Sonographic Evaluation of Achilles Tendon Thickness in Patients With Type 2 Diabetes: A Potential Diagnostic Tool to Predict Foot Ulcers

Abstract

Objective:

This study aimed to determine the correlation of Achilles tendon thickness (ATT) with peripheral neuropathy (PN) and foot ulcer, and the ATT measurement that could predict the development of foot ulcers in patients with type 2 diabetes mellitus (DM).

Materials and Methods:

We enrolled 65 patients with type 2 DM and 85 control patients. ATT was evaluated using ultrasonography. A monofilament test was used to determine the presence of PN; the development of foot ulcers in this diabetes cohort was assessed over a 4-month period.

Results:

PN in the patients significantly correlated with ATT (p = .000). Mean ATT was significantly higher in DM + PN than those of DM–PN and control groups (10.06 ± 1.68 vs 7.23 ± 2.10 vs 6.71 ± 1.27 mm; p < .05). An ATT of 9.925 mm was identified as the diagnostic cutoff and had high accuracy (92.31%), sensitivity (85.00%), and specificity (95.60%) to accurately classify these diabetic patients with the likelihood of developing foot ulcers within 4 months.

Conclusion:

The measurement of ATT significantly correlated with PN and foot ulcer in this cohort of patients. ATT was significantly thicker in diabetic patients with PN than those of diabetic patients without PN and nondiabetic patients. Ultrasonographic assessment of ATT revealed high sensitivity, specificity, and accuracy in predicting the development of foot ulcers in this cohort of patients with type 2 DM. This study needs to be expanded and replicated owing to the potentiality of ultrasonography to be used as an additional diagnostic tool in the prediction of foot ulcer in patients with diabetes.