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Soft tissue tumors of the foot - Introduction

Introduction: 

This learning module introduces soft tissue tumors of the foot.

Summary: 

This learning module describes soft tissue tumors of the foot, explains how to differentiate between benign and malignant soft tissue tumors of the foot, describes common types of soft tissue tumors of the foot, and describes treatment for sarcomas.

Topic Presentation: 

Tumors of the foot and ankle represent a unique subset of all soft tissue tumors, showing variance in type, location, age, prognosis and treatment from tumors in the rest of the musculoskeletal system. Soft tissue tumors of the foot and ankle may be degenerative, reactive, post-traumatic, or neoplastic in origin, or they may arise from an unknown cause.

Careful attention to the details of the history and the physical examination, combined with an informed analysis of appropriate imaging studies allows the surgeon to reliably differentiate benign from malignant tumors in many cases. However, malignancies appear to comprise a larger proportion of tumors in the foot and ankle than elsewhere in the body. The incidence of soft tissue sarcoma is 8700 per year in the United States, with an estimated 10% of these occurring in the distal lower extremity.

Synovial sarcoma, clear cell sarcoma, and Ewing sarcoma are the most common soft tissue sarcomas in the foot and ankle. Soft tissue sarcomas have no predilection for any race or sex. Treatment of sarcomas requires resection with a wide margin, plus adjuvant chemotherapy and/or radiotherapy depending on tumor type. In the foot and ankle, adequate resection with a wide margin may require some sort of amputation.

Limb salvage following removal of tumors in the foot and ankle is complicated by the loads on the skeletal elements and the generally scant soft tissue coverage. The ultimate goal of treatment is elimination of the tumor and restoration of the patient's long-term mobility and function. Patient survival is significantly better in distal lower extremity tumors than for sarcomas in other musculoskeletal sites. (1)