Evaluation of Achilles Tendon in Type 2 Diabetes Mellitus Patients Using Sonoelastography

Abstract

Abstract Background Diabetes mellitus is an endocrine disease associated with several metabolic disorders and long-term complications. Achilles tendon is the largest and strongest tendon in the human body playing a crucial role in foot biomechanics. Hyperglycaemia in Diabetes Mellitus aids the deposition of glycosylated end products in most tissues including the Achilles tendon, which in turn alters its structure and function. Objectives The study aims to investigate the differences in Achilles tendon thickness and stiffness in people with and without type 2 diabetes mellitus. Patients and Methods This is a case control study, where the Achilles tendons of 20 type 2 DM patients and 21 non-diabetic controls were examined for the thickness and stiffness. Achilles tendon thickness was measured using B-mode ultrasonography while its stiffness was evaluated by compression elastography. Results This study included 20 type 2 DM patients (40 Achilles tendons), and 21 non-diabetic controls (42 Achilles tendons). The Achilles tendon thickness was significantly higher in the diabetic group with a mean thickness of 4.23 ± 0.95 mm, compared to 3.06 ± 0.83 mm in the control group (p < 0.01). A statistically significant difference of the Achilles tendon stiffness was also established. The diabetic group showed a greater percentage of soft tendons (47.5%) compared to the control group (16.7%). The diabetic group also showed a smaller percentage of hard tendons (52.5%) compared to the control group (83.3%) (p < 0.05). Conclusion Achilles tendons of type 2 DM patients are both thicker and softer than their non-diabetic counterparts.