title: Intrinsic foot muscle and plantar tissue changes in type 2 diabetes mellitus.
abstract: BACKGROUND
  Diabetes mellitus is a metabolic disorder with involvement of the neurovascular and muscular system. Peripheral neuropathy (PN) is thought to be the principal cause of foot complications in type 2 diabetes mellitus (T2DM). However, foot evaluation using ultrasonography early in the course of diabetes has not gained due importance. The aim of the present study was to evaluate the thickness of intrinsic foot muscles, plantar skin, plantar fascia, and plantar fat pad in T2DM subjects with and without PN using musculoskeletal ultrasonography.
  
  
  METHODS
  This study was conducted in 30 T2DM subjects with and without PN and 30 age-matched non-diabetes mellitus (NDM) subjects. After detailed clinical evaluation, high-frequency musculoskeletal ultrasonography was used to measure the thickness of the intrinsic foot muscles and plantar tissue thickness under the metatarsals. Data were analyzed using independent t-tests to compare T2DM groups with NDM subjects, and one-way ANOVA followed by Tukey's honestly significant difference test for between- and within-group analyses.
  
  
  RESULTS
  There was a significant reduction in the thickness of the intrinsic foot muscles and plantar tissue in T2DM compared with NDM subjects (P < 0.05). However, there were differences in intrinsic foot muscle and plantar tissue thickness between T2DM subjects with and without PN.
  
  
  CONCLUSIONS
  There was a substantial decrease in intrinsic foot muscle and plantar tissue thickness in T2DM compared with NDM subjects, indicating that structural changes appear in the foot before PN develops. The techniques used in this study cannot exclude the possibility that neuropathic changes that are clinically undetectable may develop in parallel with changes in plantar tissues.
authors.affiliation: Department of Physiotherapy, School of Allied Health Sciences, Manipal, India.
authors.forename: C G Shashi
authors.initials: CG
authors.lastname: Kumar
authors.affiliation: Department of Radio Diagnosis, Kasturba Medical College, Manipal, India.
authors.forename: K V
authors.initials: KV
authors.lastname: Rajagopal
authors.affiliation: Department of Medicine, Manipal University, Manipal, India.
authors.forename: H Manjunath
authors.initials: HM
authors.lastname: Hande
authors.affiliation: Department of Physiotherapy, School of Allied Health Sciences, Manipal, India.
authors.forename: Arun G
authors.initials: AG
authors.lastname: Maiya
authors.affiliation: Department of Statistics, Manipal University, Manipal, India.
authors.forename: Shreemathi S
authors.initials: SS
authors.lastname: Mayya
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging* / Q000294:innervation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000294:innervation; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D011237:Predictive Value of Tests; D014463:Ultrasonography
keywords: peripheral nervous system disease; type 2 diabetes mellitus; ultrasonography; 关键词：周围神经系统疾病，2型糖尿病，超声波检查