Football is the most popular sport worldwide and is associated with a high injury rate, most of w... more Football is the most popular sport worldwide and is associated with a high injury rate, most of which are the result of trauma from player contact. Ankle injuries are among the most commonly diagnosed injuries in the game. The result is reduced physical activity and endurance levels, lost game time, and considerable medical cost. Sports medicine professionals must employ the correct diagnostic tools and effective treatments and rehabilitation protocols to minimize the impact of these injuries on the player. This review examines the diagnosis, treatment, and postoperative rehabilitation for common football injuries of the ankle based on the clinical evidence provided in the current literature.
Corticosteroid injections have been used for a variety of foot and ankle pathologies over the yea... more Corticosteroid injections have been used for a variety of foot and ankle pathologies over the years, and our aim was to evaluate the efficacy and safety of them in our clinic. We performed a retrospective review of notes and a telephone questionnaire on the clinical outcome of all patients who underwent a corticosteroid injection of the foot or ankle in a year. All procedures were performed in an outpatient setting by a consultant musculoskeletal radiologist using either ultrasound or X-ray guidance and had a minimum of 2 years of follow-up. Overall, 314 of 365 (86%) patients reported a significant improvement in symptoms, and 242 (66%) reported complete resolution of their pain, with 107 (29%) remaining asymptomatic at the 2-year follow-up. The mode time of recurrence of pain was 3 months. Fifty-one (14%) underwent a further injection and 88 (24%) underwent operative intervention within the follow-up period. Complication rates in our series were low. There were no reported infectio...
Treatment of fifth metatarsal fractures in elite athletes or delayed/non unions often requires op... more Treatment of fifth metatarsal fractures in elite athletes or delayed/non unions often requires operative fixation. However, this can cause technical difficulties and we present an operative tip to avoid complications is presented.
Journal of Bone and Joint Surgery British Volume, Jul 1, 1999
Mitchell's osteotomy secured by either a suture followed by immobilisation in a plaster boot for ... more Mitchell's osteotomy secured by either a suture followed by immobilisation in a plaster boot for six weeks, or by a cortical screw with early mobilisation.
Posterior ankle impingement syndrome (PAIS) was first described in ballet dancers but is increasi... more Posterior ankle impingement syndrome (PAIS) was first described in ballet dancers but is increasingly being diagnosed in other sports. Operative treatment may be indicated when nonoperative measures have failed. Traditionally, operative treatment has involved an open approach; more recently, posterior ankle arthroscopy has been employed. This study was conducted to describe the factors that influence return to play in professional athletes after posterior ankle arthroscopy for posterior ankle impingement syndrome. Case series; Level of evidence 4. A consecutive series of 28 elite professional soccer players who had clinically and radiologically diagnosed posterior ankle impingement syndrome that failed to respond to nonoperative treatment underwent posterior ankle arthroscopy for bony or soft tissue posterior ankle impingement syndrome over 5 years. Of the 28 players, 27 were available for follow-up. Five had a diagnosis of soft tissue impingement and underwent debridement with flexor hallucis longus release, 13 had a symptomatic os trigonum that was excised arthroscopically, and 9 had removal of a bony avulsion fragment from the posterior ankle ligament complex. The mean length of time to return to training postoperatively was 34 days and return to playing was 41 days (range, 29-72 days). The duration of symptoms before surgery and excision of bony impingement were significantly correlated with the time to return to training and playing. There were no major complications and no reoperations at an average of 23 months of follow-up (range, 15-49 months). Posterior ankle arthroscopy is safe and effective in the treatment of posterior ankle impingement syndrome in the elite soccer player, with return to training expected at an average of 5 weeks.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 18, 2016
To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and... more To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients. Following a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence. 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6 % (95 % CI 0.4-0.8 %) and 1 % (95 % CI 0.2-1.7 %), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5 % (95 % CI 6.8-18.2 %) and 10.5 % (95 % CI 5.0-15.9 %), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7 ...
Seminars in Musculoskeletal Radiology, Feb 1, 2011
Achilles tendinopathy is a common overuse injury in patients engaged in athletic activities. Tend... more Achilles tendinopathy is a common overuse injury in patients engaged in athletic activities. Tendon degeneration is often accompanied by paratendinitis. Radiologists are frequently asked to use imaging techniques to evaluate patients with problems at or around the Achilles tendon. The main imaging modalities used in the assessment of Achilles tendon disorders are plain radiography, ultrasound, and magnetic resonance imaging. In recent years, ultrasound has also been used to guide minimally invasive local treatments for Achilles tendinopathy, which may prevent the need for surgery if conservative treatments have failed. In this article, we review the imaging features of Achilles tendinopathy and consider the relative strengths and weaknesses of the various imaging techniques. The role of imaging in directing patient management is also discussed, with particular focus on ultrasound-guided treatments.
