Metastatic skeletal disease of the foot: case reports and literature review.
BACKGROUND
Metastatic disease of the skeleton occurs in at least 20% to 30% of patients with malignancy, but metastasis to the foot and hand (acrometastasis) is extremely rare (0.007% to 0.3%). Metastases to the feet are even rarer and have been reported in half to one-third the rate for hand metastases. Failure to recognize these lesions has led to delayed diagnosis and/or inappropriate treatment. The purpose of this report is to highlight the clinical and radiologic features that aid in the diagnosis and potential treatment of this condition along with a pertinent review of the literature.


METHODS
In a retrospective review of 694 patients with histologically proven metastatic skeletal disease (January 1988 to January 2007), 14 cases of metastatic lesions to the foot were identified.


RESULTS
The most frequent primary site was in the genito-urinary system in eight patients and the most common bones involved were the calcaneus and the talus in six patients each. All patients died after a mean survival of 14.8 (range, 1 to 54) months after diagnosis of metastases.


CONCLUSIONS
Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot, especially if suspicious radiographic changes are present in an older patient. The common primary sites are the genito-urinary, lungs, breast, and the colo-rectum. Treatment is usually palliative to reduce pain and maintain function.
Maheshwari
Aditya V
AV
Cedars Medical Center, Suite 4036, 4th floor, East building, 1400 NW 12th Ave, Miami, FL 33136, USA. adityavikramm@gmail.com
Chiappetta
Geno
G
Kugler
Carlos D
CD
Pitcher
J David
JD
Temple
H Thomas
HT
D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D005529:Foot Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D005534:Foot Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011859:Radiography; D014565:Urogenital Neoplasms / Q000473:pathology