Ultrasonographic and elastographic evaluation of plantar fascia and Achilles tendon alterations in type 2 diabetes mellitus.

Abstract

Background/aim: The primary aim of this study was to compare the thickness and stiffness of the plantar fascia (PF) and Achilles tendon (AT) between healthy volunteers and patients with type 2 diabetes mellitus (T2DM). A secondary objective was to explore the correlations between the thickness and stiffness of the PF and AT and diabetes duration (in months) and hemoglobin A1c (HbA1c) levels in T2DM patients without peripheral neuropathy or foot ulcers, with peripheral neuropathy, or with foot ulcers.

Material and methods: A total of 289 participants, including 117 healthy volunteers (Group A) and 172 T2DM patients (59.5%), matched for age, sex, and body mass index, were included. The T2DM cohort was stratified into three subgroups: Group B (without peripheral neuropathy or foot ulcers), Group C (with peripheral neuropathy), and Group D (with foot ulcers). Ultrasonography (USG) and shear wave elastography (SWE) were used to assess PF and AT properties, and correlations with diabetes duration and HbA1c levels were analyzed.

Results: T2DM patients exhibited significantly greater PF and AT thickness, and lower stiffness compared to healthy controls (p < 0.001). Among subgroups, Group D had the greatest PF and AT thickness and the lowest stiffness, followed by Group C and then Group B (p < 0.001 for all comparisons). Positive correlations were observed between diabetes duration, HbA1c levels, and tendon thickness, while negative correlations were identified with stiffness (p < 0.001 for all).

Conclusion: USG and SWE revealed significant alterations in PF and AT properties in T2DM patients compared to healthy individuals, with these changes correlating with diabetes severity and duration.