Multiple classification systems have been created for charcot neuroarthropathy. These classification systems have been made wether based on natural history of the disease, anatomical patterns, association with ulceration or infection, or in combination. These classification systems are made for the use of management and/or to predict prognosis of the disease.
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Modified Eichenholtz classification
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| Modified Eichenholtz classification - may help to serve as a guide for management of Charcot foot |
The Eichenholtz classification system was initially developed in 1966 to stage the progression of Charcot neuroarthropathy and recommend treatment based on corresponding clinical and radiographic patterns. Initially there are only 3 stages ( 1 - 3). The newer modified Eichenholtz classification was developed later, which includes also stage 0. Stage 0 and stage I constitute the acute phase of the disease. Stage II and stage III constitute the chronic phase of the disease.
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Sanders and Frykberg classification
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| Sanders and Frykberg classification |
Pattern I involves the forefoot joints and common radiographic changes include osteopenia, osteolysis, juxta-articular cortical bone defects, subluxation and destruction.
Pattern II involves the tarsometatarsal joints including the metatarsal bases, cuneiforms and cuboid. Involvement at this location may present as subluxation or fracture/ dislocation, and it frequently results in the classic rocker bottom foot deformity.
Pattern III involves Chopart’s joint or the naviculocuneiform joints. Radiographic changes typically show osteolysis of naviculocuneiform joints with fragmentation and osseous debris dorsally and plantarly.
Pattern IV involves the ankle with or without subtalar joint involvement. Radiographs reveal erosion of bone and cartilage with extensive destructive of the joint, which may result in complete collapse of the joint and dislocation. Typically, this pattern of involvement results in a severe unstable deformity.
Pattern V is isolated to the calcaneus and usually results from an avulsion of the Achilles tendon off the posterior tubercle.
The authors reported the midfoot (patterns II and III) to be the most common area of involvement and these patterns are often associated with plantar ulceration at the apex of the deformity.
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Modified Brodsky and Rouse classification
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| Modified Brodsky and Rouse classification |
Brodsky and Rouse initially described four distinct anatomical areas of the foot and ankle that are most commonly affected by Charcot arthropathy.Type 1 often leads to a rocker bottom foot with symptomatic bony prominences and often results in skin breakdown plantarly at the apex of the deformity. Type 2 and type 3 (A and B) involvements are most likely to result in instability. As this classification system fails to include multiple regions of involvement, and the forefoot, therefore it has been modified to include Type 4 (multiple regions) and Type 5 (forefoot).
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Rogers and Bevilacqua classification
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| Rogers and Bevilacqua classification may help to predict outcomes of the charcot foot |
This classification system considers deformity, ulceration and osteomyelitis, and may be helpful in predicting amputation. This is a two- axis system (XY) . The X- axis marks the anatomic location of involvement and the foot and ankle are divided into three regions: forefoot, midfoot and rearfoot/ankle. The Y- axis describes the degree of complication in the Charcot joint. A is acute Charcot with no deformity, B is Charcot foot with deformity, C is Charcot foot with deformity and ulceration, and D includes osteomyelitis. Therefore, one moves across the X- axis (anatomic involvement) and/or down the Y- axis (complicating factors) as the Charcot foot becomes “more complicated” and is accordingly at greater risk for amputation. A 1A Charcot foot (acute Charcot arthropathy localized to the forefoot) is relatively simple and at lower risk for amputation in comparison to a 3D Charcot foot (rearfoot and/or ankle involvement with underlying osteomyelitis).
