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Most hindfoot tumors require below-knee amputation

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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.