Abstract
Aims
Malignant tumours of the foot and ankle are rare, but easily missed. NICE guidelines for bone and soft tissue tumours may be less appropriate for the foot and ankle than elsewhere. The purpose of this study was to identify the clinical features and treatment of malignant tumours arising in the foot and ankle to see if guidelines should be modified.
Patient and Methods
This was a retrospective review of patients presenting to the Bone and Soft Tissue Tumour Service with a suspected tumour of the foot or ankle. Between March 1998 and July 2009, 132 patients were identified from a prospectively collected database of patients reviewed at a weekly multidisciplinary meeting.
Results
Of 132 patients, 43 had benign tumours, 26 malignant tumours and 65 tumour like conditions (eg. ganglions, epidermal cysts, osteophytosis). In the malignant tumour group, the median duration of symptoms prior to presentation was 24 months, with a painful, small but enlarging mass being the most common clinical presentation. In 4 of the 26 cases (12%) unplanned excision had been undertaken prior to referral.
Of the 26 malignant tumours, 4 were primary bone tumours (1 Ewing's sarcoma, 1 osteosarcoma and 2 chondrosarcomas) and 22 were soft tissue tumours of which 9 (41%) were synovial sarcomas. In 15 of 26 (58%) of cases the malignant tumour was high grade. In 10 of 26 (39%), amputation was required in order to achieve curative margins and 7 (25%) cases required soft tissue reconstructive surgery following tumour resection.
Conclusions
The majority of malignant tumours in the foot and ankle are soft tissue in origin and high grade. Their clinical presentation can make early detection challenging and a high index of suspicion is required. In this review most malignant tumours presented as longstanding, small but enlarging, painful masses. Specific guidelines for investigation and referral may be warranted in addition to the current NICE recommendations.
