Metastases to the foot bones are uncommon and they mimic inflammatory conditions. Acrometastases may be the first manifestation of an unknown primary malignant disease. We report a case in which the first sign of lung adenocarcinoma was a pathological fracture due to metastasis to a proximal toe phalanx. A 68-year-old man was evaluated for pain in his fifth toe of the left foot after a trauma. Biopsy and immunohistochemistry reactions confirmed the metastatic lesion. Unfavorable clinical course and imaging exams showed advanced disease. A review of the literature indicates that acrometastases should be well-thought-out in aging patients complaining of foot pain and presenting osteolytic lesions.