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Forum Name: Rheumatology Topics

Question: Treatment Options>Subchondral cysts,Osteophytes on foot


 Expand My Knowledge - Sun May 24, 2009 1:55 pm

I am posting this on behalf of my mom, she is 49 and has been diagnosed in July 2008 with early onset of Osteo-arthritus in her right knee. Recent tests reveal she is now suffering with chronic osteo-arthritus and she is experiencing symptoms in her right foot too.

She had Knee Arthroscopy surgery in February of this year but still continues to get excrutiating pains in the knee as well as subchondral cysts, osteophytes & osteophytic lipping on her right foot, other symptoms include numbness in toes and gout attacks in the same foot.

Latest (taken last week) radiology results state:
ap and oblique views only - right foot
The first mtp marginal osteophytic lipping with a few generative subchondral cysts are noticed.Further generative cysts are noted within head of the first proximal phalanx.Medial tibio - taler marginal osteophytes are noted.Further lateral malleolar tip osteophytic lipping with lateral calcaneo - cuboid marginal osteophytic lipping noted.Mid and hind foot soft tissue swelling is noted.

My mom is due to see a surgeon tomorrow, Please can you advise me of what the difference is between generative and subchondral cysts? and what are the treatment options for this, advising me of what you think the best is in your opinion? I have read that these cysts can be drained or injected topically with methylprednisolone acetate.

In addition to this, Please can you advise me of what exactly ''Further lateral malleolar tip osteophytic lipping with lateral calcaneo - cuboid marginal osteophytic lipping noted.'' means? and what is the best treatment for this, as well as..if surgery is the best option in treating osteophytes?

Thank you very much In Advance.
 Tom Plamondon PA-C - Mon Jun 08, 2009 6:47 am

User avatar Hello,
In general osteophytic lipping is bone spurs. In this report, the spurs are in the lateral ankle and lateral midfoot (cuboid). She probably has been compensating for the knee pain by bearing more weight on the lateral foot to avoid the pain of the medial knee compartment.

If the spurs are not causing pain or dysfunction then no operative treatment is needed. Even with minor symptoms, conservative treatment ie physical therapy and medicine is tried before surgery.

The subchondral cysts are treated likewise. Conservative management first then surgery if needed.

An MRI of the foot may be in order when considering the extent of the cyst involvement.

I am unfamiliar with the term generative cyst - perhaps it is a typo and should read general. Again, an MRI would better rank the cyst as mild, moderate or severe.

Take care.

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