The Bible Cyst: Ganglion Cysts


Ganglion cysts are the most common benign soft tissue mass in the foot, even though they occur more in the hands and wrists (2). They are nicknamed the “Bible cyst” due to the historical treatment of smashing the mass with a heavy book (I do not recommend).

Presentation & Symptoms

The cyst consists of an encapsulated sack filled with a clear gelatinous material. They typically originate from joints or along tendon sheaths, present as a round lump, and can be singular or multilobulated in nature (2).

On the lower extremities, they most often occur along the extensor (top) surfaces. The mass itself is not painful; however, based on its location and/or size, it may cause pain, especially if it is near a nerve or causes added pressure while wearing shoes.

Causes of Ganglions

The etiology of ganglions is not exactly known; however, trauma is often considered a possible cause.


The diagnosis is often done clinically, based on the location and presentation; however, imaging studies are better able to visualize the mass. Radiographs are usually not helpful, but an ultrasound or MRI can be performed. With an MRI, certain details, such as the size, shape, and extension, can be analyzed. Lastly, aspiration of the mass’s fluid can be performed and then sent to pathology for examination.


If the cyst is not painful, it can be left alone; however, it should be monitored closely for any changes, including increasing size or pain. If the cyst becomes painful, treatment options are available, including aspiration and surgical resection. I usually combine aspirations with a steroid injection, followed by compression for a couple weeks. Regardless of treatment, the recurrence rate of ganglions is rather high, being around 50% for nonsurgical treatment options and 34% for surgical treatment (1).

DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.


1. Dodd, L. G., & Layfield, L. J. (1996). Fine‐needle aspiration cytology of ganglion cysts. Diagnostic cytopathology15(5), 377-381.

2. Llauger, J., Palmer, J., Monill, J. M., Franquet, T., Bagué, S., & Rosón, N. (1998). MR imaging of benign soft-tissue masses of the foot and ankle. Radiographics18(6), 1481-1498.

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