Combined Ozone Therapy and Negative Pressure Wound Therapy with Instillation for Charcot Neuroarthropathy-Associated Foot Wounds

Background/Objectives: Charcot neuro-osteoarthropathy (CNO) complicated by ulceration and infection represents a major limb-preservation challenge in diabetes-related foot disease. Evidence regarding the combined use of ozone therapy (OT) and negative pressure wound therapy with instillation and dwell time (NPWTi-d) remains limited. This study evaluated outcomes of a multimodal treatment protocol incorporating both modalities. Methods: This retrospective study included 30 patients with diabetes and CNO-associated foot wounds managed using a multidisciplinary protocol incorporating OT and NPWTi-d. The primary outcome was wound volume reduction, while secondary outcomes included pain, inflammatory biomarkers, microbiological findings, and safety. Results: Wound volume decreased significantly during follow-up, from a median of 8.0 cm3 at baseline to 1.5 cm3 after 3 weeks, with further reduction to 0 cm3 by week 6 (all p < 0.001). Significant improvements were observed in wound bed characteristics and exudate. Mean pain intensity (NRS) decreased from 6.9 ± 1.1 to 0.9 ± 1.1 points (p < 0.001). CRP and PCT concentrations declined significantly (both p < 0.001). Follow-up wound cultures demonstrated a lower frequency of isolation of several initially identified pathogens. No serious treatment-related adverse events occurred. Conclusions: This retrospective case series demonstrated favourable short-term changes in wound-related outcomes during a multimodal treatment strategy incorporating OT and NPWTi-d in patients with CNO-associated wounds. Given the uncontrolled study design and concurrent interventions, these findings should be considered exploratory and do not establish the independent efficacy of either modality or their combination.