Epidermal Cyst in the Foot and Ankle

Ki-Won Young; Jin-Su Kim; Joo-Won Joh; Cheul-Hyun Yeom; Young-Uk Park; Kyung-Tai Lee

doi:10.4055/jkoa.2013.48.2.104

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Young, Kim, Joh, Yeom, Park, and Lee: Epidermal Cyst in the Foot and Ankle

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2013; 48(2): 104-110.

Published online: 25 April 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.2.104

Epidermal Cyst in the Foot and Ankle

Ki-Won Young, M.D., Ph.D., Jin-Su Kim, M.D., Ph.D., Joo-Won Joh, M.D., Cheul-Hyun Yeom, M.D., Young-Uk Park, M.D., Ph.D.^*, Kyung-Tai Lee, M.D., Ph.D.^*

Department of Surgery of Foot and Ankle, Eulji General Hospital, Eulji University, Seoul, Korea.

^*KT Lee's Orthopedic Hospital, Seoul, Korea.

Correspondence to: Jin-Su Kim, M.D., Ph.D. Department of Surgery of Foot and Ankle, Eulji General Hospital, Eulji University, Hangeul-biseokgil 14, Nowon-gu, Seoul 139-872, Korea. TEL: +82-2-970-8561, FAX: +82-2-974-8259, jins33@hanmail.net

Received 6 December 2012 Revised 16 January 2013 Accepted 25 January 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 15.5×15.0×7.9 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.

Keywords: foot, ankle, epidermal cyst, biopsy, recurrence

Figures and Tables

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.

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.

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.

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.

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).

Table 1

Demographics of Epidermal Cysts of the Foot and Ankle (n=37)

Values are presented as number or number (%) or mean (±standard deviation). M, male; F, female.

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