Twenty cases of malignant sarcomas of the foot and ankle included: four osteosarcomas, three Ewing’s sarcomas, three chondrosarcomas, three fibrosarcomas, five synovial cell sarcomas, one clear cell sarcoma and one malignant schwannoma. Five-year survival was: three of the nine who had B-K amputation, five of the nine who had more distal amputation or local resection, for a total of eight of eighteen. More distal amputation than B-K or local resection was offered if plantar sensation and stability of the foot could be retained, and was accepted by half of the patients. There were no local recurrences of eighteen operated. Twenty cases of malignant sarcomas of the foot and ankle seen over a ten-year period from 1985 to 1995 were reviewed retrospectively. Eleven tumors arose from bone and nine from soft tissue. The bone tumors were: four osteosarcomas, three Ewing’s sarcomas, three chondrosarcomas, and one fibrosarcoma. The soft tissue sarcomas were: five synovial cell sarcomas, two fibrosarcomas, one clear cell sarcoma and one malignant schwannoma. The average age for all patients was twenty-four years. Two patients presented with chest metastases, both had palliative radiation and one had palliative B-K amputation. The surgical treatment given for the eighteen non-metastatic cases was: B-K amputation nine, Symes, Chopart, or ray amputation six, and wide excision of the tumor three patients. Five-year survival was eight of eighteen: three of the nine who had B-K amputation, four of the six who had more distal amputation, and one of the three who had local resection. There were no local recurrences, all deaths were from distant metastases. Although B-K amputation is often recommended, in our series more distal amputation or local resection was offered for the non-metastatic patient if plantar sensation and stability of the foot could be retained. This gave good function in nine of eighteen patients, with no local recurrences. A long duration of symptoms before presentation or referral influenced the outcome of the disease. In selected patients, amputation more distal than B-K level or wide local resection can give good function without compromising the prognosis.
