You have been directed to this section of the website because you have developed a soft tissue mass on your foot/ankle.
There are many types of abnormal swellings that can occur on the foot and ankle. The most common are ganglion cysts or bursae (fluid filled sacs). Other causes include lipoma (fat tissue), plantar fibroma (nodule), or cyst formation due to a reaction to a foreign body that has become buried under or within the skin.
Soft tissue masses are not normally painful although they can catch on footwear or irritate nerves under the skin and can become problematic. Those on the bottom surface of the foot can be sore when standing or walking.
It is very important to note that whilst it is possible, the development of cancerous soft tissue masses in the foot is exceptionally rare.
The diagnosis is usually made following a clinical examination. The location, texture and size of the lesion all provide clues as to the nature of the soft tissue mass. An x-ray may occasionally be request to help exclude the possibility of an underlying bony abnormality and an MRI or ultrasound may also be required to help provide further details on the true size and location as well as involvement of other structures. On occasions, Mr McCallum may not be able to give a definite diagnosis without surgically removing the soft tissue mass and sending it for analysis.
Types of soft tissue masses:
• Ganglions: Ganglions vary in size and are fluid filled lumps that can occur on many locations over the body although the top of the foot and hand are the commonest locations. They may feel firm and rubbery in texture and they may move under the surface of the skin. It is common for the size of a ganglion to change over the course of time depending on how much fluid fills into the sac.
• Bursa: A bursa is fairly similar to a ganglion although they are a normal finding in the body. They are generally found close to or overlying joints and generally only become noticeable whenever they swell or become inflamed. This can occur due to irritation or repetitive pressure.
• Plantar Fibroma: A plantar fibroma (not to be confused with plantar fasciitis) is a fibrous nodule that develops on the bottom surface of the foot; normally within the arch. They vary in size and may result from trauma to the plantar fascia, which then undergoes rapid repair and the thickened nodules form. They are often pain free and totally harmless. Patients often present because they are concerned about the growth rather than any pain associated with it. They can be tender with pressure.
• Cyst: Cysts around a foreign body can develop due to irritation or puncture of the outer skin layer. A reaction occurs that may be an asymptomatic swelling or an irritating lesion.
Soft tissue masses often do not require any treatment. Treatment is indicated whenever the swelling becomes a problem due to discomfort or difficulty with footwear fitting.
• Wider/deeper footwear
• Anti-inflammatory or pain killing medication
• Aspiration (draining the fluid through a needle and syringe)
• Steroid injection
This involves excision of the lesion. All soft tissue masses that are surgically removed are sent off for analysis to allow for accurate identification/diagnosis.
• Ganglion: An incision is made over or around the swelling and the sac is dissected out from the surrounding tissues. Ganglions can recur and for this reason, surgery should be considered only if the lesion is problematic.
• Plantar fibroma: A curved or Z-shaped incision is made over the fibroma on the bottom of the foot. The fibroma is excised along with a section of the surrounding healthy plantar fascia. The incision may result in a thickened scar and this can be painful to walk on. There is a high recurrence rate following surgical excision of plantar fibromas and so surgery is rarely indicated. Incisions on the sole of the foot normally require a non-dissolvable stitch which remains in the skin for 3-weeks before removal.
• Skin lesion/foreign body: an incision is made over the lesion and the mass is removed.
A protective shoe will be put onto your foot before you leave the hospital. This is removable and can be taken off when resting. Crutches will also be provided when necessary.
You should travel home by car and keep your foot elevated on the back seat where possible. When you go home, you must rest with the leg elevated for the first 2-4 days (essential walking only). It is important that you do not interfere with the dressings and that you keep them dry. You can buy a purpose made waterproof device from the chemist if you wish.
Mr McCallum will review you within one week of your operation for a change of dressing and at the 2-week mark, the dressings will be removed and the sutures will be cut. You can wash your foot as normal from this point and return to a comfortable shoe. Massaging around the surgical site will help prevent a build up of scar tissue in the surgical area, which can be painful. Some patients find this uncomfortable but it will not cause any damage to your foot.
The foot should gradually improve over the course of time but it can be up to 6-months before the foot has completely settled down.
Possible Complications following surgery:
Outlined below are the possible problems or the rare complications following foot surgery with serious outcomes. In cases where there are no accurate audit results, published results from podiatric literature have been used.
• Prolonged swelling taking more than 6-months to resolve can occur in 1 in 500 operations.
• Haematoma- a painful collection of blood under the skin. This can increase the risk of developing an infection and may require further surgery to resolve.
• Thick or sensitive scar.
• Adverse reaction to the post-operative pain killers. 1 in 50 patents report that codeine preparations make them feel sick.
• Infection of the soft tissue. 1 in every 83 operations.
• Infection of bone- osteomyelitis. This is a serious complication and in severe cases, can lead to amputation.
• Delayed healing of soft tissue or bone.
• Circulatory impairment with loss of tissue.
• Loss of sensation can occur although this is not normally permanent and can continue to improve over 18-months.
• Deep vein thrombosis (blood clot) can result in the clot travelling to the lung and this can be a life threatening condition. Deep vein thrombosis incidence is 3 in 1000 cases.
• Complex pain syndrome- a condition where the nervous system dealing with pain over reacts. This is a very painful condition that can result with even with minor trauma. It normally requires management by specialists in this condition and does not always resolve. This is a rare condition that occurs in 3 in 2500 cases.
• Recurrence of deformity or failure of the surgery.
The risk of developing a complication can be minimised when the patient and all those concerned with the operation and aftercare work together. This starts with the pre-operative screening and continues through to the post-operative regime.
The pre-operative screening helps us determine whether you are fit for surgery or if any extra measures need to be considered to minimise your risk of developing a complication. It is important that you disclose your full medical history. If there is a query regarding your health then further investigations may be required and Mr McCallum will liaise with the appropriate medical specialists. Mr McCallum and the there team will ensure that your operation is carried out safely and effectively.
You can improve your healing process and reduce the risks by:
• Adhering to the post-operative instructions, which include resting and elevating the operated foot. Keeping the wound dry and clean until advised otherwise. Please ask Mr McCallum if you are not sure what to do.
• Having a healthy diet is important; this provides the nutrition required for healing.
• Alcohol can interact with the drugs that are prescribed and can impair wound healing.
• Post-operative mobilisation will be advised; this helps improve flexibility, strength and stability of your foot.