Friday, January 13, 2012

Modified Eichenholtz Classification of Neuropathic Joints

Neuropathic (Charcot) arthropathy of the foot and ankle has been divided into three stages by Eichenholtz (1966) and modified by Johnson (1998). The classification is based on the natural history of the disease.
  • Stage I (Dissolution): 2-6 months. Patients present with an acutely inflamed and hyperemic foot that can be mistaken for an infection. Pain is present in most patients, in spite of the underlying sensory neuropathy.

    Radiographs typically reveal periarticular soft-tissue swelling, regional demineralization, periarticular fragmentation, and dislocation. This demineralization is why operative treatment of fractures that occur in this stage have higher rates of failure of fixation, recurrent deformity, and infection.

  • Stage II (Coalescence): Patients present with decreased inflammation and swelling.

    Radiographs reveal absorption of bony debris, organization and early healing of fracture fragments, and periosteal new-bone formation.

  • Stage III (Resolution): The inflammation and swelling are minimal, and there is permanent enlargement of the foot and ankle with fixed deformity.

    Radiographs reveal smoothing of edges of large fragments of bone, sclerosis, and osseous or fibrous ankylosis.


Johnson JE. Operative treatment of neuropathic arthropathy of the foot and ankle. J Bone Joint Surg. 1998;80:1700–1709.

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