High prevalence of achilles tendon enthesopathic changes in patients with type 2 diabetes without peripheral neuropathy

Background: Metabolic disorders are known to alter the mechanical properties of tendons. We sought to evaluate the prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with type 2 diabetes mellitus (T2DM) without peripheral neuropathy. Methods: We recruited 43 patients with T2DM and 40 controls. Neuropathy was excluded with the Michigan Neuropathy Scoring Instrument. Bilateral ultrasonography of the Achilles tendon enthesis was performed. Results: Patients with T2DM had a higher prevalence of hypoechogenicity (26.7% versus 2.5%; P =.0001), entheseal thickening (24.4% versus 8.7%; P =.007), and enthesophytes (74.4% versus 57.5%; P =.02). No differences were found in the number of patients with erosions (1.2% versus 0%; P >.99), cortical irregularities (11.6% versus 3.7%; P =.09), bursitis (5.8% versus 3.7%; P =.72), or tears (2.3% versus 1.2%; P >.99). The mean ± SD sum of abnormalities was higher in patients with T2DM (1.5 ± 1.1 versus 0.7 ± 0.6; P <.0001), as was the percentage of bilateral involvement (72.1% versus 45.0%; P =.01). Mean ± SD thickness did not differ between patients and controls (4.4 ± 1.1 mm versus 4.2 ± 0.8 mm; P =.07). Conclusions: According to our data, there is an elevated prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with T2DM independent of peripheral neuropathy.