Plantar fascia enthesopathy in diabetes

NewsBot · Apr 4, 2017

Members do not see these Ads. Sign Up.
Plantar fascia enthesopathy is highly prevalent in diabetic patients without peripheral neuropathy and correlates with retinopathy and impaired kidney function
Francesco Ursini , Franco Arturi, Kassandra Nicolosi, Antonio Ammendolia, Salvatore D’Angelo, Emilio Russo, Saverio Naty, Caterina Bruno, Giovambattista De Sarro, Ignazio Olivieri, Rosa Daniela Grembiale
PLoS ONE 12(3): e0174529. doi:10.1371/journal.pone.0174529

Background
Aim of this study was to evaluate the prevalence of plantar fascia (PF) enthesopathy in Type 2 diabetes mellitus (T2DM) patients without distal peripheral neuropathy (DPN).

Methods
We recruited 50 T2DM patients without DPN and 50 healthy controls. DPN was excluded using the Michigan Neuropathy Screening Instrument (MNSI). All patients underwent a bilateral sonographicevaluation of the enthesealportion of the PF.

Results
PF thickness was significantly higher in T2DM patients (p<0.0001). T2DM patients presented a higher prevalence of entheseal thickening (p = 0.002), enthesophyte (p = 0.02) and cortical irregularity (p = 0.02). The overall sum of abnormalities was higher in T2DM patients (p<0.0001), as was the percentage of bilateral involvement (p = 0.005). In a logistic regression analysis, retinopathy predicted entheseal thickening (OR 3.5, p = 0.05) and enthesophytes (OR 5.13, p = 0.001); reduced eGFR predicted enthesophytes (OR 2.93, p = 0.04); body mass index (BMI) predicted cortical irregularity (OR 0.87, p = 0.05); mean glucose predicted enthesophyte (OR 1.01, p = 0.03); LDL cholesterol predicted cortical irregularity (OR 0.98, p = 0.02).

Conclusions
Our data suggest that T2DM is associated with PF enthesopathyindependently of DPN.
Click to expand...

Admin2 · Apr 4, 2017

Related Topics:
Chronic tendinopathies in diabetes
Tendon changes in diabetes
Diabetic foot biomechanics
Intrinsic muscle atrophy in diabetes

NewsBot · Apr 11, 2017

High Prevalence of Achilles Tendon Enthesopathic Changes in Patients with Type 2 Diabetes Without Peripheral Neuropathy.
Francesco Ursini, Franco Arturi, Salvatore D'Angelo, Lewa Amara, Kassandra Nicolosi, Emilio Russo, Saverio Naty, Caterina Bruno, Giovambattista De Sarro, Ignazio Olivieri, and Rosa Daniela Grembiale
Journal of the American Podiatric Medical Association: March 2017, Vol. 107, No. 2, pp. 99-105.

Background: Metabolic disorders are known to alter the mechanical properties of tendons. We sought to evaluate the prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with type 2 diabetes mellitus (T2DM) without peripheral neuropathy.

Methods: We recruited 43 patients with T2DM and 40 controls. Neuropathy was excluded with the Michigan Neuropathy Scoring Instrument. Bilateral ultrasonography of the Achilles tendon enthesis was performed.

Results: Patients with T2DM had a higher prevalence of hypoechogenicity (26.7% versus 2.5%; P = .0001), entheseal thickening (24.4% versus 8.7%; P = .007), and enthesophytes (74.4% versus 57.5%; P = .02). No differences were found in the number of patients with erosions (1.2% versus 0%; P > .99), cortical irregularities (11.6% versus 3.7%; P = .09), bursitis (5.8% versus 3.7%; P = .72), or tears (2.3% versus 1.2%; P > .99). The mean ± SD sum of abnormalities was higher in patients with T2DM (1.5 ± 1.1 versus 0.7 ± 0.6; P < .0001), as was the percentage of bilateral involvement (72.1% versus 45.0%; P = .01). Mean ± SD thickness did not differ between patients and controls (4.4 ± 1.1 mm versus 4.2 ± 0.8 mm; P = .07).

