A 58-year-old woman with long-standing diabetes presents with a unilateral warm, swollen, erythematous foot. Plain radiographs are normal. MRI shows bone marrow oedema of the midfoot without fracture, fragmentation, or joint destruction. In the Eichenholtz classification of Charcot neuroarthropathy, this corresponds to which stage?
- A Stage 2
- B Stage 1
- C Stage 0 ✓
- D Stage 3
Correct answer: C. Stage 0
Explanation
Eichenholtz stage 0, described later as the prodromal or inflammatory stage, shows clinical inflammation with warmth and swelling but normal radiographs; MRI demonstrates marrow and soft tissue oedema before any structural change. Stage 1 is the fragmentation stage with capsular disruption, debris, and dislocation visible on radiographs. Stage 2 is coalescence with absorption of debris and sclerosis, and stage 3 is consolidation and remodelling with residual deformity. Recognising stage 0 matters because immobilisation at this point can prevent collapse.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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