This learning module covers initial patient assessment and evaluation for patients with bone tumors of the foot.
This learning module describes how to properly examine and evaluate different types of patients with a potential bone tumor of the foot, and why certain procedures are useful and necessary.
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.
Tumor pain, while variable, is usually a gradually progressive pain, well localized, that grows more persistant over many weeks or months. In many cases the patient will ascribe the pain to some minor traumatic event. The examining physician is cautioned not to take these red-herring stories at face value. Careful questioning will often reveal that the pain clearly predated the event.
For bone tumors, the examination occasionally provides useful information pertaining to the diagnosis of the lesion. The examiner should note the palpable size, local extent, and the presence of a palpable mass in the chart.
The examination should also focus on the nearby structures of the foot or ankle to reveal possible pathology that may be causing the pain or disability. Any angular deformity or positional deformity should be noted.
The patient over 40 is at risk for metastatic cancer in the foot and ankle, and thus adults should be questioned about any personal history of cancer. The status of routine screening examinations such as the PSA level in men and mammography in women should be noted. Cancer risk factors should be enumerated, especially those related to the 5 most common tumors that contribute to bone metastasis, which are lung, breast, prostate, kidney, and thyroid.
