Charcot foot and changes in foot structure and loading

Background

Anyone working in diabetic foot care knows that Charcot foot is one of the most severe and complex conditions seen in practice. It develops in people with neuropathy and can lead to damage in the bones, joints, and soft tissues of the foot and ankle. As the condition progresses, the foot can change shape and the way pressure is distributed can also change, increasing the risk of deformity, ulceration, and in some cases amputation.

At the same time, much about Charcot foot is still unclear. In practice, there is often uncertainty about how the condition will develop, how long offloading will be needed, and why some people experience more severe deformity or poorer outcomes than others. Mechanical factors are thought to play an important role, but we still do not fully understand how changes in foot structure and loading are related to later complications.

This project focuses on that gap in knowledge. Victoria Milbourn, PhD candidate at Amsterdam UMC, studies both the mechanical and the clinical side of Charcot foot to build a clearer picture of how the condition develops and what that may mean for care.

Approach

The DC3 project brings together several types of research to better understand Charcot foot. It combines imaging, plantar pressure measurements, gait assessment, and clinical data, so that changes in the foot can be studied from different angles.

One part of the project looks at pressure under the foot. This includes measuring plantar pressure at diagnosis and in remission, and comparing offloading devices to see how well they reduce pressure during treatment. These studies help show how the foot is loaded during different stages of the condition and how treatment may influence that.

Another part focuses on structural changes in the foot. Using imaging and other measurements, the project explores how bones, joints, and soft tissues are affected in Charcot foot, and how these changes may be linked to deformity and ulcer risk.

The project also includes registry data on longer-term outcomes after a Charcot foot diagnosis, such as hospitalisation, amputation, and mortality. This helps place the condition in a broader clinical context and offers insight into how people fare over time.

By combining these different sources of information, the project aims to improve understanding of Charcot foot in a way that is relevant to both research and daily care.

From insight to care that fits better

The strength of this project lies in making a difficult and still not fully understood condition more visible in practice. Better insight into changes in foot structure and loading may help healthcare professionals understand more clearly what is happening in the foot and why the course of Charcot foot can differ so much between patients.

That matters because uncertainty affects everyday care. It influences decisions about monitoring, offloading, follow-up, and conversations with patients about treatment and recovery. If healthcare professionals have a clearer understanding of the processes behind deformity and pressure-related risk, they may be better able to interpret what they see and reflect on how care is organised.

The findings from this project may also support future use of plantar pressure measurements in Charcot foot research and specialist care. In addition, results from registry data can help multidisciplinary teams look more closely at outcome patterns and consider whether there are opportunities to strengthen monitoring, management, or the way the condition is recorded.

In that way, the project contributes to better understanding of Charcot foot and to care that is better informed, more consistent, and more responsive to the risk of deformity, ulceration, and amputation.

Research Team

The project is being carried out at Amsterdam UMC, one of the leading centres in diabetic foot research, with particular expertise in the prevention of foot ulcers and amputations. The doctoral candidate works within a multidisciplinary team of clinicians, movement scientists, and radiologists, and also collaborates with other DIALECT doctoral candidates in Amsterdam UMC who focus on the foot in remission and on footwear for ulcer prevention.

The research is embedded within the Department of Rehabilitation Medicine, which has advanced facilities for biomechanical research, including a motion analysis laboratory. It is also closely connected to the Department of Radiology, where imaging techniques such as MRI, weight-bearing CT, dual-energy CT, and ultrasound are available. In addition, the group is part of the Amsterdam Movement Sciences research institute, where there is collaboration with many partners in the field of movement and clinical research.

The project also includes external supervision and collaboration with DIALECT partners at King’s College Hospital in London and Steno Diabetes Center Copenhagen. Both centres have extensive expertise in diabetic foot care and Charcot foot research.

Amsterdam University Medical Centers

Amsterdam UMC is the largest hospital and one of the leading medical research institutions in the Netherlands, with more than 13,000 employees. It combines the former Academic Medical Center and Vrije Universiteit Medical Center. The location at Meibergdreef is part of the University of Amsterdam.

Around 2,500 staff members are fully or partly involved in medical research. Amsterdam Movement Sciences is one of the eight research institutes within Amsterdam UMC and brings together research on many different aspects of movement, both fundamental and clinical. Amsterdam UMC also offers high-quality core facilities, including a motion analysis lab, advanced imaging techniques, and medical physics support.