CLINIC: Painful Foot Growth

Wed, 22 Aug. 2012 - 7:43 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
I’ve been a regular runner for over 20 years and a marathoner for the past 10. For the last six weeks, I’ve had a pea-sized lump on the bottom of the arch of my foot. It’s tender to the touch, and swells and becomes downright painful when I run or walk long distances.
 
My doctor believes it may be a ganglion cyst, and after a series of failed conservative treatments (ice, stretching, night splint, orthotics) my doctor is now considering cortisone injections or surgery. Is it true that ganglion cysts often recur? I hate to think I may not be able to put this behind me and run regularly again. I also am still interested in running long distances at this point in my life. What kinds of success rates—and recover times—are there for the various treatment options here? 
 
Scott Zychek
Wilkes-Barre, PA
 
ANSWER:
There are lesions in the skin and lesions under the skin. If your doctor diagnosed a ganglion cyst, the growth must not be in the skin (like a wart). Of the under-the-skin growths, a fibroma is a more likely diagnosis than a ganglion cyst. A fluid-filled cyst (ganglion) is rarely painful. You ought to have a diagnostic ultrasound to identify for certain which type of lesion it is, how big it is, and where it is attached before you can begin to assess treatment options or get discouraged about time before a return to running. If the growth is solid and painful, surgical removal is usually very successful and has minimal disability.
 
David M. Davidson, DPM
Williamsville, NY
 
ANSWER:
Lesions under the skin include plantar fibroma, inclusion cyst, or ganglion cyst. If the lump is under the inside of your arch along the plantar fascia, it probably is a plantar fibroma, the most common lump we see on the bottom of the foot. It develops as a fibrous little growth and is relatively dense in consistency, whereas a ganglion cyst develops as a fluid filled sac and is usually softer and more mobile. It comes from the lining of tendons and joints, and is less likely to be under your arch. The inclusion cyst comes from something foreign under the skin, usually after a puncture wound. All of the above are not cancerous and have trauma as a factor in their development.
 
The fibroma unfortunately may grow and does have a tendency to return. The majority of them do not return, but the surgery could sideline you for several weeks. Injection of steroid into the lump is a common and effective treatment for both the fibroma and ganglion. I would recommend this as the first step. The injections will often soften the fibroma, or make a fibroma or ganglion shrink. (An inclusion cyst would require removal. Surgery would be simple and effective.) Surgery for the fibroma or ganglion is usually effective, and I would not anticipate it would bring an end to your running career.
 
Richard A. Bronfman, DPM
Little Rock, AR

(RUNNING & FITNEWS® March / April 2010 • Volume 28, Number 2)

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