Diabetic foot is one of the most feared complication of diabetes. The tendons and ligaments stiffness and elasticity are known to be altered in diabetic foot. Achilles tendon (AT) plays an important for foot biomechanics and the altered stiffness of AT may have a role in pathogenesis of diabetic foot. Determination of the early changes in AT may help to identify the risky patients for diabetic foot. Acoustic Radiation Force Impulse (ARFI) Elastography is an elastography measures the shear wave velocity (SWV) of the target region inside the region of interest without external compression. Here we aimed to evaluate the elastographic features of AT with ARFI in patients with and without diabetic neuropathy. Forty five patients with type 2 diabetes recruited from the outpatient clinics served as the study group and were divided in two subgroups according to presence of peripheral neuropathy. Those with peripheral neuropathy were defined as group I (22 patients) and those without peripheral neuropathy were defined as group II (23 patients) Thirty age-, gender-, and body mass index (BMI)-matched healthy individuals were served as controls. The middle portion of Achilles tendon which is nearly 2-6 cm proximal to the calcaneus insertion is chosen for both ultrasonographic and ARFI elastographic examination. There was no statistically significant difference between the groups in terms of gender, age, BMI, height, and weight. HbA1c levels and fasting plasma glucose were similar between group I and group II. Achilles tendon thicknesses (ATT) were similar between group I and II P=0.991). Both patient groups ATT were significantly higher than controls. (group I vs control P=0.01; group II vs control P=0.006). Stiffness of AT as represented as SWV was similar between patients without neruopathy and control group (P=0.993). SWV was significantly lower in patients with neuropathy compared with patients without neuropathy and control group (P<0.001).
|SVW of right AT (m/s)
|SVW of left AT (m/s)
To the best of our knowledge this is the first study evaluating stiffness of AT with ARFI. In conclusion diabetic patients with neuropathy have thicker and softer AT however elasticity of AT of diabetic patients without neuropathy was similar with healthy controls. Softening of AT may be an early sign of diabetic foot and may indicate risky patients for diabetic foot.
19 May 2018 - 22 May 2018