Squamous cell carcinoma of the lung usually presents as a local rather than a metastatic disease. We present a 55-year-old male who was referred to the orthopedics and traumatology clinic for evaluation of pain and discomfort around the left ankle 2 months after diagnosis of locally advanced nonsmall cell (squamous cell) lung cancer. Physical examination revealed nonspecific pain and tenderness around the ankle. T2-weighted MR images showed lesions like a bone marrow edema around the talar head

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... and neck. Whole body dynamic bone scan revealed a metastatic lesion only in the foot. The patient died 4 months after diagnosis of the metastasis. Early diagnosis of foot metastasis may be challenging and delays in diagnosis of up to 24 months have been reported. Foot metastases are usually associated with advanced metastatic disease and survival rates are poor. Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot in the elderly lung cancer patients. Palliative treatments such as pain relief medications should be chosen for patients with an expectancy of short survival whereas aggressive approaches may be applied for those with longer survival expectations.