Delayed diagnosis in metastatic lesions of the foot

Ann R Coll Surg Engl. 2014 Oct;96(7):536-8. doi: 10.1308/003588414X14055925058111.


Introduction: 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.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnosis*
  • Bone Neoplasms / epidemiology
  • Bone Neoplasms / secondary*
  • Bone Neoplasms / therapy
  • Cohort Studies
  • Combined Modality Therapy
  • Databases, Factual
  • Delayed Diagnosis*
  • Female
  • Foot Bones / pathology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Sex Distribution
  • Survival Analysis
  • Young Adult