Acrometastases. Initial presentation as diffuse ankle pain.

Acrometastases are rare and often misdiagnosed or overlooked. When it involves the feet, it generally attacks the larger bones containing the higher amounts of red marrow. The patient may or may not have a known history of cancer, which makes diagnosis much more difficult. The symptomatology is generally vague and can mimic other conditions, such as osteomyelitis, gouty rheumatoid arthritis, Reiter's syndrome, Paget's disease, osteochondral lesions, and ligamentous sprains. Therefore, the physician must consider metastatic disease in the differential diagnosis. Once the diagnosis is made, the prognosis is poor and treatment is limited to pain relief and maintaining function.