Ganglion cyst on 4th metatarsal joint

by Joann
(Illinoid)

I had Morton’s neuroma surgery last year. I have had a lot of Neuroma like pain. An ultrasound showed a stump neuroma.

My surgeon said he did not find another neuroma but a ganglion cyst on my 4th metatarsal joint. He said there was no neuroma.
Is this even possible? I am two weeks post surgery and the ball of my foot is very swollen and bruised and still really hurts, a lot.
I really like my surgeon but am confused how ultrasound showed neuroma and he said there wasn’t one . Any thoughts would be appreciated

RESPONSE

Hi Joann,

I am a bit confused and think that may be due to the fact that your surgeon has not explained things very well to you.

Last year you had neuroma surgery, apparently you were still having pain so you went back to your surgeon one year later.

I assume you had the ultrasound before you had the second surgery. The ultrasound reported a stump neuroma which is a common complication of this type of surgery, particularly if the surgeon went through the top of your foot to remove the neuroma which is on the bottom of the foot. By the way, most of us go through the top of the foot to remove a neuroma, simply to reduce the chance of scarring on the bottom of the foot.

A stump neuroma occurs when not enough of the nerve is removed and so a "stump" is left which may continue to give you neuroma type symptoms.

Unfortunately, this complication has been experienced by anyone who surgically removes neuromas. Typically the "stump" is very difficult to find as the remaining nerve retracts away from the original surgical site. If your surgeon did go through the bottom of your foot, there is a better chance of finding the "stump", but you do not mention where your scars are located.

Because finding the stump can be so difficult, I am curious as to whether or not your surgeon attempted any less invasive procedures prior to a second surgery, such as denatured alcohol injections.

Additionally, a stump neuroma would be a more difficult diagnosis to make then a ganglion cyst via an ultrasound, so I would think (guess) that there may not have been a ganglion cyst in the area even though they can occur there.

Making the assumption that the surgeon did find a ganglion cyst, I would assume he either removed it or at least drained it. In either event, if that was the source of your original pain, two weeks down the road you should be feeling better and obviously you are not.

Of course, I am only getting one side of the story and as I said initially, I find it a bit confusing.

The best advice I could give you would be to get another opinion by a foot specialist in your area. Someone who can actually examine you.

At this point, an MRI might be a better option for you then an ultrasound. Additionally, I would be careful about additional surgery. When it comes to repeated surgery in the same area, you do reach a point of diminishing returns.

Marc Mitnick DPM
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