Ultrasound evaluation of Achilles tendon among Diabetic Patients (type 2 Diabetes Mellitus)

Authors

  • Amgad M. Elsheikh
  • Sarah Elsayed Mohamed Fouad
  • Said Abdelmonem Ibrahim
  • Ahmed Mohamed Alsowey

DOI:

https://doi.org/10.52783/jns.v14.2811

Keywords:

Radiological imaging, Achilles tendon, Diabetic Patients

Abstract

The Achilles tendon (AT) is the strongest tendon in the human body, gaining its crucial importance with the upright gait of humans. The Achilles tendon (AT) is a well-studied structure that permits foot plantar flexion It connects the triceps surae muscle, consisting of the medial and lateral heads of the gastrocnemius muscle and the soleus muscle forming the dorsal shape of the calf with the calcaneus bone tuberosity. Tendinopathy is a chronic and often painful condition affecting both professional athletes and sedentary population. It is a
multi-etiological disorder, the most evident causes of tendinopathy are related to tendon overuse and overload. Ultrasound (US) performed with high-resolution linear-array probes has become increasingly
important in the assessment of ligaments and tendons around the ankle. US can provide adetailed description
of normal anatomic structures, effective for evaluation of ligament integrity. In addition, it allows the
performance of dynamic maneuvers, which may contribute to increase visibility of normal ligaments and
improve detection of tears. It can facilitate accurate identification, localization and differentiation between
synovial, tendinous and entheseal inflammation as well as joint, bursal and soft tissue fluid collection.

Downloads

Download data is not yet available.

References

Ballal MS, Walker CR, Molloy AP. The anatomical footprint of the Achilles tendon: a

cadaveric study. Bone Joint J. 2014 Oct;96-B(10):1344-8.

Winnicki K, Ochała-Kłos A, Rutowicz B, Pękala PA, Tomaszewski KA. Functional

anatomy, histology and biomechanics of the human Achilles tendon - A comprehensive

review. Ann Anat. 2020 May;229:151461.

Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, Dönmez G, Maffulli N. Functional

anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2010

May;18(5):638-43.

Edama M, Kubo M, Onishi H, Takabayashi T, Inai T, Yokoyama E, Hiroshi W, Satoshi N,

Kageyama I. The twisted structure of the human Achilles tendon. Scand J Med Sci Sports.

Oct;25(5):e497-503.

Pass B, Robinson P, Ha A, Levine B, Yablon CM, Rowbotham E. The Achilles Tendon:

Imaging Diagnoses and Image-Guided Interventions-AJR Expert Panel Narrative Review.

AJR Am J Roentgenol. 2022 Sep;219(3):355-368.

Pingel J, Petersen MC, Fredberg U, Kjær SG, Quistorff B, Langberg H, Hansen JB.

Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles

Tendinopathy. PLoS One. 2015 May 21;10(5):e0127811.

Labusca L, Zugun-Eloae F. The Unexplored Role of Intra-articular Adipose Tissue in the

Homeostasis and Pathology of Articular Joints. Front Vet Sci. 2018 Mar 5;5:35.

Pierre-Jerome C, Moncayo V, Terk MR. MRI of the Achilles tendon: a comprehensive

review of the anatomy, biomechanics, and imaging of overuse tendinopathies. Acta Radiol.

May;51(4):438-54.

Dayton P. Anatomic, Vascular, and Mechanical Overview of the Achilles Tendon. Clin

Podiatr Med Surg. 2017 Apr;34(2):107-113.

Baskerville R, McCartney DE, McCartney SM, Dawes H, Tan GD. Tendinopathy in type

diabetes: a condition between specialties? Br J Gen Pract. 2018 Dec;68(677):593-594.

Federer AE, Steele JR, Dekker TJ, Liles JL, Adams SB. Tendonitis and Tendinopathy:

What Are They and How Do They Evolve? Foot Ankle Clin. 2017 Dec;22(4):665-676.

Cannata F, Vadalà G, Ambrosio L, Napoli N, Papalia R, Denaro V, Pozzilli P. The impact

of type 2 diabetes on the development of tendinopathy. Diabetes Metab Res Rev. 2021

Sep;37(6):e3417.

Ranger TA, Wong AM, Cook JL, Gaida JE. Is there an association between tendinopathy

and diabetes mellitus? A systematic review with meta-analysis. Br J Sports Med. 2016

Aug;50(16):982-9.

Lui PPY. Tendinopathy in diabetes mellitus patients-Epidemiology, pathogenesis, and

management. Scand J Med Sci Sports. 2017 Aug;27(8):776-787.

Goyal R, Singhal M, Jialal I. Type 2 Diabetes. 2023 Jun 23. In: StatPearls [Internet].

Treasure Island (FL): StatPearls Publishing; 2025 Jan– .

Napoli N, Conte C, Pedone C, Strotmeyer ES, Barbour KE, Black DM, Samelson EJ,

Schwartz AV. Effect of Insulin Resistance on BMD and Fracture Risk in Older Adults. J

Clin Endocrinol Metab. 2019 Aug 1;104(8):3303-3310.

