Ultrasound evaluation of Achilles tendon among Diabetic Patients (type 2 Diabetes Mellitus)
DOI:
https://doi.org/10.52783/jns.v14.2811Keywords:
Radiological imaging, Achilles tendon, Diabetic PatientsAbstract
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
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
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.