Foot metastasis: Current knowledge

Abstract

Foot metastasis are rare and often overlooked due to non-specifical symptoms. This often leads to misdiagnosis delaying the right diagnosis. Metastatic disease of the foot is rare. Foot pain and swelling may be the presenting symptom of an occult malignancy. If metastatic disease is not kept in the differential diagnosis of foot pain, diagnosis and treatment will be delayed. The purpose of this study was to analyze articles presenting cases of foot metastasis to provide a more accurate incidence of symptomatic foot acrometastasis as well as to review the clinical course and outcomes. Studies were searched on PubMed/Medline from the inception to February 2020. All studies included in the review presented foot metastasis either with or without a known primary tumor. Most of the articles were case reports, to which we added two case reports of foot acrometastasis produced by our Institute. Forty-three studies with a total of 45 patients were included in this review. The literature published mostly concerning case reports about old patients (average age: 63,2), in a late phase of their disease. Lung cancer appeared to be the most common primary tumor, followed by endometrial and breast cancer. In the 36% of the cases foot metastasis were found when the primary site was still unknown. Calcaneus and metatarsal bones were the most common bones involved. Surgical solution is rare, the chosen treatments are often of palliative care. Prognosis was often poor, death occurred within 2 years since the discovery of foot metastasis in about 50% of cases.

Novel Radiographic Measurements for Operatively Treated Haglund’s Deformity

“…The clinical diagnostic criteria for Haglund's deformity included palpable calcaneal hump with posterior heel pain and local swelling in the prominence of the posterior calcaneus. After conservative treatment failed, all patients received MRI to exclude any other pathogenesis or tumor over the posterior heel [14] and underwent calcaneoplasty with open retrocalcaneal decompression performed by one single foot and ankle surgeon in our hospital.…”

Surgical treatment of metastatic bone disease of the distal extremities

“…Studies have also shown that certain tumor types, such as metastases from renal and thyroid origin, have the best prognosis when totally resected, when local recurrence and disease-free survival are the primary outcome measurements[ 29 ]. Nonetheless, prognosis of patients with acrometastatic cancer is poor[ 30 ], since most have widespread disease, and their mean survival time has been reported to be less than 6 mo[ 31 ].…”

“…The hindfoot (calcaneus and talus) is the most common site, followed by the forefoot (metatarsal bones and phalanxes) and mid foot (cuniforme-, navicular- and cuboid bones)[ 16 ]. An average survival of 15 mo for patients with acrometastases of the foot has been reported[ 30 ].…”

“…Treatments of MBD of the foot vary from simple palliative care or pharmacological treatment, radiation therapy, chemotherapy, and surgery[ 30 , 35 ]. No standard treatment protocols exist because of the rarity of the condition and therefore are often approached on a case-by-case basis.…”

Bone metastases in lung cancer

“…Lung cancer is also the most common primary cancer to give rise to acrometastases, which are extremely rare metastases located distal to the elbow and knee. [29][30][31] They determine major complications such as severe bone pain, pathological fractures, bone instability, spinal cord compression (SCC) and hypercalcemia known as skeletal-related events (SREs) responsible for significant morbidity that severely alter the patient's quality of life (QoL) and performance status (PS) from the earliest times. 32,33 SREs indeed have a huge medico-economic impact requiring frequent hospitalization and outpatient visits.…”