Conclusions: According to our data, there is an elevated prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with T2DM independent of peripheral neuropathy.
Click to expand...

NewsBot · Jun 4, 2019

SUBCLINICAL ENTHESEAL INVOLVEMENT IN LOWER
LIMBS IN PATIENTS WITH TYPE 2 DIABETES
MELLITUS: AN ULTRASOUND STUDY
Mohamed Omar et al
Source

Background: Diabetes mellitus (DM) is a group of metabolic diseases
characterized by hyperglycemia, which results from defects in insulin
secretion, insulin action, or both (1).
DM impacts the connective tissue and causes various changes in periarticular and articular structures.An increase in enthesopathic complications
in diabetic patients such as patellar tendinitis bursitis, achilles tendinopathy and plantar fasciitis, was observed In many studies.
Objectives: This study aims to detect subclinical lower limb enthesitis in
type 2 DM by musculoskeletal ultrasonography & its relation to poor glycemic control & disease duration
Methods: This study was carried out on 80 persons. Diabatic group forty
patients diagnosed as diabetes according to ADA diagnostic criteria. Control group Forty apparent healthy volunteers both groups was matched at
age and sex.Sonographic evaluations and scoring were performed according to Glasgow Ultrasound Enthesitis Scoring System(GUESS) on the
enthses of both lower limbs.
Results: At the diabetic group the Musculoskeletal Ultrasound findings
was as following. The Quariceps tendon enthesitis in 30 patients (75%),
proximal patellar enthesitis was in 28 patients (70%), Distal patellar
enthesitis in 22 patients (55%), Achilles enthesitis in 27 patients (67.5) &
planter aponeurosis enthesitis in 25 patients (55%).There is a statistically
significant difference between age and Ultrasound findings p. value
<0.05.There is a statistically significant correlation between disease duration and (proximal patellar ligament,Achilles tendon, quadriceps tendon
and plantar fascia) thickness p. value<0.05.
Conclusion: Entheseal abnormalities can be documented by ultrasonography in clinically asymptomatic patients with Diabetes. These findings could
be related to a subclinical entheseal inflammation.
Click to expand...

NewsBot · Jun 21, 2019

Plantar fasciitis in patients with type 1 and type 2 diabetes: A contemporary cohort study
Sari J.PriesandaBrian M.SchmidtaLynnAngaJames S.WrobelaMichaelMunsonaWenYebRodicaPop-Busuia
Journal of Diabetes and its Complications; 20 June 2019

Objective
Hyperglycemia leads to increase advanced glycation end products (AGEs) in patients with type 1 and type 2 diabetes. Subsequently, formation of AGEs can cause increased plantar fascial thickness (PFT), an imaging feature of plantar fasciitis (PF). This study evaluates the prevalence of PF in a contemporary cohort of type 1 diabetes and type 2 diabetes patients managed according to current standards, compared to patients without diabetes.

Research Design and Methods.

This is a five-year prevalence study in a large tertiary health system (approximately 535,000 patients/visits/year) with a single electronic medical record (EMR), applying a cohort discovery tool and database screen (Data Direct) with use of ICD-9 and ICD-10 codes. All patients with a PF diagnosis between 01/01/2011–01/01/2016 were included and divided into 3 groups: type 1 diabetes (7148 patients), type 2 diabetes (61,632 patients), and no diabetes (653,659 patients). Prevalence rates were calculated, accounting for other risk factors including BMI and gender using Fisher's exact test.

