How is Charcot arthropathy classified?

Updated: Mar 23, 2020
  • Author: Mrugeshkumar Shah, MD, MPH, MS; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Numerous classification systems based on clinical, radiographic, and anatomic pathology describe Charcot arthropathy. Anatomic classification systems are the most commonly used and have the added benefit of predicting outcome and prognosis. The most commonly used anatomic system is described by Saunders and Mrdjencovich. [3] Based on the location of the arthropathy, their system classifies Charcot arthropathy into the following five patterns:

  • Pattern 1 involves the forefoot, which includes the interphalangeal (IP) joints, the phalanges, and the metatarsophalangeal (MTP) joint
  • Pattern 2 involves the tarsometatarsal (TMT) joint
  • Pattern 3 involves the cuneonavicular, talonavicular, and calcaneocuboid articulations
  • Pattern 4 involves the talocrural, or ankle, joint, which is the articulation of the tibia, the fibula, and the talus
  • Pattern 5 involves the posterior calcaneus

Studies have shown that patterns 2 and 3 are the most common, with approximately 45% of cases involving pattern 2 and 35% involving pattern 3.

Another commonly used classification system is the Brodsky and Rouse system. This system describes three anatomic Charcot joints (types 1, 2, and 3a and 3b):

  • Type 1 involves the midfoot
  • Type 2 involves the hindfoot
  • Type 3a involves the ankle; type 3b is a pathologic fracture of the os calcis tubercle

The multilevel Schön classification system is also used; it comprises four types and characterizes Charcot joints on the basis of sites and degree of involvement. [4] Each of the four types has three subsets (eg, type IA, IB, IC), which are based on the severity of involvement. The four types are as follows:

  • Type I - Lisfranc pattern
  • Type II - Cuneonavicular pattern
  • Type III - Perinavicular pattern
  • Type IV - Transverse tarsal pattern

The Schön classification system allows the prediction of outcomes and the estimation of treatment duration.

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