Clinical photographs showing large soft tissue mass in the left great toe. Orange County, CA.

Foot or Ankle Soft Tissue Mass in Orange County

Our Orange County Podiatrist / Foot and Ankle Surgeon can evaluate and treat your foot or ankle soft tissue mass at our Irvine, CA, Huntington Beach, CA, or Orange, CA offices.

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Soft tissue lumps and masses in the foot or around the ankle are rarely dangerous tumors. Only about one in one thousand are malignant tumors capable of spreading to other parts of the body. More common are bursas, ganglion cysts, inclusion cysts, fibromas or lipomas. Ganglion cysts are best thought of as contained leaks of lubricating fluid of tendons or joints. While they are not generally harmful, they can be painful. Bursas are small sacs of fluid that the body produces to cushion prominent bones or protect tendons from irritation. On occasion they too can become inflamed and irritated. Inclusion cysts form when the body walls off a foreign body. These can often form from splinters and pet hairs.

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There are many other kinds of soft tissue mass of the foot and ankle in Orange County. It is difficult to definitively diagnose a mass based on visual findings alone. Certain types of masses occur in certain areas. While this may be a clue to the diagnosis, MRI can sometimes be used to assist with determining a likely diagnosis. To be sure about the mass, excision is often necessary.

 

What You Can Do:

• If you have a mass, have it examined.

 

What Your Orange County Foot Doctor May Do:

• Aspirate or drain the mass if it appears to be fluid-filled.

• Inject the mass with a steroid, which may shrink it.

• Order an MRI or other advanced imaging.

• Recommend and perform excision.

• The mass can then be examined by a pathologist and a final diagnosis can be made.

 

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Commonly found masses in the foot and ankle:

 

Ganglion in Orange County

A ganglion is a firm, rubbery mass that occurs on the top of the foot. On the foot, the most common area of involvement is in front of the ankle or on the outside of the ankle. A common characteristic of a ganglion is that they will enlarge and then shrink is size. They generally occur without any apparent cause.

 

Ganglions arise spontaneously from a weakness in the soft tissue covering of a joint or tendon sheath. Ballooning out of the tissue occurs and it fills with a thick mucoid fluid. In many instances, ganglions are not painful until they reach a size that causes irritation from shoe pressure. On occasion they will compress a nearby skin nerve and cause tingling into the top of the toes. Tapping on the ganglion will often result in this same tingling sensation into the toes.

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Treatment in Orange County may consist of aspiration and application of a compressive dressing, but due to a high rate of recurrence, surgical excision is commonly performed based on the size, location, and patient's symptoms.

 

Giant Cell Tumor in Orange County

This tumor was once thought to be a cancer of a tendon sheath. It is now known to be a benign non-cancerous tumor of a tendon sheath. These masses are generally found on the toes, top of the foot, or sides of the foot. They are always closely associated with a tendon sheath. They can also occur deep inside the foot. They slowly enlarge, but rarely grow any larger than 4cm in size. They are firm, irregular masses that are commonly painful.

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The diagnosis of a giant cell tumor is generally made by a pathologist following removal of the mass. Clinical history of the mass may give the surgeon an idea of what they might expect when removing the mass. X-rays may show the shadow of the mass, and in 10-20% of the cases, may demonstrate bone erosion. An MRI may be useful in determining the extent or size of the mass pre-operatively.

 

Treatment of giant cell tumors in Orange County is the excision of the tumor. Some may attempt to inject the mass with cortisone in an attempt to shrink the mass.

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Muco-Cutaneous Cyst in Orange County

A small nodular single mass that can form on the top of the toe is often times a Muco-Cutaneous Cyst. These occur most frequently at the joint just behind the toenail. These are caused by a weakening of the joint capsule, which allows swelling to occur. They are firm and rubbery to the touch. Sometimes as the skin thins, due to the stretching pressure of the mass, it will appear translucent. When the mass is broken or punctured, a thick clear fluid will leak out. If the mass does break open, the area should be kept clean and free of infection. Once the skin heals the mass will reappear.

 

Treatment in Orange County consists of surgical excision. The procedure is relatively simple. Following removal of the cyst, the foot is bandaged in a dry sterile dressing and the sutures remain in place from 7 to 10 days. The area must be kept dry during this period of time and a limitation of activity is advised.

 

Plantar Fibromatosis in Orange County

Within the arch of the foot, firm, nodular masses may form. These can occur as a single mass or in clusters. They are called plantar fibromas and are non-cancerous tumors that forms within a ligament in the arch of the foot called the plantar fascia. Frequently, they will slowly enlarge causing pain while walking. Their cause cannot always be determined. Damage to the ligament may cause their occurrence. In 10% of the cases, patients will also demonstrate similar lumps in the palms of the hands called Dupuytren’s Contracture.

 

Diagnosis is made by clinical exam. Biopsy of the masses is not recommended. The act of biopsy may cause the fibroma to enlarge. When the mass is removed a definitive diagnosis is provided by examination by microscopic examination by a pathologist

 

Treatment in Orange County consists of padding the area to reduce pressure. Functional foot orthotics will take the strain off of the plantar fascia ligament and sometimes cause the fibromas to shrink in size. Surgical excision of the mass requires removal of most of the surrounding plantar fascia. Simple excision of the mass without removal of the entire ligament generally results in recurrence of the mass. Whenever surgery is contemplated, the patient should wear a functional foot orthotic following the surgery. The orthotic helps to accommodate for the loss of the plantar fascia and its effect on foot function.

 

Achilles Tendon Xanthomas in Orange County

An uncommon cause of small lumps in the Achilles tendon is an excessively high cholesterol level in the blood stream. This is a hereditary disorder that results in the deposition of cholesterol in the Achilles tendon. Frequently people will also have yellowish plagues on the lower eye lids, This is a serious condition and requires aggressive treatment by a physician to lower the cholesterol levels. Left untreated the high cholesterol levels can lead to premature heart attack and death.

 

Diagnosis in Orange County is made by clinical exam. Palpation of the Achilles tendon will reveal multiple small nodular masses. Noting excessively high blood cholesterol levels on routine lab tests provides confirmation of the condition. A biopsy of the lesion will also make the diagnosis.

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The nodules in the Achilles tendon are generally left alone as there is no value in removing them. Treatment should be directed at lowering the blood cholesterol levels.

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Please contact our office in Irvine, Orange, or Huntington Beach in Orange County, CA to make an appointment with our foot and ankle surgeon / podiatrist (Dr. Coyer) to have your foot or ankle soft tissue mass in Orange County fully evaluated.