Question
QUESTION: I began having sharp, periodic pain at the base of my left big toe after a week on a bicycle tour (about 50 miles per day). My podiatrist diagnosed it as hallux valgus and prescribed orthotics for me. I've been using them about a month and they have helped eliminate the pain, but now I have what the doctor has diagnosed as a ganglion cyst on the bottom of my foot in the space between the bottom of my great toe and the ball of my foot. Could the orthotics have caused this? Is there anything I should be doing to prevent further problems other than wearing the orthotics? I exercist a lot by bike riding, hiking, walking, step aerobics, etc. I do not want to let my foot problems go to the point where I am incapacitated.
Thanks for your advice.


ANSWER: Hi Tina,

First, how was the diagnosis of a ganglion cyst made?  Have you had x-rays?  MRI? Is there swelling or pain?  If there is swelling does the area get larger and smaller?  Is there purple discoloration under the skin?

Ganglion cysts come from stress around the joint or tendon.  It would be more likely that the bike trip led to the cyst. However, the location is not all that common.

Are the orthotic devices comfortable when you wear them?  How long have you had a bunion/hallux valgus?  Has there been a similar problem before?

Let me know the answers to these questions and we can move on from there.

Sincerely,


Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com


---------- FOLLOW-UP ----------

QUESTION: Hello Dr. Katz, and thank you for your quick reply.

The diagnosis was made by looking at the lump and manipulating it. It is on the surface,just under the skin and can be moved a bit from side to side. No x-rays or MRIs were done. (X-rays were done before I received the orthotics...might those show if the cyst existed before now? However, if it did, it is certainly bigger.) There is no pain associated with it, just a sort of numbness around the area. There is no purple discoloration, it is slightly white.

The orthotics have been comfortable from the start and do not rub or chafe the bottom of my feet anywhere.
I should tell you that I am not style conscious and do not wear high heeled shoes, so I don't feel like I did anything unusual to cause this. I prefer to be comfortable.

The bunion (I do have a small one started according to the x-rays), hallux valgus and pain began last August. I reduced my running and other high impact activities in hopes it would go away. I finally went to the doctor in January.
I have never had any problems with my feet at all prior to this.

Thanks for your help.
Tina


Answer
Hi Tina,

It is likely that your activities are causing alot of stress on your feet.  It is good that you are using the orthotic devices.  As I mentioned you are likely not doing damage or causing more problems from wearing the orthotic.  The orthotic is an excellent simple way for long term control of your foot problems.

If you were my patient and had a cyst, especially if it was enlarging and causing some numbness, I would get an MRI with and without contrast.  You would not see a soft tissue cyst on x-ray.

Keep exercising because that is more beneficial to your health than anything else. A good Podiatrist can help you through your foot problems so that you can continue.

Good Luck,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com