Clinical Orthopaedics and Related Research®

, Volume 471, Issue 3, pp 871–877

Primary Osseous Tumors of the Hindfoot: Why the Delay in Diagnosis and Should We Be Concerned?

  • Peter S. Young
  • Stuart W. Bell
  • Elaine M. MacDuff
  • Ashish Mahendra
Symposium: Highlights from the First Combined 2011 Meeting of the Musculoskeletal Tumor Society and Connective Tissue Oncology Society

DOI: 10.1007/s11999-012-2570-6

Cite this article as:
Young, P.S., Bell, S.W., MacDuff, E.M. et al. Clin Orthop Relat Res (2013) 471: 871. doi:10.1007/s11999-012-2570-6



Bony tumors of the foot account for approximately 3% of all osseous tumors. Diagnosis is frequently delayed as a result of lack of clinician familiarity and as a result of their rarity. The reasons for the delays, however, are unclear.


We therefore determined (1) how hindfoot tumors present and the specific reasons for delay in diagnosis; (2) whether the spectrum of disease varies between the talus and calcaneus; and (3) how these patients were treated.


We retrospectively reviewed the medical notes and imaging for all patients with 34 calcaneal and 23 talar tumors recorded in the Scottish Bone Tumour Registry. Demographics, presentation, investigation, histology, management, recurrence, and mortality were recorded.


Hindfoot tumors present with pain and often swelling around the heel (calcaneus) or ankle (talus), most often misdiagnosed as soft tissue injury. Calcaneal lesions were more likely to be malignant than talar lesions: 13 of 34 versus three of 23.


Clinicians should be aware that hindfoot tumors can be initially misdiagnosed as soft tissue injuries and suspicion of a tumor should be raised in the absence of trauma or persistent symptoms. Lesions affecting the calcaneus are more likely to be malignant. Early diagnosis and adjuvant therapy are important.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Peter S. Young
    • 1
  • Stuart W. Bell
    • 1
  • Elaine M. MacDuff
    • 2
  • Ashish Mahendra
    • 1
  1. 1.Department of Musculoskeletal Oncology Glasgow Royal InfirmaryGlasgowUK
  2. 2.Department of Histopathology Western InfirmaryGlasgowUK