Primary Tumors of the Os Calcis

The os calois is an unusual site of origin of a bone tumor. In fact, in Christensen's study of one thousand bone tumors but 20 were located in the bones of the foot, and fewer than half of these were situated in the os calcis. As early as 1880 Schwartz collected 155 bone tumors of the extremities, of which 8 were primary in the bones of the foot. Thirty years later Stern found that of 20 primary bone tumors of the foot, 18 were in the os caleis but, as he was primarily interested in the os ealeis, his figures cannot be taken to indicate the relative frequency of os caleis involvement. He asserted that the indefiniteness of the clinical manifestations and the roentgen picture of os csleis tumors, like that of other small bones of the body, will rarely permit a positive preoperative diagnosis and reliable prognosis. The credit for first describing a case of primary sarcoma of the os ealeis with histologic data belongs to Robert (1859). Bayer, in 1882, reported what we must conclude was an endothelioma of the os calcis. His patient had a tumor for three years, died two weeks after amputation, and showed at necropsy metastatic tumors in the left side of the heart, lungs, pleura, mesentery and intestinal tract, liver, and mediastinal lymphatics. Both the primary tumor and the metastases showed a large round-cell sarcoma with a tendency to alveolar structure. Barthauer, in 1891, seems to have been the first to give in complete detail a report of a sarcoma of the os calcis, The patient was free from recurrence two years after extirpation of the os calcis. Barthauer states that Monteggia, in 1814, first extirpated the os caleis for sarcoma, with a fatal outcome; that Ferdinand Robert repeated this operation; and that the first subperiosteal extirpation was performed by Mayer in 1845.