Soft-Tissue & Bone Tumours of the Foot & Ankle (Overview)

My approach is governed by the principle that a foot mass is malignant until proven otherwise, because malignant foot tumours are rare and are classically mistaken for benign lumps such as a ganglion, and the commonest soft-tissue sarcoma of the foot - synovial sarcoma - is exactly this kind of small, firm, slow-growing lesion. So I would not simply excise it. I would take a history and examine for red flags - a solid rather than transilluminating mass, one that is deep to fascia, fixed, enlarging, painful, larger than a few centimetres, or recurring after a previous excision. I would image it: plain radiographs to look at the bone and for calcification, and an MRI to characterise the soft tissue and define the local extent, with staging if malignancy is suspected. If it is not unequivocally benign, I would arrange a properly planned biopsy - placed so the tract can be excised en bloc with the tumour, ideally done at or after discussion with the tumour unit that would perform the definitive surgery - and refer to a specialist sarcoma centre. I would only proceed to excision once I have a diagnosis, because an unplanned excision of a sarcoma contaminates the field and roughly doubles the local recurrence rate. Benign symptomatic lesions are then treated on their merits; malignancy is managed by the multidisciplinary team with wide excision and adjuvant therapy as indicated.