Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

08 IT’S A PROCESS

Nicholas Hora, DO; Delaney Connolly, OMS-II; Mary Mitchell, DO Corresponding author:nhora@vcom.edu

VCOM Sports and Osteopathic Medicine, VCOM-Virginia, Blacksburg, Virginia Virginia Tech Sports Medicine Context: Anterior calcaneus process (ACP)

Unfortunately, she struggled with ongoing pain and a CT scan was ordered at 12 weeks which demonstrated healing nondisplaced fracture of the anterior process of the calcaneus with residual lucency of the fracture line. Comments: ACP fractures are considered rare but have become more easily detected with advanced imaging in patients with ongoing pain. Up to 88% of ACP fractures are missed on initial radiographs post-injury. If needed, surgical fixation generally involves open reduction and internal fixation or fracture fragment resection (displaced, intraarticular). Missed diagnoses of ACP fractures result in an increased risk of surgical intervention. This case highlights the need to improve early recognition and proper management of these fractures to prevent long-term morbidity and prevent surgery. While orthobiologics (PRP, prolotherapy) have some promising data for chronic pain and instability, their definitive role for this specific indication is unknown.

Differential Diagnosis: Osteochondral lesion of the talus, complete anterior talofibular ligament tear. cuboid fracture, anterior calcaneal process fracture, talar neck fracture Tests and Results: MRI Right ankle: Nondisplaced fracture anterior process calcaneus with osseous contusion at the dorsal medial aspect of the talus. Sprain of the lateral ankle ligaments and the deltoid ligament. Final Diagnosis: Right nondisplaced fracture of the anterior calcaneus process with associated ligament sprains Treatment: The treatment for ACP fractures depends on the classification of the fracture. This patient sustained a nondisplaced (Type I) injury and these can often be treated nonoperatively with rest and tip-toe weight bearing. The patient had trialed this, and was started in physical therapy. At 6 weeks post-injury, she received a platelet rich plasma injection in the ankle and subtalar joint to aid in healing and ongoing pain. She remained in the walking boot. Return to Activity: After the 6-week mark and her injection, she weaned out of the boot as tolerated while completing aggressive physical therapy.

fractures are injuries of the front most portion of the calcaneus articulating with the cuboid bone. The exact mechanism of ACP fractures is unknown, but they are often related to ankle sprain mechanisms or high energy falls from height resulting in a significant axial load on the calcaneus. It has been estimated that 2-5% of ankle sprain mechanisms result in ACP fractures. Report of Case: A 33-year-old female patient presented with persistent right ankle pain following an inversion injury stepping off a curb four weeks prior. She reports that she felt multiple pops at that time. She was diagnosed with an ankle sprain initially at another location following negative radiographs. She states that she had significant swelling and ecchymosis at the time of injury. She trialed crutches for 2 weeks and a walking boot for 3 weeks, but when weaning out and using an ankle brace she felt deep aching and put the boot back on. Physical exam: There was some ankle swelling present but no bruising. Tenderness to palpation over the anterior talofibular ligament and the calcaneofibular ligament. Some tenderness over the distal fibula, the cuboid, and the talar dome. No tenderness of the fifth metatarsal.

Table of Contents

139 2026 Research Recognition Day