Ursini F, Arturi F, D'Angelo S, Amara L, Nicolosi K, Russo E, Naty S, Bruno C, De Sarro

G, Olivieri I, Grembiale RD. High Prevalence of Achilles Tendon Enthesopathic Changes

in Patients with Type 2 Diabetes Without Peripheral Neuropathy. J Am Podiatr Med

Assoc. 2017 Mar;107(2):99-105.

Partridge L, Rajbhandari S. Achilles Tendon in Diabetes. Curr Diabetes Rev.

;13(4):424-427.

Zakaria MH, Davis WA, Davis TM. Incidence and predictors of hospitalization for tendon

rupture in type 2 diabetes: the Fremantle diabetes study. Diabet Med. 2014

Apr;31(4):425-30.

Abate M, Schiavone C, Pelotti P, Salini V. Limited joint mobility in diabetes and ageing:

recent advances in pathogenesis and therapy. Int J Immunopathol Pharmacol. 2010 Oct

Dec;23(4):9971003.

Dimitri-Pinheiro S, Pimenta M, Cardoso-Marinho B, Torrão H, Soares R, Karantanas A.

Diabetes: a silent player in musculoskeletal interventional radiology response. Porto

Biomed J. 2021 Jan 26;6(1):e112.

Maffulli N, Longo UG, Maffulli GD, Khanna A, Denaro V. Achilles tendon ruptures in

diabetic patients. Arch Orthop Trauma Surg. 2011 Jan;131(1):33-8.

Shi L, Rui YF, Li G, Wang C. Alterations of tendons in diabetes mellitus: what are the

current findings? Int Orthop. 2015 Aug;39(8):1465-73.

de Oliveira RR, Lemos A, de Castro Silveira PV, da Silva RJ, de Moraes SR. Alterations

of tendons in patients with diabetes mellitus: a systematic review. Diabet Med. 2011

Aug;28(8):886-95.

Sconfienza LM, Orlandi D, Lacelli F, Serafini G, Silvestri E. Dynamic high-resolution US

of ankle and midfoot ligaments: normal anatomic structure and imaging technique.

Radiographics. 2015 Jan-Feb;35(1):164-78.

Wijesekera NT, Calder JD, Lee JC. Imaging in the assessment and management of

Achilles tendinopathy and paratendinitis. Semin Musculoskelet Radiol. 2011

Feb;15(1):89-100.

Kim DH, Choi JH, Park CH, Park HJ, Yoon KJ, Lee YT. The Diagnostic Significance of

Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional

Achilles Tendinopathy in Patients with Heel Pain. J Clin Med. 2021 May

;10(10):2165.

Ibrahim NM, Elsaeed HH. Lesions of the Achilles tendon: Evaluation with

ultrasonography and magnetic resonance imaging. The Egyptian Journal of Radiology and

Nuclear Medicine. 2013 Sep 1;44(3):581-7.

Pierre-Jerome C, Moncayo V, Terk MR. MRI of the Achilles tendon: a comprehensive

review of the anatomy, biomechanics, and imaging of overuse tendinopathies. Acta

Radiol. 2010 May;51(4):438-54.

Nadeau MJ, Desrochers A, Lamontagne M, Larivière C, Gagnon DH. Quantitative

ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic

individuals: reliability and minimal detectable change. J Foot Ankle Res. 2016 Aug

;9:30.

Bakkegaard M, Johannsen FE, Højgaard B, Langberg H. Ultrasonography as a prognostic

and objective parameter in Achilles tendinopathy: a prospective observational study. Eur J

Radiol. 2015 Mar;84(3):458-462.

Del Buono A, Chan O, Maffulli N. Achilles tendon: functional anatomy and novel

emerging models of imaging classification. Int Orthop. 2013 Apr;37(4):715-21.

Afolabi BI, Idowu BM, Onigbinde SO. Achilles tendon degeneration on ultrasound in

type 2 diabetic patients. J Ultrason. 2021;20(83):e291-e299.

Fenech M, Ajjikuttira A, Edwards H. Ultrasound assessment of acute Achilles tendon

rupture and measurement of the tendon gap. Australas J Ultrasound Med. 2024 Apr

;27(2):106-119.

Szaro P, Nilsson-Helander K, Carmont M. MRI of the Achilles tendon - a

comprehensive pictorial review. Part two. Eur J Radiol Open. 2021 Mar 27;8:100343.

Schneebeli A, Fiorina I, Bortolotto C, Barbero M, Falla D, Cescon C, Raciti MV,

Tarantino F, Preda L. Shear wave and strain sonoelastography for the evaluation of the

Achilles tendon during isometric contractions. Insights Imaging. 2021 Feb 17;12(1):26.

DeWall RJ, Slane LC, Lee KS, Thelen DG. Spatial variations in Achilles tendon shear

wave speed. J Biomech. 2014 Aug 22;47(11):2685-92.

Downloads

Published

2025-03-30

How to Cite

1.
Elsheikh AM, Mohamed Fouad SE, Ibrahim SA, Mohamed Alsowey A. Ultrasound evaluation of Achilles tendon among Diabetic Patients (type 2 Diabetes Mellitus) . J Neonatal Surg [Internet]. 2025 Mar. 30 [cited 2026 Feb. 10];14(9S):781-800. Available from: https://jneonatalsurg.com/index.php/jns/article/view/2811