Journal Scan

Most hindfoot tumors require below-knee amputation

Posted on August 6, 2021

Good local control is often achieved after resection of bone sarcomas of the foot, although the majority of patients with hindfoot tumors require below-knee amputations, according to a study.

In this retrospective study, 50 patients with primary malignant bone sarcoma of the foot who underwent surgery were followed for a median of 68 months. Overall, 23 patients had chondrosarcoman, 14 patients had Ewing’s sarcoma, and 13 patients had osteosarcoma; and primary sites included metatarsal (n = 18), phalanges (n = 15), calcaneus (n = 13) and others (n = 4).

The 5-year disease-specific survivals were 100% in chondrosarcoma, 83% in Ewing’s sarcoma, and 83% in osteosarcoma. In 21 patients underwent below-knee amputation, 24 patients underwent ray/toe amputation, 2 patients underwent excision, and 3 underwent curettage.
In 94% of mid/hindfoot tumors, below-knee amputation was performed. In most patients (42/50), surgical margins were wide/radical. Marginal and intralesional margins were achieved in 5 and 3 patients, respectively.  Overall, 3 patients developed local recurrence, however, no local recurrence was observed in patients with wide/radical margins.
Postoperative complications occurred in 3 patients, including surgical site infection in 2 patients and delayed wound healing in 1 patient.

Tsuda Y, Fujiwara T, Stevenson JD, et al. Surgical outcomes of bone sarcoma of the foot. Jpn J Clin Oncol. 2021;doi: 10.1093/jjco/hyab118. Epub ahead of print. PMID: 34345896.