SLR - November 2023 - Vaknin
Title: Functional and oncological outcome of patients with benign hindfoot tumors treated by curettageReference: Wael Mohamed Safwat Sadek, Mostafa Salah-Eldeen Salem, Mohamed Salah Said Mohamed, Walid Atef Ebeid. Functional and oncological outcome of patients with benign hindfoot tumors treated by curettage Foot and Ankle Surgery 2023 July 29;4 (393)
Level of evidence: IV Therapeutic study
Reviewed by: Oren Vaknin
Residency Program: New York College of Podiatric Medicine
Podiatric Relevance: Bone tumors in the hindfoot exist, albeit rare, and still need treatment. How can we as physicians treat patients and return them to how they were prior? When we see inconclusive imaging at times, we still need to operate to prevent the unthinkable, so if it is needed the goal is to prevent complications and return to everyday life function with minimal or no change. The study’s goal is to carefully review efficacy based off recurrence and risk of complications in treatment of these tumors.
Methods: 41 patients were retrospectively studied (after exclusion criteria) with benign hindfoot osseous tumors over 20 years. 17 talar tumors and 24 calcaneal tumors were studied. Extended curettage, high speed burr + PMMA, was used for 31 patients with the remaining 10 undergoing simple curettage. These groups were compared based off size of tumor from CT and specific location on their respective bone. Patients were instructed to partial weight-bear at week 4 and transition to full WB at week 8. Functional outcome was then quantitively reviewed using the Musculoskeletal Tumor Society Scoring System (MSTS).
Results: MSTS scores were higher in patients with simple curettage and noted to be statistically significant. With those whose tumor was not near the articular surface MSTS showed significant improvement. Four patients showed recurrence of tumor in which none showed statistically significant results in MSTS improvement with a higher incidence in calcaneal tumors. Most common functional complication noted was arthritis. There were no notable complications with talar tumors.
Conclusions: Albeit rare benign tumors can be debilitating and cause minimal discomfort and at times a risk of causing malignancies. To treat a patient with simple curettage seems to be sufficient and proper given less complications, but given surgeon preference, I personally understand the want to eradicate any lesions. The hindfoot carries a lot of weight biomechanically as well as, in relation to the talus, has a decreased vascularity for an increased complication rate. Given the plethora of tumors studied and the small sample size and the fact this is very preliminary data, but given patient outcomes, curettage is acceptable, but there is still more to be reviewed. One should be more careful given the higher risk of complications with calcaneal tumors, even with a superior blood supply. A prospective study in relation to treatment with hindfoot curettage in general should be studied to help with return to function and further research on hindfoot tumor removal.