Predictors of malignancy in surgically removed foot and ankle masses: a retrospective multi-center study

Abstract

Purpose Foot and ankle masses, though uncommon, are an important subset of musculoskeletal tumors, encompassing benign and malignant forms. Malignant tumors often necessitate aggressive treatment, including amputation, and unplanned resections can worsen outcomes by increasing recurrence risk. Identifying predictors of malignancy and functional deficits is vital for improving treatment strategies. Methods A retrospective review of 120 tumors in 112 patients (2017-2024) assessed demographics, tumor characteristics, size, surgical approach, and outcomes. Interventions included excision, curettage, and amputation, with reconstruction when needed. Predictors of malignancy and functional outcomes were statistically analyzed. Results Malignancy was observed in 9.8% of cases, with tumor size > 45 mm and age > 45 years identified as significant predictors. The majority of surgeries were excisions (83.9%), followed by curettage in 13.3% and amputation in 2.8%. Complete resection (R0) was achieved in 94.5% of cases. Early-term (0-180 days) wound complications occurred in 5.4%, while late-term recurrence (median 22 months) was observed in 4.5% Conclusion Tumor size and patient age are key malignancy predictors. Complete resection improves outcomes, highlighting the importance of tailored surgical planning.