Acral metastases of the foot and ankle are rare and commonly misdiagnosed, resulting in delays in diagnosis. Although acral metastases are generally associated with advanced disease in some cases, they may be the first manifestation of metastatic disease. Primary tumors commonly associated with acral metastases are lung and genitourinary cancers. The overall prognosis is poor. Treatment is most often non-operative, although surgical management is necessary in selected patients. Both limb salvage and amputation are acceptable methods of controlling local disease, mitigating pain, and improving function.