At podiatric centers, physicians see a multitude of varied pathologies. On occasion, there are difficult wounds which are otherwise well treated, but still fail to heal. This is something that may require advanced care and a more thorough diagnostic approach.Sometimes wounds will not heal for more obvious reasons. One of these is too much pressure on the area or underlying bone infections that are present which will preclude closure of the site. Sometimes, there is an underlying metabolic pathology which can go unrecognized and lead to failure of wound healing, such as in the case of underlying calcinosis cutis.What is this?This can be seen sometimes on plain radiographic images, where one may see some abnormality in the soft tissue which can look like a bone, or bone densities within the soft tissue. This is not very common, but may lead to wound healing delays. Sometimes, there is pain associated with it.Other times this may be found only on skin biopsies of the ulcer may find the calcifications on a microscopic level, and in my opinion any peculiar skin lesion should have a biopsy done to check for cancer or any other pathology that may otherwise not be detected. In fact, in the case of any non healing ulcer that is present for more than 4 weeks, a biopsy should always be done to further assess and treat the site along with bacterial culture and even CBC and C-reactive protein with BMP labwork.Basically, there are varieties of presentations of calcinosis cutis, but the main concept here is that it may cause wound healing delays or preclude any healing from the site. This may require systemic treatment and evaluation from renal specialists, rheumatology specialists, and even vascular surgeons to some extent. Regardless, extensive workup must be entertained in any wound care patient in order to identify reasons for nonhealing. This also potentiates the need for aggressive debridement, as the tissue itself may be too compromised for any reasonable healing to occur, and with an aggressive debridement the tissue may be allowed to "reset" and build the scaffolding for dermal/epidermal cells again from "scratch".

Depending on the underlying cause, the signs and symptoms of calcinosis cutis vary. These lesions frequently appear as firm, whitish/yellowish papules, plaques or nodules on the surface of the skin. One or more lesion may develop on the skin. Lesions may become tender and ulcerate, discharging chalk-like creamy material consisting mainly of calcium phosphate with a small amount of calcium carbonate.

Depending on the underlying cause, a multidisciplinary team of physicians may be needed to manage the calcinosis cutis.