Is the Eichenholtz classification still valid for the diabetic Charcot foot?

Abstract

In his 1966 monograph "Charcot joints", Sidney N. Eichenholtz (1909-2000) described "three well defined stages … in the course and development of a Charcot joint", based on plain X-rays of 68 patients. Since then, medical imaging has advanced very much: computed tomography and magnetic resonance imaging (MRI) scans exceed plain X-ray by far in detecting foot fractures and other injuries. The earliest, nondeforming, X-ray-negative inflammatory stage of the acute Charcot joint of the diabetic foot can be visualised only by use of MRI. This stage, which Eichenholtz evidently failed to recognise, will heal without significant arthropathy, if treated in time. By contrast, the stages considered by Eichenholtz inevitably result in major arthropathy and foot deformity. Hence, superseding the Eichenholtz classification is overdue. We propose an MRI-based classification comprising two severity grades (0 and 1, according to absence/presence of cortical fractures) and two stages (active/inactive, according to presence/absence of skeletal inflammation).

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

“…The diagnosis of active-stage diabetic Charcot foot was based on typical clinical and MRI findings [19]. Onset of the condition was assumed, when the key symptom, foot swelling, was first recognized and other pathology like a gout attack had been excluded.…”

Diabetic neuroosteoarthropathy: the modern approaches for diagnosis and immobilization period determination (review)

“…и Grutzner G. предложили новую классификацию, в осно-ве которой лежат клинические проявления и данные МРТ [40]. Согласно ей в течении ДНОАП можно выделить две стадии и две степени тяжести.…”

Visualization of local cortical defects in Charcot foot using microcomputed tomography

“…Eine Neubewertung der EichenholtzKlassifikation auf der Grundlage moderner Visualisierungsmöglichkeiten, v. a. mittels Magnetresonanztomographie (MRT), wurde von Chanteleau u. Grütz-ner [6] vorgeschlagen. In dieser auf der MRT basierenden Klassifikation werden zwei Schweregrade (0 und 1, in Abhän-gigkeit von der Diagnose von Frakturen der Kortikalis) und zwei Stufen (aktiv und inaktiv, in Abhängigkeit von der Diagnose von Knochenentzündungen) unterschieden.…”

“…B. Trabekelanzahl, mittlere Trabekeldicke und Kortikalisdicke, als auch als Ausgangspunkt für biomechanische Simulationen [15]. In diesem Zusammenhang spielt laut Chanteleau u. Grützner [6] …”