My Podiatrist says it's a cyst

by Jenn
(Nebraska)

I have a portion of big toe that is numb and the next toe is also numb and will also burn, like it's been scraped or something but there is no wound. The toes are not discolored and I don't have diabetes. I went to my podiatrist and he thinks it's a cyst on the top of my foot. However, I don't feel or see a lump. I have had cysts on my wrist and there was a definite lump there. So, I am wondering if the pain is truly from a cyst. Wearing tennis shoes seems to make it worse even with different lacing techniques but with my slip on shoes the pain isn't as bad but the toes are still numb. The numbness has been there for about 3 months.

RESPONSE

Hi Jenn,

Your symptoms appear to be a classic example of irritation to one of the sensory nerves that travel down the top of the foot. These nerves give you sensation on top of the foot. The nerve involved sounds like the intermediate dorsal cutaneous nerve.
Because of the way the nerve travels down the foot, it happens to go over the top most portion of the foot.
What happens in many individuals, the nerve, due to its position, then gets irritated from the top of the shoe rubbing against the bones on top of the foot with the nerve getting caught in between. Irritation of the nerve on the top of the foot will then cause nerve like sensations (numbness, tingling, burning, etc.) on part of the big toe and the second toe as well. That occurs because that is the course the nerve travels.
Many times just by tapping the top of your foot with your index finger, you may be able to replicate the sensation you are getting in the toes. This is called a positive Tinel's sign.
In conjunction with the nerve entrapment from shoe pressure, you can also develop a cyst. Generally it is a ganglion cyst, causes by the same mechanism of shoe pressure rubbing on the top of the foot and in this case irritating the tendons that pass over the top of the foot.
The issue then becomes what can be done about this and of course this is assuming that you actually have this problem since I am only going by information you have afforded me and I have not had the luxury of actually examining you.
The nerve can be either caught up in mild scar tissue from chronic shoe pressure or the ganglion may be pressing against the nerve.
In my practice I start with a simple cortisone injection in an effort to reduce the inflammation around the nerve regardless of the cause. If you do have an actual ganglion cyst, your doctor may attempt to drain that as well, which in theory should help. Just keep in mind, ganglion cysts have a tendency to recur.
A simpler solution for many is to just avoid shoe pressure on top of the foot by carefully shopping for styles that do not put pressure on that part of the foot.
You should also have an x-ray taken because in many instances the nerve and/or cyst will be aggravated by any bone spurs that you may have on the top of the foot and if push comes to shove, you may have to consider having them surgically removed if conservative treatment does not help.

see related article....ganglion cyst

see related article....midtarsal fault

Marc Mitnick DPM
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