Soft tissue sarcomas of the foot and ankle: a 12 year Sarcoma Centre experience

T. Paavana, T. Ankers, P. Cool, C. Heaver

Introduction: Soft tissue sarcomas of the foot and ankle are a rarely encountered condition. We report a 12 year experience at a Sarcoma Centre.

Methodology: A retrospective review of prospectively gathered electronic database was performed from January 2011 to December 2022. Of 265 referrals, 14 (5%) sarcomas (7 males, 7 females) were identified. Excel and R was used for analysis.

Results: Mean age at diagnosis was 42 (range 10-80) years. Eleven of these had a clear history of pain documented. Duration of reported symptoms ranged widely from 4-60 (mean 20) months. Five diagnoses were unexpected following excision performed elsewhere. Synovial Sarcoma was most frequently identified (6), followed by Clear Cell Sarcoma (2). Others observed were Sarcoma NOS (2), Low Grade Fibromyxoid Sarcoma (1), Leiomyosarcoma (1), Myxofibrosarcoma (1) and Extraskeletal myxoid chondrosarcoma (1). The most common location was the midfoot (6), followed by the ankle (4) and hindfoot (4). No forefoot lesions were identified. Most lesions were high (9) or intermediate (4) grade; One was low grade. One patient had metastases at referral following local excision elsewhere and underwent palliative chemotherapy. Primary surgical treatment modalities included below knee amputation (6), ray amputation (2), limb salvage surgery (6). Three patients underwent adjuvant radiotherapy. No significant difference was observed between limb salvage and amputation groups. Overall survival at 2 years was 78%; 5 year survival was 69%. Two patients developed local recurrence and subsequent metastases. A further three patients developed metastases without local recurrence. The presence of local recurrence or metastases conferred a poor prognosis (p=0.021).

Conclusion: Soft tissue sarcomas of the foot and ankle are rare. The history of a painful lesion should raise clinical suspicion. Long duration of symptoms is not necessarily reassuring. Development of local recurrence or metastases is a poor prognostic sign and may inform patient discussion.