Abstract Tumoral calcinosis is a rare disorder characterized by calcium phosphate crystal deposition in soft tissues, typically occurring in peri-articular regions of large joints, though secondary forms associated with metabolic dysregulation may develop in atypical, non-articular soft tissues, including post-amputation sites. We present the case of a 37-year-old woman with end-stage renal disease (ESRD) on hemodialysis secondary to diabetic nephropathy, peripheral vascular disease, who had a history of left transmetatarsal amputation and presented with worsening pain and a plantar soft tissue mass at the amputation site. Physical exam revealed a bulbous lesion with a full-thickness ulceration and overlying callus. Laboratory evaluation showed markedly elevated phosphorus and parathyroid hormone levels, and magnetic resonance imaging demonstrated multilobulated calcified soft tissue lesions with associated osteomyelitis. Surgical intervention included partial resection of the first through fifth metatarsals and debridement of a viscous white-yellow substrate consistent with tumoral calcinosis. Pathology revealed benign inflammatory tissue. The patient underwent staged reconstruction procedures including skin substitute grafting, wound vacuum-assisted closure, and distal transverse tibial bone transport which ultimately led to complete wound healing. This case underscores the importance of considering secondary tumoral calcinosis in ESRD patients presenting with soft tissue calcifications, especially in atypical locations such as the foot, and highlights the need for combined surgical and medical management targeting both local disease and underlying metabolic dysregulation.
Salamah et al. (Sun,) studied this question.