SUMMARY
Objective. There is a greater risk of tendon rupture requiring hospitalization in people with diabetes. Diabetes could induce substantial alteration in Achilles tendon (AT) that could affect its mechanical properties mainly in relation to gait and foot ulceration. Many studies reported AT morphological changes using diagnostic methods in clinical settings. However, there is no quantitative synthesis of the published data.
Methods. A systematic review was conducted using several electronic databases. Only comparative clinical studies comparing AT changes and findings between healthy people and patients with diabetes, with and without neuropathy were included. Studies using ultrasound or MRI were eligible for inclusion.
Results. Seventeen studies comprising 2,938 subjects (5,822 tendons) were analyzed.
Increased AT thickness in patients with diabetes was found, but the difference did not reach significance. The weighted Odds Ratios (OR) were all significantly favoring changes in diabetes: 1) overall AT morphological changes (OR 3.5, CI 2.970-4.181); 2) AT fiber disorganization (OR 3.48, CI 2.291-12.1840); 3) tendinopathy (OR 3.5, CI 2.934-4.333), d) enthesopathy (OR 4.08, CI 1.130-14.723), and 4) calcifications (OR 2.38, CI 1.424-3.976).
Conclusions. A trend for increased Achilles tendon thickness was noticed in diabetic patients, especially those with peripheral neuropathy. When compared to healthy subjects, patients with diabetes expressed greater morphological changes in the form of tendon fiber disorganization, calcifications, and enthesopathies. Such anomalies could increase the risk of Achilles rupture, falls and the development of diabetic foot ulcers.
Morphological Changes and Pathological Findings in the Achilles Tendons of Diabetic Patients: A Meta-Analysis of Comparative Clinical Studies
Kaissar Yammine, Elio Daccache, Chahine Assi
Review, 201-210
Keywords: Achilles tendon, diabetes mellitus, diabetic neuropathies, Magnetic Resonance Imaging, ultrasound,
Table of Content: Vol. 13 (No.2) 2023 April/June
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Morphological Changes and Pathological Findings in the Achilles Tendons of Diabetic Patients: A Meta-Analysis of Comparative Clinical Studies
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