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Mucoid Cysts

What Is A Mucoid Cyst?

A mucoid cyst is a benign lump that occurs in the distal joints around fingers and toes.

A mucoid cyst in the 2nd toe arising from the DIP joint

A mucoid cyst in the 2nd toe arising from the DIP joint

What Can Cause It?

No one really knows why mucoid cysts occur, although there is an association with arthritis of the DIP joint and rarely trauma.

What Are The Symptoms?

Most people with a mucoid cyst have no symptoms.

Some people do complain of pain in the underlying DIP joint and this is due to arthritis in the joint. Patients that do present to a doctor typically do so because of frequent discharge from the cyst which almost invariably fills up again.

Rarely patients may complain of nail changes.

To summarise common symptoms include:

  • Pain
  • Discharge
  • Swelling
  • Nail changes

What Investigations May Be Required?

Investigations are rarely necessary to make diagnosis.

Radiographs may demonstrate osteophytes (bony spurs) in the DIP joint or evidence of arthritis.

Can The Problem Get Worse?

The vast majority of people with a mucoid cyst are asymptomatic. It is a condition that can get worse.

If a mucous cyst ruptures & become infected, then a septic joint may result. This is a very rare complication however.

If there is a history of increasing pain, frequent discharge, swelling or an inability to do sports you may wish to consult with Mr Malik, an orthopaedic foot & ankle surgeon for further advice.

Non-Operative Treatment Options

Non-operative management aims at relieving pain and limiting deformity progression. It is likely to be most effective in the early stages of the condition.

It should always be the first line of treatment. Options include:

Toe sleeves 

Made of silicon can be worn over the toe to protect from direct pressure and rubbing against footwear.


Footwear

The use of stiff soled shoes that do not bend and therefore protect the DIP joint. Wearing a shoe with a wide and deep toe box to minimise pressure on the cyst.


Non steroidal anti-inflammatories

The use of non-steroidal anti-inflammatory drugs (NSAIDs) can decrease discomfort from an arthritic DIP joint.


Needle aspiration

Will most likely result in recurrence and is not recommended.

Operative Treatment Options

Surgical management is reserved for patients who have failed to respond to non operative treatment.

Patients should understand that the decision to undergo surgery should not be taken lightly.

Any intervention is considered in a step wise manner, with the least invasive procedure carried out first.


Treatment options include:

  • Excision of cyst – associated with high recurrence rate and wound problems
  • Excision of osteophytes – associated with high recurrence rate
  • Fusion of DIP joint – high success rate

Our favoured option is DIP joint fusion as this reliably relieves any arthritic pain in the DIP joint and has the lowest risk of recurrence.

Potential Complications

It should be borne in mind that complications can result from a condition with or without surgery.


Potential complications of non-operative treatment include:

  • Worsening pain
  • Increasing deformity/swelling
  • Chronic wound/ulcer
  • Septic joint

Complications can occur as with any type of surgery. Please see Complications for more detailed explanation of post surgical complications.

Potential general complications of any operative treatment include:

  • Risks and complications of anaesthesia
  • Bleeding
  • Infection (superficial and deep)
  • Blood clots
  • In the case of an MIS procedure it may be necessary to proceed to open surgery if during the operation it is felt that a better outcome will be achieved using an open technique
  • Failure to fully correct deformity (particularly if longstanding deformity)
  • Need for further surgery
  • Complex regional pain syndrome

Potential specific complications of operative treatment of mucoid cyst include:

  • Painful non union of the DIP joint
  • Recurrence of the mucoid cyst
  • Malunion
    • It is not uncommon for the toe to heal in a position that may not be perfectly straight
    • Minor degrees of deformity will be mostly a cosmetic concern, which is why almost all orthopaedic foot and ankle surgeons discourage patients from having toe surgery if the underlying issue is cosmetic!
    • In the unlikely case that there is a severe malunion further surgery may be required
  • Stiffness of the MTP joint
  • Wound healing problems (particularly when correcting a chronic deformity the soft tissue can become contracted)
  • Compromise to the blood supply (particularly when correcting a chronic deformity the blood vessels can become contracted)
    • If the blood supply to the tip of the toe is lost the tissue will die and it may be necessary to amputate part, or all of the toe
    • This is a very small risk
  • Nerve injury to the toes causing numbness

Note – these complications are not exhaustive and are meant as a guide

Post Operative Period & Recovery

Please read the information regarding what to expect post surgery on this website.

