Sonographic evaluation of the prevalence of Achilles tendon tear in patients with type-2 diabetes

INTRODUCTION: The integrity of the Achilles tendon (AT) plays a significant role in foot biomechanical efficiency. Diabetes mellitus contributes to the development of AT tears which impairs movement and productivity. The objective of this study was to sonographically assess the prevalence and associated factors of Achilles tendon tears in Type-2 diabetes mellitus, with and without peripheral neuropathy (PN), and compare with a control population. METHODS: A prospective cross-sectional study was conducted on 71 Type-2 diabetics subjects and 80 controls. AT tears and calcifications were detected in the subjects using high resolution B-mode ultrasound. RESULTS: AT calcification was significantly associated with dominant and non-dominant foot AT tear, while HbA1c and PN were significantly associated with dominant foot AT tear (P < 0.05, respectively). There were significantly more AT calcifications and tears on the dominant foot AT of diabetics with PN (P < 0.001). The prevalence of AT tears in Type-2 diabetics was 7.75%. HbA1c ≥ 6.95% was shown to have a high sensitivity (75%), specificity (74.60%) and accuracy (75.35%) to correctly predict the development of a non-traumatic AT tear in diabetics with PN. CONCLUSION: The prevalence of AT tear in Type-2 diabetics, based on sonographic diagnosis, is low. The likelihood of AT tears increases in the dominant foot when HbA1c level equals or exceeds 6.95% in diabetics with peripheral neuropathy. This preliminary study showcases the need to incorporate Achilles tendon sonographic evaluation to rule out tears in the management of diabetics.