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Small blue round cell tumors of childhood rarely present in the foot or ankle. The following is a case presentation of an 18-year-old male with a large soft-tissue mass of the foot with associated lung metastasis. A definitive diagnosis could not be fully made, even with immunohistochemical and genetic testing. Diagnosis favored poorly differentiated synovial sarcoma. (J Am Podiatr Med Assoc 101(4): 363–369, 2011)