Presurgical Perspective and Posttreatment Evaluation of Soft Tissue Tumors of the Ankle and Foot in Adults

Abstract

This article discusses soft tissue tumors of the ankle and foot region in adults, including tumors of the joints, and also briefly addresses tumor-simulating lesions. We offer general recommendations and describe specific aspects of common entities in that region, such as typical imaging appearance, therapeutic strategies, and posttherapeutic considerations. Focal masses and diffuse swelling are common in the foot and ankle region; most of them are non-neoplastic. Some of the tumors, such as plantar fibromatosis, tenosynovial giant cell tumor, synovial chondromatosis, or schwannoma, have a very typical appearance on magnetic resonance imaging. Sarcomas are rare among true soft tissue tumors; however, they can be small and well demarcated, may grow slowly, and are often misinterpreted as benign. This is especially true for synovial sarcoma, one of the most common sarcomas in this region. Densely packed tissues in the foot and ankle may hamper determining the tissue of origin. Adherence to diagnostic guidelines and cooperation with tumor centers is crucial including for posttherapeutic surveillance. We also describe typical posttherapeutic changes and complications after surgery, radiation therapy, and chemotherapy, as well as parameters for the detection and exclusion of recurrence of soft tissue tumors of the ankle and foot.

Imaging Recommendations for Diagnosis, Staging, and Management of Soft Tissue Sarcomas

“…While almost all cases will require imaging to further investigate, it is important to remember that the vast majority will be benign. 1 10 11 A detailed clinical history and thorough clinical examination should therefore be performed to triage those cases in which there is a higher suspicion of malignancy. This will enable appropriate onward referral.…”

“…16 17 In contrast to plain radiographs, ultrasound provides good soft tissue resolution and is a useful triage test to differentiate benign pathology such as simple lipomas, ganglion cysts, muscle hernias, and uncomplicated vascular malformations from more sinister lesions. 11 17 The easy access of ultrasound to most primary care physicians has the advantage of providing patients reassurance and reducing the referral burden on local tertiary referral centers. 10 It is, however, limited by several factors, including but not limited to operator experience and patient body habitus.…”

“…Clinical findings that raise the concern of malignancy include but are not limited to a size of more than 5cm, pain/tenderness, and lesion growth. 10 11…”