What is a mucoid cyst?

A mucoid cyst is a small, round, dome-shaped fluid-filled sac that appears on the end joint (nearest the nail) of the toe. These lumps are benign (non-cancerous) and usually appear over a period of time with some gradual enlargement. They often have an almost translucent (see-through) appearance as they fill with clear synovial fluid which leaks from the joint and stretches the overlying skin.

Mucoid cysts can sometimes become painful or leak clear fluid. They are usually associated with arthritis in the underlying joint. Mucoid cysts are sometimes also known as mucous cysts, synovial cysts or mucoceles.

Why is a mucoid cyst excision necessary?

This type of surgery is elective (you chose to have it done). Some people find the lump is painful, particularly in shoes. It can rub and become inflamed or it may leak fluid which may leave you prone to infections. 
Some people find the cyst leaks fluid and reduces in size, but it will usually re-fill and become a prominent lump again. The underlying joint may be painful if it is affected by arthritis, and this can be addressed at the same time as removing the cyst.

What are the alternatives to surgery?

• You may want to avoid surgery or try all the alternatives first. Non-surgical options include:
• Changing footwear to prevent rubbing.
• Wearing pads to cushion the area.
• If the cyst is very large an aspiration and steroid injection may be an option (draining the fluid away with a needle and syringe). The recurrence rate from this is around 40%.

What does the operation involve?

This procedure can be performed as a day case operation, using either a general or local anaesthetic. You will have a small skin incision followed by some stitches and a dressing to cover the wound. If you have underlying arthritis in the end joint of your toe, a small piece of bone can be removed from that joint to address this (exosectomy/arthroplasty/arthrodesis).

You will have a post-operative shoe and may have crutches. You must have a responsible adult at home to support you afterwards.

What will happen after the surgery?

The first 1-3 days may be uncomfortable. You will receive advice on how to manage pain and will be told how to take painkillers. You should spend a restful few days with your foot elevated as much as possible. You should drink plenty of fluid and move around the home to fetch refreshments and use the toilet.

You will be able to weight-bear on the foot using your shoe and crutches, unless you’ve been advised otherwise.

Around 2 weeks following surgery, you will have your dressing removed and stitches removed. You can usually bathe again once stitches are removed and return to wearing normal shoes, driving and other activities. Time from work varies depending on occupation, but you can usually return to work once skin stitches are removed and the wound is completely healed.  If you have had a small piece of bone removed from the underlying joint to address arthritis, you may need a week or two longer to recover.

You may have some swelling in the area for a few weeks after surgery. This is normal and can be affected by the amount of activity you do.

You will normally be completely recovered by 6 months. 

Risks

• COVID-19 infection increases the risk of complications and we recommend you read the separate leaflet about this. If you are in one of the vulnerable groups you should think very carefully about proceeding with surgery unless it is absolutely necessary.
• Specific risks of mucoid cyst excision include:
• Recurrence of the cyst (approx. 2-16% with surgery, approx. 40% with aspiration/injection)
• Nail plate deformity.
• Joint stiffness.

All surgery carries general risks such as:

• Infection
• Painful/ thickened scarring
• Numbnes
• Bleeding
• Swelling
• Excess and prolonged pain (Chronic Regional Pain Syndrome - CRPS)
• Blood clots (Deep Vein Thrombosis & Pulmonary Embolism), anaesthetic complications and tourniquet complications.

Further Information

The British Orthopaedic Foot & Ankle Society (BOFAS) - www.bofas.org.uk