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THE CHARCOT FOOT. A CRITICAL REVIEW AND AN OBSERVATIONAL STUDY OF A GROUP OF 60 PATIENTS. Gerardus J. Onvlee. $35.00, 231 pp. (To obtain a copy of this book, you may contact the author directly at: van Daatselaarhof 44, 3833 HV Leudsen, The Netherlands, or at his e-mail address: gerard.onvlee@wxs.nl.)

A patient with diabetes mellitus walks into your office with a chief complaint of a swollen left foot. He has no history of trauma and no major discomfort. His main concern is that his foot no longer fits inside his shoe. A radiograph shows a Lisfranc fracture-dislocation. For the physician who has not dealt with diabetic patients on a daily basis, the idea that a patient with a severe traumatic injury could walk into the office with neither a history of trauma nor pain seems farfetched. As the patient is diabetic, a diagnosis of infection or possibly osteomyelitis seems more realistic. The patient is managed with intravenous administration of antibiotics and perhaps a bone biopsy; an amputation may follow. Non-weight-bearing, use of a cast, and open reduction and internal fixation are not considered as part of the treatment regimen. The Charcot foot is one of the most misdiagnosed and mistreated problems seen in diabetic patients.

This book goes a long way in helping to remedy the situation just described. It contains information about the history of the study of Charcot arthropathy as well as its natural history and etiology, and it thoroughly describes the pathological process. While the condition is most often seen in diabetic patients, other conditions that are associated with Charcot-type destruction are also discussed. There are chapters on definitions, clinical presentation, radiographic signs, treatment options (both operative and nonoperative), and complications. The references alone comprise thirteen pages.

The cases of sixty patients (eighty-four feet) are documented in detail. After one has read a few of them, however, they all start to sound the same: a patient with neuropathy who is unaware of the severe nature of the problem is seen because of pain and swelling of the foot, which usually resolve after restriction of activity, treatment with a cast, and long-term nonoperative care. The case-history section is basically a collection of anecdotal information; therefore, the reliability of the statistical data presented with each case is questionable. However, surgeons will find the discussions of treatment especially relevant.

Anyone who reads this book from cover to cover will come away with a greater understanding of the Charcot joint and how best to diagnose and treat it. However, the book may be too much of a good thing. Each aspect of the Charcot foot is described in such detail that reading the text in its entirety is exhausting; the reader's concentration may falter before he or she obtains the necessary information. In addition, because the author's native language is not English some of the text is less readable and more verbose than it should be. Onvlee, an orthopaedic surgeon who performed the study at the University Hospital in Leiden, does, however, demonstrate his knowledge and command of the subject.

This book does a great service by presenting information about an important topic that becomes more relevant every day as the number of diabetic patients continues to increase. The chapter on the psychological aspects of loss of sensation and perception of pain is especially important to any practitioner who deals with patients with neuropathy on a regular basis.

There is something in this book for everyone, regardless of their level of medical education or specialty training. While the monograph could have been further synthesized and condensed to make the information more accessible, it is still strongly recommended as truly worthwhile. Students will learn much by reading it but may have difficulty avoiding boredom. Primary-care physicians should read it before they misdiagnosis another patient who has a Charcot foot as having infectious cellulitis. The reader who is prepared to wade through a lot of excess information will find nuggets of gold that will be useful to anyone who wishes to manage neuropathic patients effectively and successfully.

David Agoada, D.P.M.

Harvard Vanguard Medical Associates

Boston, Massachusetts

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This Article Extract Full Text (PDF) Free Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Agoada, D. Search for Related Content PubMed Articles by Agoada, D. Social Bookmarking                   What's this?

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