Introduction to Bone Tumors in the Foot
Bone tumors in the foot are uncommon, but any orthopedic surgeon or podiatric surgeon in active practice will encounter a significant number in the course of their practice. In addition, these lesions figure prominently on the board exams we are all required to pass to complete our training.
To begin with, one should become familiar with the general algorithm for management of bone tumors that can be applied to any lesion to increase the chance of an accurate and timely dignosis and decrease the chance of diagnositic delays and errors as well as inappropriate treatments. More information on the initial approach to a bone tumor, regardless of location, is here.
Most Common Benign Bone Tumors in the Foot
The most common benign bone tumors in the foot include osteochondroma, enchondroma, osteoid osteoma, chondromyxoid fibroma, chondroblastoma, aneurysmal bone cyst, osteoblastoma, giant cell tumor, and unicameral bone cyst. Other tumors may occur in the foot and are detailed in the appropriate section of this page.
Bone Tumors: Benign and Malignant
In the foot, the ratio of benign to malignant tumors is different from that in the extremities in general. The ration has been reported as 5:1 and 10:1 in various series. (1, 2) This is because benign tumors are less common and certain malignant tumors are more common in the foot than elswhere.
Tumor mimics (non-neoplastic lesions that imitate the appearance or behavior of true tumors) are as common as real tumors in some clinical settings. Practicioners should use extra caution in managing tumors in the foot because of the increased likelihood of malignancy.
Biologic Behavior of Tumors
To determine the optimum management strategy for any given tumor in the foot, the behavior of the tumor must be known as accurately as possible. The clinician should be aware that bone tumors may exhibit three types of behavior: Latent, active, or aggressive. "Latent" is not a synonym for "benign" although most latent tumors are in fact benign. Similarly, "aggressive" tumors are not necessarily malignant, although most are.
A latent tumor may exibit no growth, there is no ongoing reaction on the part of the host bone, there may be no symptoms or physical findings on exam No intervention of any kind may be necessary for a latent tumor unless special circumstances exist.
An active lesion exhibits progressive growth, there may be a mild or moderate reaction to the tumor by the host bone, and the patient usually has progressive pain and dysfunction of the part. Treatment by careful diagnosis, biopsy, and surgical removal of the tumor is usually required.
Aggressive tumors grow progressively and may grow rapidly, the host bone shows a marked reaction to the tumor, and the patient has progressive pain, a mass or even a pathological fracture. Treatment usually requires with a complete cancer staging work-up with a biopsy as the last step, and may involve multimodal treatment with chemotherapy, radiation, surgery, or some combination of these.
The author of this work recommends that every clinician who makes treatment decisions regarding bone tumors should begin by trying to determine whether the tumor is latent, active, or aggressive
Specifics on benign bone tumors of the foot
This section has 5 parts:
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