Introduction. Bone tumours of the foot are rare, representing 3–6% of all bone tumours. Of these 15–25% are thought to be malignant. Obtaining clear surgical margins remains an important factor in improving outcome from tumours. However, the anatomical complexity of the foot can lead to an inadequate resection, particularly if the operating surgeon is attempting to preserve function. The aim of this paper is to identify the clinical course of patients suffering from malignant bone tumours of the foot. Method. A prospective tumour registry over a 30 yr period was used to identify patients with a malignant bone tumour of the foot. Patient demographics along with the site of primary malignancy, region of the foot involved and clinical management were recorded. Results. 70 patients with a malignant foot tumour were identified. 25(35%) were chondrosarcomas, 20 Ewings Sarcoma, 10 Osteosarcoma and 15 were metastatic lesions. Of those diagnosed with a primary bone tumour, 8(14.5%) were referred following a “whoops” procedure. The median length of symptoms prior to diagnosis was 52 weeks. The most common regions affected were the 1. st. Ray (31%) and Calcaneus (22%). The mainstay of treatment involved either Ray or Below Knee Amputation in 70% of cases. 11 patients developed either local recurrence or metastatic disease. Conclusion. We present the largest single centre review of malignant bone tumours affecting the foot. Our series confirms that patients often have to suffer with protracted symptoms prior to the establishment of the correct diagnosis. The variety of differential diagnoses may explain the long delay in diagnosis. Worryingly, 14.5% of the primary bone malignancies in our series underwent a “whoops” procedure. This highlights further that physicians need to maintain a high index of suspicion when treating a patient with foot symptoms, even when the symptoms may be protracted

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

We present the results of ankle fusion using the Ilizarov technique for bone loss around the ankle in 20 patients. All except one had sustained post-traumatic bone loss. Infection was present in 17. The mean age was 33.1 years (7 to 71). The mean size of the defect was 3.98 cm (1.5 to 12) and associated limb shortening before the index procedure varied from 1 cm to 5 cm. The mean time in the external fixator was 335 days (42 to 870). Tibiotalar fusion was performed in 19 patients and tibiocalcaneal fusion in one. Associated problems included diabetes in one patient, pelvic and urethral injury in one, visual injury in one patient and ipsilateral tibial fracture in five. At the final mean follow-up of 51.55 months (24 to 121) fusion had been achieved in 19 of 20 patients. A total of 16 patients were able to return to work. The results were graded as good in 11 patients, fair in six and poor in three. The mean external fixation index was 8.8 days/mm (0 to 30). One patient with diabetes developed severe infection which required early removal of the fixator. Refractures occurred in three patients, two of which were at the site of fusion and one at a previous tibial shaft fracture site. Equinus deformity of the ankle fusion occurred after a further fracture in one patient. There were two patients with residual forefoot equinus, and one developed late valgus at the fusion site.

Poor consolidation of the regenerated bone in two patients was treated by bone grafting in one and by bone and fibular strut grafting in the other. Residual soft-tissue infection was still present in two patients.