Case Report| Volume 49, ISSUE 2, P159.e15-159.e20, March 2010

Download started.


Treatment of Metastatic Prostate Adenocarcinoma to the Calcaneus

Published:December 16, 2009DOI:


      Metastatic skeletal adenocarcinoma is an all too common and unfortunate complication of advanced oncologic states. Mortality rates are usually elevated when bony metastasis are evident, as this signifies advanced disease. The foot and ankle are uncommon sites for metastatic deposits, but may occur. As such, the foot and ankle surgeon must be aware of the potential for such disease, and be able to proceed with an imaging and medical work-up of the patient with foot and ankle skeletal metastasis. The goal of treatment is pain relief and the preservation of functional ambulation, which may greatly enhance the quality of remaining life for patients. A team approach is mandatory to manage the patients with metastatic disease. We present a case of an elderly male with a known history of prostate cancer, who presented with unrelenting heel pain, which upon diagnostic work-up, proved to be progressive calcaneal as well as axial metastasis after a brief period of clinical remission. Operative management coupled with palliative radiation and bisphosphonate therapy provided symptomatic pain relief and maintenance of functional ambulation.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Schwartz E.D.
        • Donahue F.I.
        • Bromson M.S.
        • Blaise J.F.
        Metastatic prostate carcinoma to the foot with magnetic resonance imaging and pathologic correlation.
        Foot Ankle Int. 1998; 19: 594-597
        • Lee D.K.
        Prostate cancer metastases to the leg, ankle, and foot.
        J Am Podiatr Med Assoc. 2008; 98: 242-245
        • Maheshwari A.V.
        • Chiappetta G.
        • Kugler C.D.
        • Pitcher Jr., J.D.
        • Temple H.T.
        Metastatic skeletal disease of the foot: case reports and literature review.
        Foot Ankle Int. 2008; 29: 699-710
        • Hattrup S.J.
        • Amadio P.C.
        • Sim F.H.
        • Lombardi R.M.
        Metastatic tumors of the foot and ankle.
        Foot Ankle. 1988; 8: 243-247
        • Gall R.J.
        • Sim F.H.
        • Pritchard D.J.
        Metastatic tumors to the bones of the foot.
        Cancer. 1976; 37: 1492-1495
        • Zindrick M.R.
        • Young M.P.
        • Daley R.J.
        • Light T.R.
        Metastatic tumors of the foot: case report and literature review.
        Clin Orthop Relat Res. 1982; 170: 219-225
        • Zindrick M.R.
        • Young M.P.
        • Daley R.J.
        • Light T.R.
        Metastatic tumours of bones of the hand and foot. A comparative review and report of 43 additional cases.
        Skeletal Radiol. 1987; 16: 387-392
        • Oh W.K.
        • Loda M.
        • Kantoff P.W.
        • Janicek M.
        Progressive sclerosis of isolated foot metastasis of prostate cancer.
        J Urol. 2002; 167: 1392
        • Gisserot O.
        • Jaureguiberry J.P.
        • Carli P.
        • Paris J.F.
        • Jaubert D.
        • Chagnon A.
        Heel pain as the inaugural manifestation of metastatic prostate cancer.
        Rev Rhum Engl Ed. 1996; 63: 870-871
        • Aaron A.D.
        Treatment of metastatic adenocarcinoma of the pelvis and the extremities.
        J Bone Joint Surg (Am). 1997; 79: 917-932
        • Sugiura H.
        • Yamada K.
        • Suguira T.
        • Hida T.
        • Mitsudomi T.
        Predictors of survival in patients with bone metastasis of lung cancer.
        Clin Orthop Rel Res. 2008; 466: 729-736
        • Beheshti M.
        • Vali R.
        • Waldenberger P.
        • Fitz F.
        • Nader M.
        • Hammer J.
        • Loidl W.
        • Pirich C.
        • Fogelman I.
        • Langsteger W.
        The use of F-18 choline PET in the assessment of bone metastases in prostate cancer: correlation with morphological changes on CT.
        Mol Imaging Biol. 2009 Jul 9; ([Epub ahead of print])
        • Klepzig M.
        • Jonas D.
        • Oremek G.M.
        Procollagen type 1 amino-terminal propeptide: a marker for bone metastases in prostate carcinoma.
        Anticancer Res. 2009; 29: 671-673
        • Lewis V.O.
        What's new in musculoskeltal oncology.
        J Bone Joint Surg (Am). 2009; 91: 1546-1556
        • Odero-Marah V.A.
        • Wang R.
        • Chu G.
        • Zayzafoon M.
        • Xu J.
        • Shi C.
        • Marshall F.F.
        • Zhau H.E.
        • Chung L.W.
        Receptor activator of NF-kappaB Ligand (RANKL) expression is associated with epithelial to mesenchymal transition in human prostate cancer cells.
        Cell Res. 2008; 18: 858-870
        • DeHaan A.M.
        • Wolters N.M.
        • Keller E.T.
        • Ignatoski K.M.
        EGFR ligand switch in late stage prostate cancer contributes to changes in cell signaling and bone remodeling.
        Prostate. 2009; 69: 528-537
        • Armstrong A.P.
        • Miller R.E.
        • Jones J.C.
        • Zhang J.
        • Keller E.T.
        • Dougall W.C.
        RANKL acts directly on RANK-expressing prostate tumor cells and mediates migration and expression of tumor metastasis genes.
        Prostate. 2008; 68: 92-104
        • Brown J.M.
        • Corey E.
        • Lee Z.D.
        • True L.D.
        • Yun T.J.
        • Tondravi M.
        • Vessella R.L.
        Osteoprotegerin and rank ligand expression in prostate cancer.
        Urology. 2001; 57: 611-616