As a medical school Professor and international medical educator, Dr. Foye provides free educational content through many different social media sites.
Here are some places where you can find Dr. Foye and his educational materials online:
Note and Disclaimer: Public education via social media is NOT a substitute for in-person medical attention from a physician with experience in treating your condition. Posts by Dr. Foye in public website should NOT be considered as a recommendation for any specific person to take or not take any particular action regarding their medical care. Instead, those with medical conditions should discuss their conditions with their in-person treating physicians. Also, Dr. Foye’s comments online do not necessarily reflect the views of any university, school, hospital or employer. Also, medical knowledge and opinions change over time, so the materials you may read may become outdated over time and, once again, you should discuss all options and concerns with an in-person physician with experience in treating the condition that you are suffering from.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
Many patients come to see me for coccydynia (coccyx pain, tailbone pain).
Occasionally we discover that their pain seems to be coming from a mass, tumor, abscess, or similar problem. (We see these types of things in ~ less than 5% of our patients with coccyx pain.)
One such mass is called a Tailgut Cyst (Retrorectal Hamartoma).
Tailgut Cysts are Located Near the Coccyx
This mass is typically located just in front of the coccyx or just below the coccyx, or sometimes in front of the lower sacrum.
Note: a ‘Tailgut’ Cyst is very different from a ‘Tarlov’ Cyst.
Note that Tailgut Cysts fail to show up on plain x-rays, which is why advanced imaging studies such as MRI are often helpful and necessary in cases where coccyx pain is persisting or failing to improve with standard non-surgical treatments. (But the MRI needs to be done correctly! See: Link)
Excellent recent article on Tailgut Cysts
There was a recent (2019) research study and review article on this topic which was excellent. I recommend that you use the link below to read the full article, for free, at the Journal’s website. The journal is called: the Annals of Coloproctology.
Below are my summary points from the article (highlighting important points or quotes from the article, as part of Fair Use commentary):
Surgery is recommended for Tailgut Cysts, for a few reasons:
1) to confirm the diagnosis,
2) to make sure the mass is not a cancer,
3) to avoid complications that can occur if left in place, such as infection or the mass turning into a cancer.
Important quote from the article:
“Surgical treatment is always required because of complications including malignant transformation, infection, and perianal fistula formation.”
Should Coccygectomy be done for a Tailgut Cyst (Retrorectal Hamartoma)?
On the topic of whether the surgery for a tailgut cyst should also include coccygectomy (surgical removal/amputation of the coccyx), this seems to be up for debate:
“Debate persists about whether the coccyx should be removed with the cyst.Several studies advocate coccygectomy since it improves surgical exposure and decreases risk of recurrence assuming that the coccyx may harbor a nidus of totipotential cellular remnants that may cause recurrence [4, 26]. However, the concern that the coccyx will increase risk of recurrence has not been demonstrated in other studies, especially for cysts not adherent to the coccyx and that can be removed entirely without coccygectomy; hence, coccyx removal is not required [27]. Removal of coccyx was based on the cyst itself and not the coccyx harboring aberrant remnants of the postanal gut leading to cyst formation. Recent trials report preserving the coccyx unless en bloc resection is required for malignancy or cysts densely adhere to the coccyx. Based on our findings, we removed the coccyx for 4 patients: 3 due to the cyst adhering to the coccyx and 1 for a large cyst requiring a combined coccygectomy and lower sacrectomy; the latter cyst was malignant.”
Ann Coloproctol. 2019 Oct;35(5):268-274. doi: 10.3393/ac.2018.12.18. Epub 2019 Oct 31.
Single-center Experience of 24 Cases of Tailgut Cyst.
Sakr A1,2, Kim HS1, Han YD1, Cho MS1, Hur H1, Min BS1, Lee KY1, Kim NK1.
Author information: 1: Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Author information: 2: Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt.
Journal article on 24 Cases of Tailgut Cysts, 2019, Annals of Coloproctology
Also, below is a different link to a review article by different researchers who looked at 196 cases of Tailgut Cysts, and reported that as high as 26% of them became malignant (cancer). https://onlinelibrary.wiley.com/share/G6DK393WUEMJNUQFUFUW?target=10.1111/codi.14628 or https://doi.org/10.1111/codi.14628
Reference: Nicoll K, Bartrop C, Walsh S, Foster R, Duncan G, Payne C, Carden C. Malignant transformation of tailgut cysts is significantly higher than previously reported: systematic review of cases in the literature. Colorectal Dis. 2019 Aug;21(8):869-878. doi: 10.1111/codi.14628. Epub 2019 Apr 30. PMID: 30932326.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Below is the abstract: (Presented here as part of “Fair Use” for discussion, commentary, etc.)
World Neurosurg. 2020 Jan 10. pii: S1878-8750(19)33195-X. doi: 10.1016/j.wneu.2019.12.163. [Epub ahead of print]
Myelographic CT, a check-valve mechanism, and microsurgical treatment of sacral perineural Tarlov cysts.
Kikuchi M, Takai K, Isoo A, Taniguchi M.
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, Japan.
Abstract
“OBJECTIVE:
There is currently no consensus regarding surgical indications for symptomatic sacral perineural cysts.