Knee Surgery Sports Traumatology Arthroscopy, Mar 1, 2010
The midfoot plays a vital role in the stability of the foot as a whole. Injuries to the midfoot m... more The midfoot plays a vital role in the stability of the foot as a whole. Injuries to the midfoot may be subtle and can lead to significant long-term morbidity, especially where there is a delay in diagnosis and treatment. This article describes the anatomy of the midfoot that is relevant to surgical practice. It should provide the reader with an understanding of how the anatomy of the midfoot relates to its function as well as discussing the anatomical considerations of injuries and surgery in this area. Anatomical knowledge aids clinical practice in terms of the recognition of abnormalities and the guidance of treatment.
Unnecessary appendicectomy carries long-term risks to the patient. The decision for surgical inte... more Unnecessary appendicectomy carries long-term risks to the patient. The decision for surgical intervention is often made based on the patient's history and the findings of clinical examination. This article reviews recent papers published on the various methods of reducing the incorrect diagnosis of acute appendicitis, and the advances in its treatment.
We conducted magnetic resonance imaging of the posterior tibial (PT) and flexor digitorum longus ... more We conducted magnetic resonance imaging of the posterior tibial (PT) and flexor digitorum longus (FDL) muscle bellies in 12 patients undergoing surgical treatment for unilateral posterior tibial tendon (PTT) dysfunction. All patients had atrophy of the PT muscle compared to the normal leg (mean 10.7%, p = 0.008). In those patients with a complete rupture of PTT there was replacement of the PT muscle by fatty infiltration. Conversely, the FDL muscle showed a compensatory hypertrophy (mean 17.2%, p < 0.002). We support the use of FDL as an appropriate tendon for augmentation of PTT in stage II disease. This study also demonstrates that in the presence of a complete rupture, excision of the PTT is a reasonable surgical procedure and pure tenodesis will be more likely to fail because the PT muscle belly undergoes fatty infiltration. In patients with a diseased but intact PTT there was no fatty infiltration and the muscle volume was at least 83% of the normal side in all cases. We therefore suggest that in the presence of an intact PTT the PT muscle belly may provide some useful function if used to augment the FDL transfer when the diseased tendon is excised.
We investigated a previously reported technique for the repair of acute Achilles tendon ruptures ... more We investigated a previously reported technique for the repair of acute Achilles tendon ruptures using the percutaneous Achillon suture system (Intega Life Sciences Corporation, Plainsboro, NJ). Twenty-five patients with Achilles tendon ruptures were studied prospectively with a minimum of 12 months followup. A single 2- to 3-cm horizontal incision and the Achillon suture system were used. Early rehabilitation and an active range-of-motion brace were instituted. There were no wound problems, sural nerve injuries, or re-ruptures. All patients were able to return to their previous sporting activities by 6 months. This independent study confirms that the technique offers patients a safe operative procedure for repair of acute Achilles tendon ruptures that allows early active rehabilitation.
M anipulation of the metatarsophalangeal joint and injection with steroid and local anaesthetic a... more M anipulation of the metatarsophalangeal joint and injection with steroid and local anaesthetic are widely practised in the treatment of hallux rigidus, but there is little information on the outcome. We report the results of this procedure carried out on 37 joints, with a minimum follow-up of one year (mean, 41.2 months). Patients with mild (grade-1) changes gained symptomatic relief for a median of six months and only one-third required surgery. Two-thirds of patients with moderate (grade-2) disease proceeded to open surgery. In advanced (grade-III) hallux rigidus, little symptomatic relief was obtained and all patients required operative treatment. We recommend that joints are graded before treatment and that manipulation under anaesthetic and injection be used only in early (grades I and II) hallux rigidus. J Bone Joint Surg [Br] 2001;83-B:706-8.
The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study ... more The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study investigated 46 patients with isolated Lisfranc injuries at a minimum of two years after surgery. Thirteen patients had a poor outcome and had to change employment, or were unable to find work as a result of this injury. The presence of a compensation claim (p = 0.02) and a delay in diagnosis of more than six months were associated with a poor outcome (p = 0.01). There was no association between poor functional outcome and age, gender, mechanism of injury or previous occupation. This study may have medico-legal implications on reporting the prognosis for such injuries, and highlights the importance of prompt diagnosis and treatment.
Brailsford's disease and Kohler&a... more Brailsford's disease and Kohler's disease are two conditions of uncertain etiology affecting the navicular in adults and children, respectively. Kohler's disease has been universally agreed to have an excellent outcome in all cases. There have been no recorded cases of a child with Kohler's disease having persistent clinical and radiological abnormalities into adulthood and no cases of patients with Brailsford's disease having had abnormalities in childhood. This case report presents a teenage patient with osteochondritis of the navicular bone with symptoms that persisted into skeletal maturity.
