Soft tissue lesions of the foot/ankle

Pathway

For patients who present with a Foot and Ankle soft tissue lesion (e.g. ganglion), we suggest that rather than referring to PhysioWorks, you should refer the patient to a Musculoskeletal Radiologist for a diagnostic ultrasound and obtain a more specific diagnosis.

Differential diagnoses are: Ganglia, Plantar Fibroma, Gouty Tophus, Lipoma, Rheumatoid nodule, Synovitis, and Malignancy (rare). For simple lesions the options are:

1. Leave
2. Accommodate/off-load 
3. Remove it

If the patient is only concerned with establishing a diagnosis, but is happy to leave it, then leave it alone unless it is rapidly enlarging or painful. However, if it is causing problems then please refer. If they want it to be removed and it is appropriate to do so please refer directly to a surgical provider e.g. Podiatric Surgery or STH Orthopaedics.

Summary

• All swellings to be scanned (Referral for Ultrasound scan to now be made by the GP).
• After scanning -all swellings can be left unless red flagged. Treatments are to accommodate / cushion or remove.
• If patient wishes, almost all lesions can be removed (exception plantar fibroma which should nearly always be left- the initial treatment is accommodate and off-load with insoles.)
• The patient needs to come back to the GP if the nature of the lesion changes – i.e. if it enlarges significantly, skin becomes broken down or if it becomes painful

We are more than happy for GPs to contact the service if they wish to discuss a specific case in more detail.