A diabetic patient presents with a warm, swollen, erythematous foot with normal radiographs. MRI shows marrow edema and microtrabecular fractures without deformity. The clinician suspects early Charcot neuroarthropathy before any radiographic change. This corresponds to which stage in the Eichenholtz classification?

• A Stage II (coalescence)
• B Stage I (development/fragmentation)
• C Stage 0 (prodromal/inflammation) ✓
• D Stage III (consolidation/remodeling)

Explanation

Eichenholtz originally described three stages based on radiographic findings: fragmentation (I), coalescence (II), and consolidation (III). Stage 0 was added later to describe the prodromal phase with clinical inflammation, normal plain films, and MRI evidence of edema and microfracture. Recognizing stage 0 matters because strict offloading at this point can prevent progression to fragmentation and deformity.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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