Most tumors of the foot and ankle will be benign, and it has been easy for clinicians to underestimate the malignant potential of a given tumor. The purpose of our study was to gain insight into the incidence of different tumor types diagnosed in patients with tumors of the foot and/or ankle treated at the Rizzoli Institute from September 1990 to December 2007. Our series included 1170 patients and 1170 lesions, with an overall mean age at diagnosis of 43 (range 5 to 81) years. Overall, 870 lesions (74.36%) were nonmalignant and 300 (25.65%) were malignant. Soft tissue lesions were diagnosed in 189 patients (16.15%), of which 91 (48.15%) were nonmalignant (pseudotumors or benign). Bone lesions were diagnosed in 981 patients (83.85%), of which 779 (79.41%) were nonmalignant. Epidemiologic knowledge of foot abnormalities and clinical suspicion, an organized diagnostic method, and evidence-based treatment of musculoskeletal tumors are essential elements to obtaining optimal results in the treatment of malignant foot tumors. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.