Biomechanical factors in Charcot neuro-osteoarthropathy and deformity

Background

One of the most complex and devastating complications of foot disease in diabetes is Charcot neuro-osteoarthropathy (or Charcot foot). In this condition, inflammatory processes in persons with neuropathy result in damage to bones, joints, and soft tissues of the foot and ankle. While biomechanical factors are important in the cause and development of the Charcot foot, there are gaps in our knowledge concerning the extent and mechanisms through which biomechanical and other factors contribute to the development of foot deformity, ulceration and amputation.

In this DIALECT project, we go beyond state-of-the-art to develop, validate and implement comprehensive and novel biomechanical analyses and models of the Charcot foot. The knowledge acquired will improve the understanding of  factors contributing to disease outcomes in this complex, and devastating condition, and pave the way for personalised medicine in ulcer and amputation prevention in these patients.

Approach

The doctoral candidate will retrospectively assess 3 unique clinical datasets on Charcot feet from Amsterdam UMC, King’s College Hospital and Glasgow Caledonian University, to identify risk factors for Charcot foot and disease progression. Subsequently, more in-depth prospective analyses in patients with Charcot neuro-osteoarthropathy will be done. These will include biomechanical and structural assessment, e.g. lower-extremity gait kinematics and kinetics and barefoot and in-shoe plantar pressures, 3D reconstruction and segmentation of foot bones using computer tomography (CT) imaging, and soft tissue morphology using magnetic resonance imaging (MRI).

Prospective inclusion will be done in Amsterdam and London. The doctoral candidate will derive from this multiscale data: Insight in the risk factors for Charcot foot and midfoot deformity; Insight in biomechanical and other markers of Charcot foot; Characterisation of foot deformities (type, distribution and prevalence) in Charcot feet; A biomechanical model of Charcot foot and midfoot deformity.  

Our Research Team

Amsterdam UMC is a leading institute on clinical, biomechanical and radiological research on diabetic foot disease, in particular, in the prevention of foot ulceration and amputation. The candidate will learn from, and collaborate with, a multidisciplinary team of clinicians, movement scientists and radiologists and also with the two other Doctoral Candidates from DIALECT in Amsterdam UMC who will focus on the foot in remission and on footwear development for ulcer prevention. The research group is embedded within the Department of Rehabilitation Medicine that has high-class facilities for biomechanical research, among which a motion analysis laboratory, and Department of Radiology, which is equipped with advanced imaging techniques such as MRI, weight-bearing and dual energy CT, and ultrasound. The research group is also embedded in the Amsterdam Movement Sciences research institute, where collaboration exists with many Amsterdam partners in the field of movement sciences, among which the Faculty of Behavioural and Movement Sciences of the Vrije Universiteit.

External supervision in this project comes from DIALECT partners at King’s College Hospital (London, United Kingdom) and Steno Diabetes Center, Copenhagen (Denmark). The Diabetic foot Clinic at King’s College Hospital is renowned for their multidisciplinary treatment of people with diabetic foot disease, and has a longstanding clinical and research experience in Charcot foot. Steno Diabetes Center is one of the world’s largest diabetes centers, with a dedicated and experienced foot team, and track record in care and research in Charcot foot.

Amsterdam University Medical Centers

The Amsterdam UMC is the largest hospital and foremost medical research institution in the Netherlands with over 13,000 employees, combining what were previously the Academic Medical Center and Vrije Universiteit Medical Center. The location of Amsterdam UMC at Meibergdreef is part of the University of Amsterdam. Some 2500 staff members are fully or partially employed in medical research. Amsterdam Movement Sciences is one of the 8 research institutes of Amsterdam UMC that conducts world-class research on many different aspects of movement, both fundamental and clinical (see here for more info). Amsterdam UMC houses high quality core facilities including a movement analysis lab, advanced imaging techniques, medical physics department.