CLINICALLY SPEAKING Grade 2 Chondrosarcoma of the Great Toe An Unusual Location Ramadan O ¨ zmanevra, MD* Ece Calikoglu, MD† Gamze Mocan, PhD† Kaan Erler, PhD‡ Enchondroma is the most common benign cartilage bone tumor of the toes. In contrast, the foot is a rare region for chondrosarcoma, and the involvement of phalanges is extremely rare. In this article, we report an unusual case of intermediate chondrosar- coma involving the proximal phalanx of the great toe of a 52-year-old woman who was previously treated with curettage and bone grafting because of misinterpretation of enchondroma at a local hospital. She presented complaining of pain and swelling that she had experienced for a period of 1 year after the first operation. Radiography revealed a lytic lesion with a subtle punctuate calcification and endosteal scalloping in the proximal phalanx of the great toe. Gadolinium-enhanced magnetic resonance imaging confirmed soft-tissue involvement and cortical destruction. Staging evaluation with computed tomographic scan of the chest, abdomen, and pelvis was performed to ensure that there was no metastatic disease. Subsequently, a bone biopsy was performed, and the diagnosis was grade 2 chondrosarcoma. The patient was informed about the recurrence of the lesion and the clinical context on the basis of tumor biology of chondrosarcoma and was offered the option of either amputation or wide resection. She preferred the latter. The patient was treated with wide resection and underwent reconstruction with cement and Kirschner wire. She remains free of disease after 1 year of follow-up. (J Am Podiatr Med Assoc 109(5): 393-396, 2019) Primary chondrosarcoma (CHS) is the third most common primary malignancy of bone after plasma- cytoma and osteosarcoma. 1 The most common skeletal sites are pelvic bones, followed by the proximal humerus, distal femur, and ribs. The small bones of the hands and feet are rarely affected (,1% of all cases of CHS). 2 When a tumor occurs in the feet, involvement of toes is extremely rare. 3 Although a positive prognosis is expected, there is little information about the biological behavior of phalangeal CHS. Phalangeal CHS acts as a locally aggressive lesion and, unlike CHS elsewhere, metastasis is rare. Chondrosarcomas are a group of tumors with a wide range of features and behavioral patterns ranging from slow-growing, nonmetastatic lesions to highly aggressive meta- static sarcomas. 4 Chondrosarcomas are innate cartilaginous malignant tumors in which the tumor matrix formation is completely chondroid. Chon- drosarcomas are most common in men aged 30 to 60 years, with a slight female dominance for phalangeal chondrosarcomas. Chondrosarcomas typically slowly develop neoplasms. The most common symptoms are mild pain and tenderness. Local swelling with soft-tissue masses and patho- logic fractures are other physical findings. Chondrosarcoma remote metastasis passes through a hematogenous pathway and typically progresses straight to the lungs. The overall prognosis is related to lesion size, anatomical location, type, and histologic grade. The 5-year survival rate for patients with grade 1 lesions is 90%; the rate decreases to 29% for those with grade 3 tumors. Grade 1 lesions do not metastasize. The radiographic appearance of conventional CHSs reveals large radiolucent areas with thick walls. These radiolucent sites have trabeculation with *Department of Orthopedics and Traumatology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus. †Department of Pathology, Faculty of Medicine, Near East University, Nicosia, Cyprus. ‡Department of Orthopedics and Traumatology, Faculty of Medicine, Near East University, Nicosia, Cyprus. Corresponding author: Ramadan O ¨ zmanevra, MD, Depart- ment of Orthopedics and Traumatology, Faculty of Medicine, University of Kyrenia, Karakum, Kyrenia 99320, Cyprus. (E- mail: rozmanevra@gmail.com) Journal of the American Podiatric Medical Association  Vol 109  No 5  September/October 2019 393