Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

04 FROM ROAD MILES TO THE TENNIS COURT - A CASE OF LATERAL FOOT INJURY WITH DUAL PATHOGENESIS

Sean Thuesen, DO; Michael Shaffer, DO; Christopher John, MD; Jonathan Stewart, MD Corresponding author:stthuesen@carilionclinic.org

Virginia Tech Carilion School of Medicine, Department of Orthopedics, Roanoke, Virginia

ligament or elsewhere in the foot or ankle. Anterior drawer and inversion stress tests were negative. The lower extremity was neurovascularly intact. Foot x-ray showed a cuboid fracture, plantar calcaneal enthesophyte, and talonavicular degenerative changes. Ankle x-ray was negative. CT revealed multiple small ossific fragments inferolateral to the cuboid, the largest likely chronic with possible pseudoarthrosis,and the other fragments age indeterminate. Additional findings included an age-indeterminate mildly displaced avulsion fracture of the distal cuboid and a possible nondisplaced fracture at the lateral base of the fourth metatarsal. Comments: This case is notable for demonstrating features of both chronic and acute injury. While the chronic changes seen on imaging likely resulted from the patient's half-marathon training and history as a recreational runner, she had no other risk factors, such as osteoporosis, relative energy deficiency, diabetes, or prior foot injury, that would place her at increased risk (Hoenig et al., 2022; Pierre-Jerome et al., 2011). Also of note, the acute injury occurred after a low-energy inversion event, whereas cuboid fractures typically result from high-energy trauma such as a fall from

height or motor vehicle accident (Borrelli, De, and VanPelt, 2012). Diagnosis: Closed displaced comminuted fracture of the right cuboid with multiple fragments. Treatment: The patient was initially immobilized in a walking boot before undergoing uncomplicated surgical removal of multiple bone fragments at the cuboid. Postoperatively, partial weight-bearing in a post-op shoe was permitted. Conclusion: At the first follow-up appointment, weight-bearing was advanced as tolerated in the post op shoe before transitioning to a regular supportive shoe as pain allowed. The patient was cleared for a gradual return to physical activity, including running and tennis, with emphasis placed on wearing supportive footwear during activity.

Context: Cuboid fractures are rare injuries that may result from either acute trauma or chronic stress, and treatment should be individualized, ranging from conservative management to surgical intervention. This case is notable for demonstrating features of both chronic and acute injury. Report of Case: The patient is a 57-year-old female who presented with right lateral foot pain. She initially experienced mild pain in this area over the summer, which she attributed to training for a half marathon, but the pain persisted despite rest after completing the race. She denied swelling or bruising at that time. Approximately three months after completing the half-marathon, while playing tennis, she sustained an inversion ankle injury with sudden pain and swelling in the lateral plantar aspect of the right foot, radiating throughout the lateral foot and ankle. Before orthopedic evaluation, she managed symptoms with ice, Advil, and crutches to avoid weight-bearing. Evaluation of the right foot and ankle revealed moderate swelling over the lateral aspect of the foot. The patient had full range of motion of the foot and ankle without increased pain. There was tenderness to palpation at the lateral cuboid, but no tenderness over the Lisfranc

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135 2026 Research Recognition Day