surgery, the operation site can take time to settle and it is common for patients to have some residual discomfort three to six months following the surgery.
Following this procedure, you may be placed in a non-weight bearing below knee cast or a heel walker for three weeks.
Following surgery, you may require an insole to help support the foot.
Lipoma
A Lipoma is a benign soft tissue mass that is comprised of fat cells. This type of mass can grow and become extensive and cause discomfort due to pressure onto adjacent soft tissue structures.
Inclusion Cyst
These are caused by a foreign body, such a splinter, getting under the skin and causing a reaction. They can become very hard and sore and often need to be excised.
Digital Myxoid Cyst
A digital myxoid cyst, sometimes called a mucous cyst, is an entirely benign swelling that arises from the joints of the fingers or toes. They are skin-coloured, reddish or slightly translucent and often form, enlarge, rupture, repair and reform and continue in this cyclical process.
Treatment of a myxoid cyst involves removal of part of the bone from the joint which is affected (arthroplasty). Trying to repair the weakness is very difficult and frequently does not remedy the problem.