Remember that below is a guide to recovery and that everyone heals at different rates and some people do take longer. Use this information to help you understand your condition, possible treatment and recovery. The timeframes given below are a minimum, it is important that you appreciate this when considering surgery as your healing and recovery may take longer.


Immediate post operative period

All surgical procedures for mucoid cyst will be undertaken as a day case.

You will have a bandage applied similar to this during the operation.

Post operative bandage of the foot

Post operative bandage of the foot

Please do not remove your bandages until you are seen by your surgeon Mr Malik at the two week post operative clinic appointment. You will also be provided with a stiff soled black post operative shoe. Please ensure you wear this whenever you are weight bearing.

Post operative stiff soled shoe

Post operative stiff soled shoe

For the first 48 hours you will be allowed to touch weight bear using two crutches. After 48hrs you can weight bear as tolerate. The physiotherapist will guide you after your operation and before your discharge from hospital with the use of crutches and mobilising.

For the first two weeks following your surgery please keep your foot elevated to the level of your heart for 95% of the time. It is recommended you stay at home during this period.

High elevation of the foot and ankle after surgery

High elevation of the foot and ankle

Naturally most people do not have a hospital bed at home. The same effect can be achieved by lying in a bed or lengthways on a sofa, with pillows behind your back and under your foot. You cannot have your leg elevated sitting in a chair. It is strongly advised that during the first two weeks you are house bound.

To minimise risk of infection keep the foot dry and cool. Avoid humid and hot environments. Keep the foot dry and when showering wear a Limbo bag.

To minimise the risk of blood clots please move your foot and ankle at regular intervals. Please ensure you are well hydrated. If you have a risk of blood clots please notify Mr Malik who may organise for you to have blood thinning injections as a precaution.


Two weeks post operatively

You will be reviewed at the clinic and your dressings removed. Your wound will be checked and your toe taped or strapped.

At this stage if the swelling has subsided sufficiently you will be advised to keep your foot in an elevated horizontal position (50-75% of the time). You will require to wear the special post operative shoe for another 4 weeks. Short trips can be made outside, within limits of pain and swelling.

Driving will be permitted for short trips if the left foot has been operated on and you drive an automatic. If the right foot has been operated on it will be at least 8 weeks before any driving is advisable.

Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area.


Six weeks post operatively

You will have radiographs taken just before you are seen in clinic. You will go over these with Mr Malik and compare the before and after images. If you have had a bony procedure, it will take a minimum of 6 weeks to heal.

At this stage if your healing is progressing satisfactorily swelling and bruising should have subsided considerably, although expect some degree of swelling for at least 3 to 4 months.

You will be able to start wearing normal footwear (swelling permitted), although stiff soled shoes are advisable. Continue to do the lesser toe exercises for another 6 weeks.


Three months post operatively

Final clinical examination. Discharge if satisfactory.

FAQs

When can I wear normal shoes?

This depends on your rate of healing and how much pain and swelling you have. For the first 6 weeks we advise you to use the stiff post operative shoe. After 6 weeks it is advised that you wear a stiff soled shoe with a wide toe box while your foot continues to heal.

When can I drive?

Please see guidance above and information here. Ultimately it is the responsibility of the patient to decide if they are safe to drive. A good way of knowing is if you can stamp your right foot heavily on the ground to mimic an emergency brake. If you have any hesitation or pain then it should suggest you are not safe to drive. Remember prolonged driving involves keeping your feet in a dependant position. This will worsen the post operative swelling.

When can I return to work?

This really depends on you and your job. If you have a job that involves a lot of standing, walking and is manual it may be 8 to 12 weeks. If you have a sedentary job, for example in an office and you have a reasonable commute you may be able to go back to work at 2 weeks, although this would be exceptional and not the norm.

What should the final outcome be?

Excellent pain relief and deformity correction. Ability to participate in sports by 6 months. Sometimes up to a year before the foot feels “normal” and fully healed.

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