lump on instep of foot

by jane
(Jamestown, North Dakota)

Hello, recently I have noticed a small pea size lump on the instep of my left foot. It hurts mildly when i try rubbing it witm my hand, and sometimes i feel a little pain when i'm wearing my high heel shoes. I don't remember getting tripped with my shoe. What could possibly cause this lump, and is there an over -the- counter treatment for this? Please help.

RESPONSE
Hi Jane,

Keep in mind since I do not have the luxury of actually examining you I am only guessing here but will discuss the most probable causes of this lump.
The first thing that comes to mind is a ganglion cyst. If the lump feels kind of spongy when you press on it and it seems to be well demarcated, meaning it is very visible and seems to be a distinct entity then it may very well be a ganglion cyst.
They are very common on the top of the foot and in most cases are a result of friction from a shoe rubbing on the tendon. The tendon covering then herniates forming this lump.
If it turns out to be a ganglion cyst then you can either live with it or live without it. What I mean here is that if you can avoid shoes that rub on the lump, chances are it will stop hurting, but keep in mind the lump may continue to enlarge and shoes that initially do not bother it may eventually also cause the foot to hurt.
If the growth is painful enough then treatment is warranted. A foot specialist would be your best bet as they are the ones that treat this condition on a regular basis.
Simple treatment for a ganglion cyst generally includes putting a needle into the lump and draining it. In general it is not a particularly painful procedure and is done right in the office. After I drain them, I typically inject some cortisone in an effort to reduce recurrence. The problem with ganglion cysts is that they have a very high recurrence rate, particularly if you keep wearing the same shoes that aggravated the cyst in the first place.
If that ends up being your situation then your next step would be surgical removal. Although the recurrence rate is far less with surgical excision, nonetheless there is still a recurrence rate. The problem here is that meticulous dissection is required to remove all of the cyst particularly at the stalk, or the point it originates from. Unfortunately what happens is the cyst may be accidently cut and it then bursts making it very difficult to actually find the stalk of the cyst and removing it.
The point to take away from this discussion is the fact that although your growth sounds like a ganglion cyst based on its location, it is not the only possible diagnosis. There are a multitude of lesser conditions that will cause lumps to form.
Although in most cases the lumps are benign there is always the possibility that the lump may be a malignant growth.
I would suggest you make an appointment with a doctor to have the lump examined to determine whether or not it is something to be worried about. At that point you can discuss your options with the doctor.

Marc Mitnick DPM
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