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.