Table 1.

The modified Eichenholtz [7] classification

Stage	Radiographic findings	Clinical findings	Treatment
0 (prodromal)	Normal radiographs	Swelling, erythema, warmth	Patient education, serial radiographs to monitor progression, protected weightbearing
I (development)	Osteopenia, fragmentation, joint subluxation or dislocation	Swelling, erythema, warmth, ligamentous laxity	Protected weightbearing with total contact casting or prefabricated pneumatic brace. Cast or brace should be used until radiographic resolution of fragmentation and presence of normal skin temperature (usually needed for 2–4 months).
II (coalescence)	Absorption of debris, sclerosis, fusion of larger fragments	Decreased warmth, decreased swelling, decreased erythema	Total contact casting, prefabricated pneumatic brace, Charcot restraint orthotic walker, or clamshell ankle-foot orthosis
III (reconstruction)	Consolidation of deformity, joint arthrosis, fibrous ankyloses, rounding and smoothing of bone fragments	Absence of warmth, absence of swelling, absence of erythema, stable joint ± fixed deformity	Plantigrade foot: custom inlay shoes with rigid shank and rocker bottom sole. Nonplantigrade foot or ulceration: débridement, exostectomy, deformity correction, or fusion with internal fixation.

Stages I-III described by Eichenholtz, Stage 0 added by Shibata et al. [21], because clinical signs of Charcot arthropathy were found to precede radiographic changes.