title: Delayed diagnosis in metastatic lesions of the foot.
abstract: BACKGROUND
  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.
authors.affiliation: Royal Orthopaedic Hospital NHS Foundation Trust, UK.
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.forename: A
authors.initials: A
authors.lastname: Ramasamy
authors.forename: L
authors.initials: L
authors.lastname: Jeys
authors.forename: R
authors.initials: R
authors.lastname: Grimer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D057210:Delayed Diagnosis; D005260:Female; D005529:Foot Bones / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D055815:Young Adult