Football is the most popular sport worldwide and is associated with a high injury rate, most of w... more Football is the most popular sport worldwide and is associated with a high injury rate, most of which are the result of trauma from player contact. Ankle injuries are among the most commonly diagnosed injuries in the game. The result is reduced physical activity and endurance levels, lost game time, and considerable medical cost. Sports medicine professionals must employ the correct diagnostic tools and effective treatments and rehabilitation protocols to minimize the impact of these injuries on the player. This review examines the diagnosis, treatment, and postoperative rehabilitation for common football injuries of the ankle based on the clinical evidence provided in the current literature.
Corticosteroid injections have been used for a variety of foot and ankle pathologies over the yea... more Corticosteroid injections have been used for a variety of foot and ankle pathologies over the years, and our aim was to evaluate the efficacy and safety of them in our clinic. We performed a retrospective review of notes and a telephone questionnaire on the clinical outcome of all patients who underwent a corticosteroid injection of the foot or ankle in a year. All procedures were performed in an outpatient setting by a consultant musculoskeletal radiologist using either ultrasound or X-ray guidance and had a minimum of 2 years of follow-up. Overall, 314 of 365 (86%) patients reported a significant improvement in symptoms, and 242 (66%) reported complete resolution of their pain, with 107 (29%) remaining asymptomatic at the 2-year follow-up. The mode time of recurrence of pain was 3 months. Fifty-one (14%) underwent a further injection and 88 (24%) underwent operative intervention within the follow-up period. Complication rates in our series were low. There were no reported infectio...
Treatment of fifth metatarsal fractures in elite athletes or delayed/non unions often requires op... more Treatment of fifth metatarsal fractures in elite athletes or delayed/non unions often requires operative fixation. However, this can cause technical difficulties and we present an operative tip to avoid complications is presented.
Journal of Bone and Joint Surgery British Volume, Jul 1, 1999
Mitchell's osteotomy secured by either a suture followed by immobilisation in a plaster boot for ... more Mitchell's osteotomy secured by either a suture followed by immobilisation in a plaster boot for six weeks, or by a cortical screw with early mobilisation.
Posterior ankle impingement syndrome (PAIS) was first described in ballet dancers but is increasi... more Posterior ankle impingement syndrome (PAIS) was first described in ballet dancers but is increasingly being diagnosed in other sports. Operative treatment may be indicated when nonoperative measures have failed. Traditionally, operative treatment has involved an open approach; more recently, posterior ankle arthroscopy has been employed. This study was conducted to describe the factors that influence return to play in professional athletes after posterior ankle arthroscopy for posterior ankle impingement syndrome. Case series; Level of evidence 4. A consecutive series of 28 elite professional soccer players who had clinically and radiologically diagnosed posterior ankle impingement syndrome that failed to respond to nonoperative treatment underwent posterior ankle arthroscopy for bony or soft tissue posterior ankle impingement syndrome over 5 years. Of the 28 players, 27 were available for follow-up. Five had a diagnosis of soft tissue impingement and underwent debridement with flexor hallucis longus release, 13 had a symptomatic os trigonum that was excised arthroscopically, and 9 had removal of a bony avulsion fragment from the posterior ankle ligament complex. The mean length of time to return to training postoperatively was 34 days and return to playing was 41 days (range, 29-72 days). The duration of symptoms before surgery and excision of bony impingement were significantly correlated with the time to return to training and playing. There were no major complications and no reoperations at an average of 23 months of follow-up (range, 15-49 months). Posterior ankle arthroscopy is safe and effective in the treatment of posterior ankle impingement syndrome in the elite soccer player, with return to training expected at an average of 5 weeks.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 18, 2016
To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and... more To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients. Following a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence. 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6 % (95 % CI 0.4-0.8 %) and 1 % (95 % CI 0.2-1.7 %), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5 % (95 % CI 6.8-18.2 %) and 10.5 % (95 % CI 5.0-15.9 %), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7 ...
Seminars in Musculoskeletal Radiology, Feb 1, 2011
Achilles tendinopathy is a common overuse injury in patients engaged in athletic activities. Tend... more Achilles tendinopathy is a common overuse injury in patients engaged in athletic activities. Tendon degeneration is often accompanied by paratendinitis. Radiologists are frequently asked to use imaging techniques to evaluate patients with problems at or around the Achilles tendon. The main imaging modalities used in the assessment of Achilles tendon disorders are plain radiography, ultrasound, and magnetic resonance imaging. In recent years, ultrasound has also been used to guide minimally invasive local treatments for Achilles tendinopathy, which may prevent the need for surgery if conservative treatments have failed. In this article, we review the imaging features of Achilles tendinopathy and consider the relative strengths and weaknesses of the various imaging techniques. The role of imaging in directing patient management is also discussed, with particular focus on ultrasound-guided treatments.
