While there are many causes of bumps and lumps on top of the foot, the two most common are:

  1. A bone spur on top of the foot
  2. A soft fluid filled sack called a ganglion cyst (tend to be soft and movable but sometimes can become firm)

This page focuses primarily on ganglion cysts. We’ll discuss the cause in more depth and guide you through the best treatment options.

Click here for more information on hard bumps on top of the foot often caused by bone spurs.

Video: lumps and bumps on Top of the foot – causes, treatment

Ganglion Cysts and Other Soft Lumps on Top of the Foot

While ganglion cysts are considered tumors, they are completely benign, harmless lumps; a fluid-filled sack beneath the skin, most commonly found above a joint or in the fibrous tissue that covers a tendon. The cyst is commonly round in shape and varies from squishy to firm to the touch; it is often more irritating than painful. The fluid within the cyst is known as synovial fluid.

The Cause of Ganglion Cysts

While thought to be caused by direct trauma or degeneration in the lining of a joint, the exact cause of ganglion cysts in not known. The fluid within the cyst, like any fluid, tends to travel the path of least resistance, moving away from bone and joints to form a lump beneath the skin; a cyst.

The cyst will often feel “squishy” or “spongy” but is commonly firm. The size of the cyst may fluctuate. It may be pain free, being merely uncomfortable when wearing shoes, or it may become painful when the joint is flexed, such as when walking, running, or climbing stairs.

Ganglions can usually be diagnosed by examination alone, but we will also sometimes use ultrasound to determine the size and extent of the cyst. In rare occasions, it may also be necessary to use an MRI to further diagnose the cyst

Aspiration: The Best Treatment for Ganglion Cysts

Conservative treatment of ganglion cysts should always be the first option, with surgery performed only as a last resort. In fact, many cysts will resolve on their own, without treatment at all. They will simply disappear. However, an examination by your podiatrist is highly recommended to confirm that the lump on your foot is harmless.

The most common and effective conservative treatment for ganglion cysts is a procedure known as aspiration. Aspiration of ganglion cysts involves the placement of a needle within the cysts to draw out the fluid within. This is then followed by a steroid injection to reduce inflammation and prevent recurrence of the cyst.

Should the cyst return after aspiration, ganglion surgery may be required.  We recommend surgery only as a very last resort and, if you are in the Seattle area, recommend you contact us for a second opinion before proceeding with any foot surgery.  As with most foot surgery, surgery for ganglion cysts can be painful and temporarily debilitating, and may require immobilization, before returning to regular activity.

Surgery for Ganglion Cysts

Surgery is rarely necessary for treatment of ganglion cysts.  In fact, over 99% of the ganglions treated in our Seattle clinic are treated without surgery. If you have already tried conservative treatment, however, and wish to learn about surgical options, then read on.  Remember, however, foot surgery of any sort should always be the last treatment resort.

Should conservative therapies fail to eliminate the ganglion cyst, or the cyst returns multiple times, then surgery will likely be required. Surgery for ganglion cysts is typically an outpatient procedure, with the patient returning home immediately following the procedure. The procedure is fairly straightforward, with “dissection” of the cyst for the surrounding tissue, followed by removal of the cyst.

Recovery from surgery for ganglion cysts will depend largely on the location and size of the cyst, as well as the extent of the dissection of the surrounding tissue required. Patients can often bear weight while using a walking boot after ganglion surgery but  sometimes non-weight bearing activity may be required following ganglion cyst removal, with crutches, walking cast, or a below-the-knee cast required for immobilization during healing.

Possible side-effects of surgery for ganglion cysts

As with any surgery, there may be some side-effects following ganglion cyst removal. The risks of surgery for ganglion cysts include:

  • Possible Infection
  • Possible Nerve damage
  • Possible Excessive swelling

If you have developed a lump on the top of either foot, you may have developed a ganglion cyst. Especially if it’s painful, please make an appointment today in our Seattle foot and ankle clinic, where we will make every effort to avoid surgery and provide you with effective treatment and relief.