Soft Tissue Surgery Perth
Ganglions And Cysts
What are Soft Tissue Lesions?
Soft tissue lesions are unusual tissue growth that leads to protrusions or bulges on or within the foot. They can be painful and usually develop slowly over time, for example over several months. Lesions can be caused by soft‑tissue swelling, sacs of fluid (ganglions), fatty tissue and nerve, vessel or muscle enlargements. A common example is a ganglion cyst, a sac of tissue that is filled with synovial fluid, the liquid that is found in joints and in the sheath of tendons. Ganglions can be large and appear as palpable bumps that are firm, but movable, often on the top of the foot. Similar lumps on the skin can be caused by various other types of lesions. When lesions are deeper in the foot often pain is the main symptom and no protrusion is easily notable on the skin. Medical imaging, including ultrasound and MRI (magnetic resonance imaging), may be helpful and necessary if a soft tissue lesion is suspected.1 Soft tissue lesions can occur at all ages, with a large variety of types common in the foot.2
Lesions become problematic and painful if they occur in a location that either receives direct pressure from weight bearing and shoes, or where they place pressure on other structures, for example adjacent nerves. Tight footwear, standing, walking or running and jumping complicate the effects of soft tissue lesions in the foot leading to pain and loss of function. It is important that soft tissue lesions are assessed by a Podiatric Surgeon or podiatrist to ensure that benign lesions are distinguished from more aggressive or malignant lesions.
Treatment can be conservative or surgical and all procedures aim to reduce pain and increase function. If you have noticed a growing lump or prominence on your foot or you are experiencing pain with normal activities and weight bearing that is affecting your daily or sporting activities your foot should be examined by a Podiatric Surgeon or podiatrist who are exclusively trained foot and ankle specialists. Dr Pocklington (Podiatric Surgeon) can provide expert assessment and treatment of all types of soft tissue lesion.
How are Soft Tissue Lesions Treated?
Depending on the location and type, soft tissue lesions can be treated conservatively or with surgical correction. It is important to consider conservative treatment before pursuing surgical options, because often conservative treatment can significantly alleviate symptoms and in some cases resolve the condition.
Dr Pocklington is both a Podiatric Surgeon (foot and ankle specialist surgeon) and trained podiatrist with extensive understanding of the form and function of the foot before and after surgery. This includes consideration of conservative as well as surgical intervention and the overall function (biomechanics of your foot).
Conservative treatment of prominent lesions can involve offloading and accommodation with pads, tape, footwear modification and orthotics. In some specific cases, aspiration (removal of liquid) or corticosteroid injection may be appropriate. If the lesion is benign accommodation and ongoing monitoring may be all that is required to get you back to normal activities.
When Should I Consider Soft Tissue Lesion Surgery?
If conservative measures are not able to alleviate your discomfort or if there is significant pain interfering with normal activities, or if the nature of the lesion is problematic and the risk is high of further complications, surgical intervention should be considered. In most cases your Podiatric Surgeon is best placed to advise you if surgical removal of a soft tissue lesion is advised.
The goal of surgery is to remove the lesion, resolve pain, and restore normal anatomy and function to the foot. The key result is return to pain free normal activities and footwear. As a Podiatric Surgeon, Dr Pocklington is a foot and ankle specialist trained comprehensively in procedures used to treat soft tissue lesions and can assist you in deciding whether surgery is right for you.
What Does Soft Tissue Lesion Surgery Involve?
The extent of a soft tissue lesion surgery depends on the location and nature of the lesion, but generally the procedure is a simple removal of the problematic tissue. In some cases, surrounding structures also need repair, for example where a tendon has to be cut and repaired to allow the removal of a fibroma (a tight, overgrown bundle of soft tissue fibres).
The surgery will involve a cut and removal of tissue. In most cases, removed tissue is sent for histology testing to confirm the nature of the lesion. All surgical procedures have advantages and risks that Dr Pocklington will discuss with you in detail prior to your surgery. Most soft tissue procedures are quick and take between 10 and 20 minutes to perform. Anaesthetic injections are used to numb your foot locally in all cases, but an anaesthetist will also provide either a general anaesthetic or IV sedation.
Care and Recovery After Surgery?
Soft tissue lesion surgery is usually a day procedure allowing you to immediately weight bear on your foot in a stiff sole surgical shoe. Sometimes people stay overnight at a private hospital and return home the following day. If the lesion is large and in a particularly problematic location, for example a lesion located within the calcaneus (heel) bone, then a period of non-weight bearing in a cast or CAM walker with crutches may be necessary.
Pain relief after surgery usually involves a combination of painkillers and anti-inflammatories, but significant pain relief is often unnecessary. Paracetamol is usually all that is required within the first week.
Healing usually occurs 2 to 4 weeks after the surgery and during this time restricted activities, including time off work may be required depending on the location and type of soft tissue lesion. If bone is involved a longer period, for example 8 weeks, may be required. Dressings are removed after 1 week, giving you an opportunity to see your progress and discuss it with Dr Pocklington (Podiatric Surgeon). Dressings are then changed regularly and instructions will be given so you can change dressings at home, if possible and convenient. Sutures are usually removed at 2 weeks. The process of healing after surgery is important and requires ongoing attention from your surgeon. Dr Pocklington (Podiatric Surgeon) will monitor your progress while you heal to ensure function is returned to the foot and your life as soon as possible.
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- Bancroft LW, Peterson JJ, Kransdorf MJ. Imaging of soft tissue lesions of the foot and ankle. Radiologic Clinics of North America. 2008 Nov 1;46(6):1093-103.
- Kransdorf MJ. Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location. AJR. American journal of roentgenology. 1995 Feb;164(2):395-402.
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