Atrophy of foot muscles in diabetic patients can be detected with ultrasonography.
OBJECTIVE
To establish a bedside test with ultrasonography for evaluation of foot muscle atrophy in diabetic patients.


METHODS
Thickness and cross-sectional area (CSA) of the extensor digitorum brevis muscle (EDB) and of the muscles of the first interstitium (MILs) were determined in 26 diabetic patients and in 26 matched control subjects using ultrasonography. To estimate the validity, findings were related to the total volume of all foot muscles determined at magnetic resonance imaging (MRI-FM(vol)). Furthermore, the relations of ultrasonographic estimates to nerve conduction, sensory perception thresholds, and clinical condition were established.


RESULTS
In diabetic patients, the ultrasonographic thickness of EDB (U-EDB(t)) was (means +/- SD) 6.4 +/- 2.1 vs. 9.0 +/- 1.0 mm in control subjects (P < 0.001), the thickness of MIL (U-MIL(t)) was 29.6 +/- 8.3 vs. 40.2 +/- 3.6 mm in control subjects (P < 0.001), and the CSA of EDB (U-EDB(CSA)) was 116 +/- 65 vs. 214 +/- 38 mm(2) in control subjects (P < 0.001). The MRI-FM(vol) was directly related to U-EDB(t) (r = 0.77), U-MIL(t) (r = 0.71), and U-EDB(CSA) (r = 0.74). U-EDB(t) and U-MIL(t) were thinner in neuropathic than in nonneuropathic diabetic patients (5.8 +/- 2.1 vs. 7.5 +/- 1.7 mm [P < 0.05] and 28.3 +/- 8.8 vs. 35.6 +/- 4.3 mm [P < 0.03], respectively).


CONCLUSIONS
Atrophy of intrinsic foot muscles determined at ultrasonography is directly related to foot muscle volume determined by MRI and to various measures of diabetic neuropathy. Ultrasonography seems to be useful for detection of foot muscle atrophy in diabetes.
Severinsen
Kaare
K
Department of Neurology, Aarhus University Hospital, 8000 Aarhus C, Denmark.
Obel
Annette
A
Jakobsen
Johannes
J
Andersen
Henning
H
D000328:Adult; D001284:Atrophy / Q000000981:diagnostic imaging*; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000473:pathology; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology* / Q000502:physiology / Q000503:physiopathology*; D012016:Reference Values; D014463:Ultrasonography