title: Primary osseous tumors of the hindfoot: why the delay in diagnosis and should we be concerned?
abstract: BACKGROUND
  Bony tumors of the foot account for approximately 3% of all osseous tumors. Diagnosis is frequently delayed as a result of lack of clinician familiarity and as a result of their rarity. The reasons for the delays, however, are unclear.
  
  
  OBJECTIVE
  We therefore determined (1) how hindfoot tumors present and the specific reasons for delay in diagnosis; (2) whether the spectrum of disease varies between the talus and calcaneus; and (3) how these patients were treated.
  
  
  METHODS
  We retrospectively reviewed the medical notes and imaging for all patients with 34 calcaneal and 23 talar tumors recorded in the Scottish Bone Tumour Registry. Demographics, presentation, investigation, histology, management, recurrence, and mortality were recorded.
  
  
  RESULTS
  Hindfoot tumors present with pain and often swelling around the heel (calcaneus) or ankle (talus), most often misdiagnosed as soft tissue injury. Calcaneal lesions were more likely to be malignant than talar lesions: 13 of 34 versus three of 23.
  
  
  CONCLUSIONS
  Clinicians should be aware that hindfoot tumors can be initially misdiagnosed as soft tissue injuries and suspicion of a tumor should be raised in the absence of trauma or persistent symptoms. Lesions affecting the calcaneus are more likely to be malignant. Early diagnosis and adjuvant therapy are important.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK. Peteryoung2@nhs.net
authors.forename: Peter S
authors.initials: PS
authors.lastname: Young
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Bell
authors.forename: Elaine M
authors.initials: EM
authors.lastname: MacDuff
authors.forename: Ashish
authors.initials: A
authors.lastname: Mahendra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001706:Biopsy; D001859:Bone Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016025:Bone Transplantation; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002648:Child; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010027:Osteotomy; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012606:Scotland; D018461:Soft Tissue Infections / Q000175:diagnosis; D013628:Talus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult