Delayed diagnosis in metastatic lesions of the foot

Abstract

INTRODUCTION Pedal acrometastases are a rare complication of disseminated malignancy. To date, there is little in the literature documenting their clinical course. METHODS Our large orthopaedic oncology database was used to review the clinical course of symptomatic pedal acrometastases. RESULTS A total of 15 cases of pedal acrometastases were identified from 2,595 patients with metastases. The median age at presentation was 64.5 years (range: 14-83 years) and the median length of foot symptoms (predominantly pain and swelling) prior to diagnosis of metastasis was 16 weeks (range: 6-104 weeks). The median survival following diagnosis was 4.6 months (range: 2.3-104.5 months). CONCLUSIONS This study suggests that 0.58% of all osseous metastases involve the foot, and that symptoms of foot pain and swelling are often misdiagnosed, leading to delays in treatment. A high index of suspicion is required to diagnose pedal acrometastases early, thereby allowing early treatment so that the patient's quality of life can be maintained prior to death.

Tumours of the foot and ankle

“…The commonest presentations of any tumour in the foot and ankle region are pain and a lump [7]. Certain tumours are common in particular age groups and this helps in narrowing down the diagnosis along with specific location within the bone.…”

“…Acrometastasis from primary lung cancer are reported to be common but a study published from the senior authors institution suggests infra diaphragmatic cancers to be a more common cause [7].…”

“…The commonest malignant lesions in this region are Ewing's sarcoma, Chondrosarcoma and Osteosarcoma. Delayed or missed diagnosis is a common presentation in this region which can make limb salvage surgery very demanding and ablative surgery maybe the only option [7].…”

“…These patients present with pain and swelling with lung, colon and genitourinary tumours being the commonest primary tumours. Palliative radiotherapy and surgery for local control is the main stay of treatment [7].…”

Skelettmetastasen der Extremitäten – Management und operative Behandlungskonzepte

“…Metastasen im Bereich des Fußes zählen zu den Ausnahmefällen (< 1 % aller Tumormetastasen) und sind durch das späte klinische Auftreten mit einer schlechten Prognose assoziiert [32].…”