title: Ultrasound morphology of the Achilles in asymptomatic patients with and without diabetes.
abstract: BACKGROUND
  The prevalence of tendinopathies is increased in subjects with diabetes mellitus. However, there are few data on the structural abnormalities of Achilles tendons in asymptomatic diabetic patients. The aim of the study was to assess the morphologic characteristics of the Achilles tendon in subjects with diabetes in comparison with controls without diabetes.
  
  
  METHODS
  Participants were consecutively recruited from an outpatient population. Ultrasound longitudinal and transverse scans were performed bilaterally along the full length of Achilles tendon from the musculotendinous junction to the insertion. Degenerative features (abnormal fibrillar pattern, hypo-hyperechoic areas), signs of enthesopathy (bony erosion, enthesophytes, and bursitis), and intratendinous neovessel formation were recorded.
  
  
  RESULTS
  Asymptomatic sonographic abnormalities (ASA) were significantly increased in subjects with diabetes (35/136 [25.7%] vs 32/273 [11.7%], P = .0003). Sixty tendons with ASA were observed in the first group and 45 in the latter because ASA were bilateral in 25 and in 13 subjects, respectively. ASA were more frequently localized at the enthesis (32/60 [53.3%] vs 9/45 [20%], P = .0005) in the diabetes group, whereas, on the contrary, they were more prevalent at the midportion in controls (38/45 [84.4%] vs 36/60 [60%], P < .006).
  
  
  CONCLUSIONS
  Diabetes may predispose to Achilles tendinopathy and particularly to Achilles enthesopathy. Longitudinal studies, evaluating the progression of the lesions not only in the midportion of the tendon but also at the insertion are needed to support this conclusion.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Abate
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Salini
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Antinolfi
authors.forename: Cosima
authors.initials: C
authors.lastname: Schiavone
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging* / Q000473:pathology*; D000368:Aged; D058070:Asymptomatic Diseases; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D014463:Ultrasonography
keywords: diabetes mellitus; enthesis; tendinopathy; ultrasonography