J Korean Orthop Assoc.  2013 Apr;48(2):104-110. 10.4055/jkoa.2013.48.2.104.

Epidermal Cyst in the Foot and Ankle

• Young KW
• Kim JS
• Joh JW
• Yeom CH
• Park YU
• Lee KT

• KMID: 1424095
• DOI: http://doi.org/10.4055/jkoa.2013.48.2.104

Abstract

PURPOSE
To document post-excision recurrence rates for epidermal cysts of the foot and ankle by location.
MATERIALS AND METHODS
The authors retrospectively reviewed epidermal cysts confirmed histologically by excisional biopsy in 37 patients (male 20, female 17) from 2004 to 2011. Cyst locations and sizes were analyzed and preoperative and postoperative pain levels were compared using a visual analogue scale (VAS). Rates of recurrence and patient satisfaction levels were also measured.
RESULTS
Epidermal cysts occurred most commonly on the 1st toe (15 cases, 40.6%), followed by the ankle (7 cases, 18.9%), 2nd toe (6 cases, 16.2%), 3rd toe (4 cases, 10.8%), 4th toe (1 case, 2.7%), 5th toe (2 cases, 5.4%), and heel (2 cases, 5.4%). Average cyst size in 35 cases was 15.5x15.0x7.9 mm. VAS reduced from 6.5 preoperatively to 1.0 postoperatively. Cysts recurred in 7 cases (18.9%); on the 1st toe in 5 and on the 2nd toe in 2. Thirty patients (81.0%) were very satisfied with treatment results, 2 patients (5.4%) were satisfied, and 5 (13.5%) were not satisfied. Recurrence occurred in 4 cases, and in one of these cases the cyst recurred after second excision.
CONCLUSION
The excision of epidermal cysts in the foot and ankle area was found to have an 18.9% recurrence rate. To achieve good results, the precise location of cysts should be determined by imaging study before excision, and cysts must be excised completely.

Keyword

foot; ankle; epidermal cyst; biopsy; recurrence

MeSH Terms

Animals
Ankle
Biopsy
Epidermal Cyst
Female
Foot
Heel
Humans
Pain, Postoperative
Patient Satisfaction
Recurrence
Retrospective Studies
Toes

Figure

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  Figure 1 Picture showing a hyperkeratotic dome-shaped protruding epidermal cyst on a left sole. This patient had a chief complaint of a painful plantar mass.

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  Figure 2 Zones of the foot used for analysis by Kirby et al.4) Epidermal cysts were located in zones 1, 2, 3, 4, and 5 in 7, 2, 0, 9, and 19 cases, respectively.

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  Figure 3 Distribution of epidermal cysts categorized by digit number, heel, and ankle. The most common location was the great toe, including first-second web space.

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  Figure 4 Photograph of a cyst of the great toe (Kirby's zone 5) in a 53-year-old woman. The cyst was treated by excision but recurred 6 months later.

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  Figure 5 Ultrasonographic findings (A) showing a well-defined hypoechoic mass with a smooth margin. The 24×27×29 mm sized, well-defined, soft tissue mass was located in the plantar subcutaneous layer. The central portion of the mass demonstrated intermediate signal intensity by T1-weighted imaging (C), low signal intensity by T2-weighted imaging (D), and a high signal intensity at its periphery by T1 and T2-weighted imaging. Enhanced sagittal magnetic resonance image showed epidermal wall enhancement (B).

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