Pulsed Electromagnetic Field Stimulation Therapy for Charcot Foot Ulcer: A Randomized Controlled Trial

BACKGROUND: Charcot foot is a debilitating complication of peripheral neuropathy and is primarily associated with diabetes, leading to structural damage, ulceration, and osteomyelitis. Pulsed electromagnetic field (PEMF) therapy is a promising treatment modality for wound healing and bone metabolism. OBJECTIVE: To evaluate the efficacy of PEMF therapy in promoting bone growth and ulcer healing in patients with Charcot foot ulcers. MATERIALS AND METHODS: This prospective, single-blinded, controlled trial included 34 patients with stage 2 or 3 chronic Charcot foot with ulceration who were randomized into 2 groups. Group A (study group) received PEMF therapy in addition to transcutaneous electrical nerve stimulation (conventional TENS), medical treatment, and standard wound care, while group B (control group) received conventional TENS and the same medical treatment and standard wound care as those in group A, 3 times per week for 3 months. Primary outcomes were assessed with plain radiographs and wound surface area tracing pre-intervention, 6 weeks post-intervention, and 12 weeks post-intervention. RESULTS: No significant differences were evident at baseline analysis. After 6 weeks, both groups showed significant change in Charcot foot signs as well as a reduction in wound surface area (P < .05). In the study group, 23.5% of participants showed complete resolution of Charcot signs (normal appearance), 5.9% progressed to stage 2 (bone sclerosis), and 70.6% remained at stage 1. Regarding wound healing, the study group showed greater reduction in wound surface area, with a median (IQR) of 8.5 cm2 (9.4 cm2-12.2 cm2) compared with 11.5 cm2 (9.4 cm2-15.5 cm2) in the control group. By 12 weeks, 94.1% of the study group showed complete radiological resolution of Charcot signs vs 5.9% in the control group (P < .001). Median wound surface area was significantly reduced in the study group to 0.0 cm² (0.0 cm²-1.0 cm²) compared with 6.6 cm2 (5.7 cm²-7.9 cm²) in the control group (P < .05), indicating superior healing outcomes with PEMF therapy. CONCLUSION: PEMF therapy is an efficacious adjunctive treatment for Charcot foot ulcers, facilitating both wound healing and bone regeneration.