Not every tumorous lesion necessarily requires surgery or other therapy. Lesions which can be clearly assigned to a specific benign entity after a thorough clinical and radiological assessment, that do not jeopardize the mechanical strength of the bone and are asymptomatic can be observed over the course of time or sometimes neglected at all. This applies, amongst others, to non-ossifying fibroma (NOF) and certain forms of osteochondromas or enchondromas. Nevertheless, an individual analysis of the specific lesion and the affected patient is always required to avoid over- or undertherapy.

The surgical therapy of foot tumors is basically no different from other localizations of the skeleton and and is based on the well-known principles of classification and therapy of benign and malignant musculo-skeletal neoplasms by Enneking. The different variants of surgical tumor resection can be classified on the basis of their resection margins into intralesional, marginal, wide, and radical resections. However, the planning of individual surgical therapy, which includes not only tumor resection but also subsequent reconstruction, is influenced by numerous other factors. Biological age, life expectancy, activity levels, compliance, and personal preferences of the patient must all be considered in a joint decision-making process. Compromises at the expense of a tumor-radical approach are obsolete in curative therapeutic approaches. An multidisciplinary tumor board is the central decision-making body. Relevant local factors for surgical therapy are the extent of the tumor in the bone, joint involvement, and soft tissue involvement including neurovascular structures and adjacent compartments. In this regard, magnetic resonance imaging (MRI) is crucial for accurate preoperative diagnostics.
The tumor resection with appropriate resection margins (intralesional – marginal – wide – radical) is performed according to the histopathological grading and dignity of the lesion. Furthermore, due to the limited anatomical properties of the foot, radical resections are usually equivalent to ray amputation and are more often necessary than in the rest of the musculoskeletal system. If the tumor resection includes the resection of plantar nerves, a (partial) amputation of the foot must be considered, since the loss of relevant senso-motoric structures is equivalent to a functional amputation.