Knee Surgery Sports Traumatology Arthroscopy, Mar 1, 2010
The midfoot plays a vital role in the stability of the foot as a whole. Injuries to the midfoot m... more The midfoot plays a vital role in the stability of the foot as a whole. Injuries to the midfoot may be subtle and can lead to significant long-term morbidity, especially where there is a delay in diagnosis and treatment. This article describes the anatomy of the midfoot that is relevant to surgical practice. It should provide the reader with an understanding of how the anatomy of the midfoot relates to its function as well as discussing the anatomical considerations of injuries and surgery in this area. Anatomical knowledge aids clinical practice in terms of the recognition of abnormalities and the guidance of treatment.
Unnecessary appendicectomy carries long-term risks to the patient. The decision for surgical inte... more Unnecessary appendicectomy carries long-term risks to the patient. The decision for surgical intervention is often made based on the patient's history and the findings of clinical examination. This article reviews recent papers published on the various methods of reducing the incorrect diagnosis of acute appendicitis, and the advances in its treatment.
We conducted magnetic resonance imaging of the posterior tibial (PT) and flexor digitorum longus ... more We conducted magnetic resonance imaging of the posterior tibial (PT) and flexor digitorum longus (FDL) muscle bellies in 12 patients undergoing surgical treatment for unilateral posterior tibial tendon (PTT) dysfunction. All patients had atrophy of the PT muscle compared to the normal leg (mean 10.7%, p = 0.008). In those patients with a complete rupture of PTT there was replacement of the PT muscle by fatty infiltration. Conversely, the FDL muscle showed a compensatory hypertrophy (mean 17.2%, p < 0.002). We support the use of FDL as an appropriate tendon for augmentation of PTT in stage II disease. This study also demonstrates that in the presence of a complete rupture, excision of the PTT is a reasonable surgical procedure and pure tenodesis will be more likely to fail because the PT muscle belly undergoes fatty infiltration. In patients with a diseased but intact PTT there was no fatty infiltration and the muscle volume was at least 83% of the normal side in all cases. We therefore suggest that in the presence of an intact PTT the PT muscle belly may provide some useful function if used to augment the FDL transfer when the diseased tendon is excised.
We investigated a previously reported technique for the repair of acute Achilles tendon ruptures ... more We investigated a previously reported technique for the repair of acute Achilles tendon ruptures using the percutaneous Achillon suture system (Intega Life Sciences Corporation, Plainsboro, NJ). Twenty-five patients with Achilles tendon ruptures were studied prospectively with a minimum of 12 months followup. A single 2- to 3-cm horizontal incision and the Achillon suture system were used. Early rehabilitation and an active range-of-motion brace were instituted. There were no wound problems, sural nerve injuries, or re-ruptures. All patients were able to return to their previous sporting activities by 6 months. This independent study confirms that the technique offers patients a safe operative procedure for repair of acute Achilles tendon ruptures that allows early active rehabilitation.
M anipulation of the metatarsophalangeal joint and injection with steroid and local anaesthetic a... more M anipulation of the metatarsophalangeal joint and injection with steroid and local anaesthetic are widely practised in the treatment of hallux rigidus, but there is little information on the outcome. We report the results of this procedure carried out on 37 joints, with a minimum follow-up of one year (mean, 41.2 months). Patients with mild (grade-1) changes gained symptomatic relief for a median of six months and only one-third required surgery. Two-thirds of patients with moderate (grade-2) disease proceeded to open surgery. In advanced (grade-III) hallux rigidus, little symptomatic relief was obtained and all patients required operative treatment. We recommend that joints are graded before treatment and that manipulation under anaesthetic and injection be used only in early (grades I and II) hallux rigidus. J Bone Joint Surg [Br] 2001;83-B:706-8.
The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study ... more The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study investigated 46 patients with isolated Lisfranc injuries at a minimum of two years after surgery. Thirteen patients had a poor outcome and had to change employment, or were unable to find work as a result of this injury. The presence of a compensation claim (p = 0.02) and a delay in diagnosis of more than six months were associated with a poor outcome (p = 0.01). There was no association between poor functional outcome and age, gender, mechanism of injury or previous occupation. This study may have medico-legal implications on reporting the prognosis for such injuries, and highlights the importance of prompt diagnosis and treatment.
Brailsford's disease and Kohler&a... more Brailsford's disease and Kohler's disease are two conditions of uncertain etiology affecting the navicular in adults and children, respectively. Kohler's disease has been universally agreed to have an excellent outcome in all cases. There have been no recorded cases of a child with Kohler's disease having persistent clinical and radiological abnormalities into adulthood and no cases of patients with Brailsford's disease having had abnormalities in childhood. This case report presents a teenage patient with osteochondritis of the navicular bone with symptoms that persisted into skeletal maturity.
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Papers by James Calder