Head and neck squamous cell carcinomas (HNSCCs) are tumors with propensity mostly for locoregional spread. Most frequent sites of metastasis from cancer of the oral cavity include lung, bone, liver, adrenal, heart, and kidney. The advent of newer surgical techniques and an improved understanding of head and neck cancer have further improved control of cancer above the clavicles. Furthermore, the overall survival rate in patients with advanced head and neck cancer has not improved significantly. This has been partly because of the emergence of second primary cancers and the development of distant metastasis defined as cancer deposits below the clavicles. Authors reported a case of a 60 years-old man affected by squamous cell carcinoma of the oral cavity treated with surgery and adjuvant radiochemotherapy that developed a metastatic lesion to the left talus 10 months after primary treatment. In conclusion, bone is a rare metastatic site for HNSCC, much rarer in case of sites distal to the knee. Owing to paucity of the literature on this, no definite predisposing factor is identifiable. Because of the rarity of these lesions, bone scintigraphy remains not indicated in case of HNSCC, but attention has to be paid to eventual symptoms, also if frequently sensitive for advanced lesions.