Initial patient assessment and examination

The patient presenting with a mass in the foot and ankle should have a complete history and physical examination. It is important to precisely determined the time of onset of the pain as well as the rate of progression and precise location. This will allow the clinician to determine whether the pain is actually coming from the tumor or from some nearby less worrisome abnormality. For soft tissue tumors, physical examination findings are helpful in assessing the potential for malignancy. Malignant tumors tend to be large, deep, progressively growing, firm, and detectable as a definite soft tissue mass. Benign tumors tend to be small, superficial, soft, not growing or intermittently increasing and decreasing in size, and more difficult to detect as a definite soft tissue mass. Certain physical examination findings might point towards a specific diagnosis. For example, hemangiomas have a characteristic blue-purple color that may be visible at the skin level, and are typically painful to palpation. Laboratory testing is not very helpful in diagnosing or managing tumors in the foot and ankle. Sending a large battery of nonspecific laboratory tests is not recommended. Where infection is suspected, an erythrocyte sedimentation rate, C. reactive protein, and blood cultures are useful.

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