ReviewMalignant tumours of the foot and ankle
Section snippets
General principles
The foot has a particular anatomy with multiple small muscular compartments, the terminal neurovascular branches, and a delicate soft tissue cover including a uniquely structured sole that cannot be replaced by adequate tissue in case of loss. Surgical treatment of foot and ankle tumours, therefore, represents a true challenge. Like infections and compartment pressures, tumours may spread along the tendons which pass through fascial defects between the foot compartments and between the foot and
Sarcomas
Soft tissue sarcomas have distinct age peaks in children and middle to old aged patients [19,40]. Rhabdomyosarcoma is the most common sarcoma in the pediatric foot and ankle [28]. The need for neoadjuvant systemic chemotherapy and sentinel lymph node biopsy depends on the histological subtype of the sarcoma. Lymphatic spread is relatively rare, but must be considered in cases of synovial sarcoma, epitheloid sarcoma, and clear cell sarcoma [41].
Synovial sarcoma is the most frequent malignant
Malignant bone tumours
Because of the low prevalence and the nonspecific symptoms like pain and a hard mass, malignant tumours of the foot and ankle are often diagnosed late. Chondrosarcoma is the commonest among them, affecting predominately patients in their 40 s–50 s [11,40]. It is seen more frequently in the hindfoot than in the forefoot (Fig. 3). Radiographs show an irregular osseous lesion with central destruction and marginal calcification. MRI reveals the intramedullary extent and soft tissue involvement of
Metastatic disease
Metastases in the foot and ankle have an overall prevalence of less than 1% [16,20]. Acrometastatic lesions are generally believed to occur rather rare, and if so, then late in the course of the disseminated disease and therefore are associated with a poor prognosis [70]. The presentation is nonspecific with diffuse pain, swelling and sometimes ulceration [11]. Radiographs reveal osteolysis and sometimes a pathological fracture. Among the primary tumours squamous cell lung carcinoma, renal cell
Conclusions
Malignant tumours of the foot and ankle are frequently diagnosed late because of the relatively low prevalence and non-specific symptoms. Workup of suspicious lesions includes CT, MRI, and biopsy following strict oncosurgical guidelines. Subfascial location, lump size more than 5 cm, increase in size, painful and recurrent tumours should raise the suspicion of malignancy and lead to patient referral to a designated tumour centre. Neoadjuvant and adjuvant systemic chemotherapy and/or radiation
Confict of interest
The authors report no conflict of interest.
References (70)
- et al.
Foot compartment syndrome — a clinical review
Fuss Sprungg.
(2015) - et al.
Review of foot tumors seen in a university tumor institute
J Foot Ankle Surg
(2014) - et al.
Tumors of the foot and ankle: analysis of 196 cases
J Foot Ankle Surg
(1997) - et al.
Benefits associated with early diagnosis and treatment of soft tissue sarcomas of the foot and ankle
J Foot Ankle Surg
(2016) - et al.
Tumours of the foot and ankle
Foot
(2015) - et al.
The influence of tumor- and treatment-related factors on the development of local recurrence in osteosarcoma after adequate surgery. An analysis of 1355 patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols
Ann Oncol
(2011) - et al.
Local therapy for rhabdomyosarcoma of the hands and feet: is amputation necessary? A report from the Children’s Oncology Group
Int J Radiat Oncol Biol Phys
(2011) - et al.
Outcomes of isolated limb perfusion in the treatment of extremity soft tissue sarcoma: a systematic review
Eur J Surg Oncol
(2013) - et al.
Survival of patients with primary pedal melanoma
J Foot Ankle Surg
(2003) - et al.
Melanoma of the foot is associated with advanced disease and poorer survival
J Foot Ankle Surg
(2018)
Osteosarcoma of the bones of the foot — an easily misdiagnosed malignant tumor
Mayo Clin Proc
Should Soft tissue sarcomas be treated at a specialist centre?
Sarcoma
Tumors of the foot and ankle: experience with 153 cases
Foot Ankle Int
Tumors of the foot bones — a report from the Hamburg Bone Tumor Registry
Z Orthop Ihre Grenzgeb
Bone and soft-tissue tumors of the foot and ankle
Chirurg
Bone tumors: general aspects and data on 8543 cases
Distal lower extremity sarcomas: frequency of occurrence and patient survival rate
Foot Ankle Int
Tumoren des Fusses (Foot tumors)
Tscherne Unfallchirurgie Fuss
Delayed diagnosis in metastatic lesions of the foot
Ann R Coll Surg Engl
Mid-foot reconstruction following involvement of five bones by giant cell tumor
Skeletal Radiol
Osteoid osteoma of the talus presenting as posterior ankle impingement: case reports
Foot Ankle Int
From the archives of the AFIP: imaging of synovial sarcoma with radiologic-pathologic correlation
Radiographics
Benign and malignant tumors of the foot and ankle
Skeletal Radiol
Clinical features of soft tissue sarcomas
Ann R Coll Surg Engl
Earlier diagnosis of bone and soft-tissue tumours
J Bone Joint Surg Br
Guidelines for the management of soft tissue sarcomas
Sarcoma
Soft-tissue tumors and tumor-like lesions of the foot. An analysis of eighty-three cases
J Bone Joint Surg Am
Open biopsy of bone and soft tissue tumors: guidelines for precise surgical procedures
Operat Orthop Traumatol
Core needle biopsy and fine-needle aspiration in the diagnosis of bone
Hematol Oncol Clin North Am
Core needle biopsy for diagnosis of extremity soft tissue sarcoma
Ann Surg Oncol
Computed tomography-guided core needle biopsy versus incisional biopsy in diagnosing musculoskeletal lesions
J Orthop Surg (Hong Kong)
Expression of survivin detected by immunohistochemistry in the cytoplasm and in the nucleus is associated with prognosis of leiomyosarcoma and synovial sarcoma patients
BMC Cancer
Soft tissue sarcomas of the foot and ankle: impact of unplanned excision, limb salvage, and multimodality therapy
Foot Ankle Int
Soft tissue sarcomas of the distal lower extremities: a single-institutional analysis of the prognostic significance of surgical margins in 120 patients
Oncol Rep
Standardized approach to the treatment of adult soft tissue sarcoma of the extremities
Recent Results Cancer Res
Cited by (20)
Massive synovial chondromatosis at the sinus tarsi
2023, Fuss und SprunggelenkTenosynovial giant cell tumour of the foot and ankle: the orthopaedic tumour surgeon's perspective
2023, Fuss und SprunggelenkFibroma of the tendon sheath in the dorsum of the foot: A case report
2023, JPRAS OpenCitation Excerpt :Soft tissue tumors of the foot and ankle account for about 4–5% of all musculoskeletal tumors.1
Functional outcomes in total talus reconstruction with triangular double-barrel free fibula flap following oncological resection: A retrospective case series review
2022, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :It also reduces the risk of compression over the microvascular anastomosis, especially in the area with limited adjacent skin for coverage or in oedematous soft tissue. Furthermore, the abundance of skin available for coverage will not compromise oncological resection principles for fear of creating too large a defect; hence, the biopsy site and area with suspicious tumour invasion can be included in the resection.1 In some cases, skin division between the cutaneous perforators can be done to give more flexibility to conform to the defect's shape and size.
Distribution patterns of foot and ankle tumors
2020, Fuss und SprunggelenkLimb salvage surgery without radiation therapy for soft tissue sarcomas of the foot
2021, Foot and Ankle Surgery: Techniques, Reports and Cases