Systemic Disease Manifestations in the Foot, Ankle, and Lower Extremity by Positano Rock G.;Borer Jeffrey;DiGiovanni Christopher;Trepal Michael;

Author:Positano, Rock G.;Borer, Jeffrey;DiGiovanni, Christopher;Trepal, Michael;
Language: eng
Format: epub
Publisher: Wolters Kluwer
Published: 2017-08-15T00:00:00+00:00

Special and Unusual Features

Pathologic fractures from lymphoma may occur at the time of diagnosis, during treatment, and months or years after treatment is concluded. Fractures after treatment were attributed to radiation doses of 50 Gy or higher, chemotherapy containing prednisolone, and other risk factors such as old age, female sex, surgical infection, and Paget disease.76

METASTATIC TUMORS AND TUMOR MIMICS

Metastatic Bone Tumors in the Foot

Introduction and Demographics

Metastases distal to the knee are unusual, and metastases to the bones of the foot (acrometastases) are even more rare.56 Metastases to the bone develop in 30% of all patients with cancer, with only 0.007% to 0.3% having acrometastases.78 Libson et al.79 found that the most common sources were the colorectal, renal, and lung carcinomas, with bladder, uterus, and breast cancers also contributing metastases to the foot. Zindrick et al.56 found the main sources of metastases to the bones of the feet to be the genitourinary tract and colon.80 The talus is most commonly affected, then the calcaneus.49 The tarsal bones are involved in 50% of cases, the metatarsals in 23%, whereas the phalanges account for only 17% of the reported cases80 (Fig. 11-7).

Symptoms and Presentation

Common complaints include foot pain, localized or diffuse swelling and progressive enlargement, subungual lesion, or an ulcerated discharging lesion. Many cases present to the surgeon mimicking other benign processes, and a delay in diagnosis may result. Patients may have pain for weeks or months before radiographic changes can be detected.81 Clinical features of metastasis to the phalanges include redness, warmth, swelling, ulceration, or tenderness.80

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