METHODS:
Nine patients with symptomatic sacral perineural cysts underwent microsurgery. All patients fulfilled the following criteria: (1) cyst sizes are larger than 15 mm; (2) cysts show the “delayed inflow” and/or “delayed outflow” of contrast on myelographic CT, and (3) neurological symptoms correlate with the primary cyst.
RESULTS:
On myelographic CT, all primary cysts showed the “delayed inflow” of contrast; the average cyst/thecal sac Hounsfield units (HU) ratio was 0.17. In 7 patients, the primary cyst showed “delayed outflow”; the average cyst/thecal sac HU ratio increased to 3.12 on images obtained 24 hours after contrast injection. Regarding modified Rankin Scale, 67% of patients reported that their overall symptoms improved to normal activities after surgery. The most improved symptom was coccydynia (75% improvement, p=0.017), followed by leg radiation pain (67% improvement, p=0.027) and buttock pain (50% improvement, p=0.068). Bowel/bladder dysfunction improved in 100% of patients, but newly developed in 1 patient (p=0.32). Perineal pain only decreased in 33% (p=0.41).
CONCLUSIONS:
To the best of our knowledge, this is the first study to have performed a quantitative analysis of the dynamics of CSF in sacral perineural cysts using myelographic CT. Sixty-seven percent of patients benefited from surgery; however, our criteria may not be a necessary and sufficient condition for patient selection because 33% did not respond to surgery despite the successful elimination of the check-valve.”
Dr. Foye’s comments:
This was a small study, where there were only 9 patients.
Still, it is important for reporting that in patients who had a Tarlov Cyst and coccydynia (coccyx pain, tailbone pain), surgery for the Tarlov Cyst apparently helped relieve the the tailbone pain in a significant percentage of those patients.
So, for patients who have a Tarlov cyst and tailbone pain, if typical treatment for tailbone pain is not helping, the patient may want to consider Tarlov cyst surgery.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Today I was informed that my latest publication on coccyx pain has just been published by the Indian Journal of Orthopaedics.
The title is:
Looking Below the Sacrococcygeal Joint in Patients with Coccydynia (Coccyx Pain)
Our 3 main points:
When treating patients with tailbone pain (coccyx pain, coccydynia), unfortunately doctors often limit themselves to the sacrococcygeal joint (SCJ) and they fail to look lower than that.
Doctors often fail to consider the lower coccyx on imaging studies, or during physical exam, or when providing treatments.
This oversight is a problem since the sacrococcygeal joint is usually NOT the site that is causing the tailbone pain. Instead, more often the source of tailbone pain is one of the other joints within the coccyx, or a distal coccyx bone spur .
Due to copyright, I don’t know if I can post the full publication here on my website, so here is the Journal’s Link to the article online: https://rdcu.be/b0jak
Below are the screenshots from the congratulations/announcement of the publication, as well as the publication header and citation.
Looking Below the Sacrococcygeal Joint, by Foye, Header of Publication
Looking Below the Sacrococcygeal Joint (SCJ), email to Foye, announcing publication
Indian Journal of Orthopaedics, Journal Cover
Looking Below the Sacrococcygeal Joint, by Foye, Citation for Publication
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Podcast pic, Some of Your Parts, Interviewing Dr Foye about Coccyx Pain, Tailbone Pain, Coccydynia
Podcast, Some of Your Parts, Interviewing Dr Foye about Coccyx Pain, Tailbone Pain, Coccydynia
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Free Book on Tailbone Pain, Coccyx Pain, New Year’s Day 2020
Start the New Year with a Free Book on Coccyx Pain (Tailbone Pain, Coccydynia).
Go to Amazon’s website in your country, using the links shown at the bottom of this page.
The electronic version of the book (e-book, Kindle book) will be completely FREE all day, on New Year’s Day, Pacific Time zone.
If the Amazon website initially shows you the paperback version, click the line that says “show all formats” and then it will show you the e-book version, which will be free on this day.
The images below show where you need to click to get the book for free.
Near the bottom of this page there is a list of website links to Amazon’s website in different countries that provide this book.
Free Book on Tailbone Pain, Coccyx Pain, on Amazon, 1-1-20
FREE Book, Select it on Amazon
Free e-book, Tailbone Pain Relief Now, by Patrick Foye MD
Dr. Foye’s book “Tailbone Pain Relief Now!” will be available for free (e-book version) worldwide via Amazon.
You can use the Amazon website specific to your part of the world.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Consultant360 Podcast Interview of Patrick Foye, MD, for Tailbone Pain Awareness Day 2019
GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com or go to Amazon.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Facebook Live, Tailbone Pain Awareness Day, Dr Foye
GET THE BOOK: To get your copy of the book “Tailbone Pain Relief Now!” go to: www.TailboneBook.com or go to Amazon.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
The day also included hundreds of free copies of the book “Tailbone Pain Relief Now!” which were given away on Amazon worldwide.
This year, 2019, is the second annual Tailbone Pain Awareness Day.
Questions about Coccyx Pain will be answered in a Facebook-Live session at 2pm (eastern time) at the following Facebook page: www.facebook.com/TailbonePainCenter/
Dr. Foye’s book “Tailbone Pain Relief Now!” will be available for free (e-book version) worldwide via Amazon.
You can use the Amazon website specific to your part of the world.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
