We describe a rare case of metastatic prostate carcinoma to the heel. Bone scintigraphy revealed high uptake simulating fractures. Standard PSMA PET/CT was negative. As PSA elevated, extended field-of-view PET/CT revealed ankle uptake with virtually identical spatial distribution and intensity of both tracers. Histopathology confirmed ankle metastases of prostate carcinoma, which retrospectively was the inaugural manifestation of the metastatic skeletal disease. This case highlights the need to consider peripheral limb bone metastases in patients with biochemical recurrence. In case of focal symptoms or unexplained bone scan findings, the PSMA acquisition coverage should be extended to include the respective body part.