What exactly is the “ankle cyst” troubling Wu Xiangdong?

Last weekend, "President" Wu Xiangdong revealed on his personal social media a worrying piece of news for the running community — a large cyst has appeared on his left ankle; ultrasound showed the cyst measured about 7 cm, and a subsequent MRI confirmed its actual size reached 9 cm.

This unexpected development undoubtedly presents a thorny problem for him as he prepares for the Berlin Marathon; runners are especially concerned about whether the President’s performance at Berlin will be affected and whether he can still achieve the PB he’s aiming for.

What kind of condition is an ankle cyst?

What Wu Xiangdong has is medically calleda tenosynovial cyst (ganglion cyst of the tendon sheath).It is a benign cystic mass that arises from a joint capsule or tendon sheath and contains a gelatinous mucinous fluid. It is not a tumor and will not become cancerous.

Ganglion/tenosynovial cysts most commonly occur on the dorsal wrist, but they can also develop on the joint capsules or tendon sheaths elsewhere in the body. Their formation is closely related to chronic overuse and trauma.During long-term, high-intensity training, repeated friction of joints and tendon sheaths can cause synovial fluid to seep out through weak points in the joint capsule and gradually accumulate to form a cystic mass.

Wu Xiangdong’s cyst is located on the medial side of the left ankle joint. That location is particularly significant — it sits next to the tarsal tunnel, a bony tunnel on the inside of the ankle through which the tibial nerve and the blood vessels to the sole pass. As the cyst enlarges, it can press on the nerves inside the tarsal tunnel.

That is exactly why Wu Xiangdong previously experienced numbness in his forefoot — the cyst was compressing the plantar nerves.He recalled that two months ago he began to feel numbness in the forefoot after runs, but at the time he didn’t take it seriously. As the cyst grew and the compression increased, the numbness became more pronounced, and he also began to experience aching and a feeling of tightness in the ankle and Achilles, which forced him to take the problem seriously.

With the big race looming, a difficult treatment choice

Faced with the ankle cyst, Wu Xiangdong has two paths to choose from.

First option:Surgical excision.This is the only method that can truly "cure" the problem, removing the cyst "at its root" and, in theory, preventing recurrence. The issue is that a 9 cm cyst is large, is often closely adherent to surrounding tendons and nerves, and the postoperative wound would be relatively extensive,with a recovery period of at least 6 to 8 weeks.

If he chooses this route, it would mean saying goodbye to this year’s Berlin Marathon.

Second option:Conservative treatment — puncture and needle aspiration to drain the accumulated fluid.Fluid inside the cyst is aspirated with a needle to provide temporary decompression. The procedure is minimally invasive and recovery is quick, but the recurrence rate is very high.

After weighing the options, Wu Xiangdong chose the latter; last Friday he had the aspiration procedure accompanied by Le Ge. But a new situation followed, becausethe fluid inside the cyst had become "gelatinous," making aspiration more difficult — three needle punctures were made and only 4 milliliters of fluid were extracted.

Facing a planned 30 km long run the next day, the club president specifically consulted the attending physician who had helped Le Ge's Achilles recover about whether the training schedule needed adjustment. After learning the president was only a bit sore from the needle sticks and otherwise fine, the doctor replied, "Then go run."

So, last Saturday we sawWu Xiangdongcomplete a high-quality 30 km training session at 1,500 m altitude, averaging 3 minutes 10 seconds per km; his overall condition was not greatly affected.

Although the doctor also clearly warned about possible consequences of taking part in the Berlin Marathon:that his competitive level might be limited. But in his latest personal video Wu Xiangdong gave an affirmative answer— "I still want to give it a try."

Not only Wu Xiangdong: athletes troubled by ankle cysts

Ankle cysts are not unique to Wu Xiangdong, nor are they injuries exclusive to marathoners. Across sports—from road running to the track, from the racetrack to the basketball court—many top athletes have been affected.

British ultrarunner Sharon Gayter underwent surgery to remove a large cyst inside the ankle bone; at first her ankle could not tolerate the stresses of outdoor running, and only after three months of rehabilitation on an underwater treadmill was she able to return to competition.

British 400 m standout Iwan Thomas missed the 1999 season because of a cyst on his left ankle bone; former NBA star Howard was at one point unable to walk in 2014 due to an ankle cyst; Australian Supercars driver Garry Jacobson developed a golf-ball-sized cyst on his left ankle used for braking, which recurred quickly after multiple aspirations. Ultimately, they only recovered after undergoing more intensive treatment.

Across these cases we can identify common factors: the affected areas are subject to high-frequency use and enormous stress, turning weak points in the ankle into sites where fluid accumulates and eventually forms a cyst.

How to prevent ankle cysts?

The current medical view is that ankle cysts cannot be 100% prevented—their root causes are related to congenital joint structure. But through scientific management, the incidence and recurrence can be effectively reduced.

· Control training load scientifically

A sudden increase in mileage or intensity will put huge pressure on the ankle joint capsule. It is recommended to follow the "10% rule"—weekly mileage increases should not exceed 10% over the previous week. Also schedule regular recovery periods to give the joints time to repair.

· Strengthen the muscles surrounding the ankle

Stronger muscles can share the load on joint capsules and ligaments. Heel-raise exercises, resistance-band work, and single-leg balance drills are all effective ways to strengthen the ankle.

· Attend to "small signals" promptly

Wu Xiangdong’s experience serves as a reminder — don’t ignore “small signals” like numbness in the forefoot; they may be the body’s SOS. If you seek medical evaluation early, many cysts can be controlled with rest and conservative treatment and don’t need to be left until they reach 9 cm before addressing them.

· Ice after exercise

If the ankle is swollen after long-distance exercise, apply ice for 15 to 20 minutes to help reduce joint effusion.

· Monitor running shoe performance

Midsole cushioning materials in running shoes degrade after accumulating a certain mileage, and this is particularly evident with the currently widespread supercritical-foamed materials. As cushioning declines, more impact is transmitted to the ankle, increasing its load, so it’s important to ensure you’re wearing shoes with good performance.

For recreational runners, the best option when an ankle cyst appears is prompt treatment and a temporary break from training.

As a professional athlete, Wu Xiangdong has many more factors to weigh; his choice representsthe bodybeing balanced against competitive ambition — opting for conservative treatment to preserve the chance of standing on the Berlin course and chasing a PB. He also said he will closely monitor changes at the affected site.

We wish Wu Xiangdong success in Berlin at the end of the month — as he said at the end of the video, let’s all cheer him on.

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#Have you ever had a ganglion cyst?#

Text/Editor: HP

Image source: Paoye Dabaozha

Visuals: Max