Metastases to bones of the foot: a case series, review of the literature, and a systematic approach to diagnosis.

Metastatic lesions to the bones of the foot are rare but pose a challenge to the treating surgeon because of variation in presentation. Cases may present as a painful or swollen toe or as an infection resistant to antibiotics, or they may mimic inflammatory arthropathy. As such, diagnosis may be delayed. Also, with the advent of new therapies for certain cancers, patients living longer have time to develop metastases. The incidence of metastases to the foot is changing. The senior author (HD) has managed 3 consecutive cases of tumorous lesions metastasizing to the foot. Patients included 1 man and 2 women, with an average age of 76.7 years (range, 57-88 years). Open biopsy was performed in 2 cases, whereas true-cut needle biopsy was performed in 1 case. The average follow-up was 16.2 months (range, 8.5-29 years). The pattern and incidence of foot metastases may be changing. Early and accurate diagnosis may help improve patient survival. A working protocol is presented here that can help in diagnosing such lesions.