Results
The overall prevalence of PF in the entire study population was 0.85%. Prevalence rates were higher in patients with diabetes, particularly with type 2 diabetes (42% and 64% higher compared with patients with type 1 diabetes and no diabetes respectively). Individually, PF rates were 0.92% in type 1 diabetes and 1.31% in type 2 diabetes compared with 0.80% in patients with no diabetes (Type 1 vs. no diabetes p = 0.26; Type 2 vs. no diabetes p < 0.0001; Type 1 vs. Type 2 diabetes p = 0.0054). Females in all groups had higher prevalence of PF than males (p < 0.0001 for all), with those patients with diabetes having higher prevalence rates than those without diabetes. Patients with higher BMI levels (BMI ≥ 30 kg/m2) were also more likely to have PF in all categories except males with type 1 diabetes (p = 0.40).

Conclusions
In this large contemporary population managed in a tertiary health system, prevalence rates of PF were substantially higher in patients with diabetes compared with no diabetes, particularly in type 2 diabetes. Female gender and higher BMI were also associated with higher prevalence of PF in this cohort.
Click to expand...

NewsBot · Nov 6, 2019

ASSESSMENT OF PLANTAR FASCIITIS AMONG ADULTS HAVING HIGHER BODY MASS INDEX AND GLUCOSE INTOLERANCE IN A MEDICAL INSTITUTE OF RAIPUR
Dr Shrikant Verma, Dr. Rahul Kewal Kumar
Home > Vol 8, No 10 (2019)

Introduction: Plantar fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin on the calcaneus. PF is reported to be the most common cause of inferior heel pain in diabetic and non diabetic patient population. Calcaneal spurs (CS) have commonly been implicated as a risk factor for PF. To this purpose we have evaluated the frequency of Calcaneal spur (CS) in obese patients with Type-2 diabetes.

Method: Study was designed as a cross sectional Analytical study . Male and female study subjects who were Obese (BMI ≥30 kg/m2), Having Diagnosed type 2 diabetes & above the age of 18 years, with a history of plantar heel tenderness and/or pain were included in the study Information was analysed by using the Microsoft Excel and SPSS . Chi square test was used for analysis.

Results: A total of 65 obese diabetic patients were included into the study. The mean age of the patients was 54±5.8 years. There were 25 males and 40 females. The median duration of diabetes was 4.2 years (1-10 years). The mean HbA1c was 8.4±0.9. 78% were having plantar fasciitis.

Conclusion: Poor diabetes control Peripheral Neuropathy seems to be the main reasons Existence seems to be in a relationship with diabetic complications; therefore, obese diabetic patients may be more prone to these complications. Therefore, weight reduction should be encouraged in these patients
Click to expand...

NewsBot · May 9, 2020

Plantar Fasciitis in Diabetic Foot Patients: Risk Factors, Pathophysiology, Diagnosis, and Management.
Gariani K, Waibel FWA, Viehöfer AF, Uçkay I.
Diabetes Metab Syndr Obes. 2020 Apr 22;13:1271-1279

Plantar fasciitis (PF) is a common degenerative disorder and a frequent cause of heel pain, mostly affecting patients in their fourth and fifth decades. Diabetic patients are particularly at risk due to the presence of common risks and co-morbidities such as obesity or a sedentary lifestyle. The diagnosis of PF is mainly clinical. Imaging is not recommended for the initial approach. The initial management is conservative and should include physiotherapy, off-loading, stretching exercises, and nonsteroidal anti-inflammatory drugs. Glucocorticoid injections or surgery is an option at a later stage in recalcitrant cases. The overall management of PF does not differ between patients with diabetic foot problems and non-diabetic patients, although the details can differ. This narrative review summarizes the state of the art in terms of the risk factors, pathophysiology, diagnosis, assessment, and management of PF in diabetic patients.
Click to expand...

NewsBot · Feb 11, 2021

Experimental Analysis
of Plantar Fascia Mechanical
Properties in Subjects with Foot
Pathologies.
Citation: Todros, S.; Biz, C.; Ruggieri,
P.; Pavan, P.G.
Appl. Sci. 2021, 11, 1517.

Plantar Fascia (PF) is a fibrous tissue that plays a key role in supporting the foot arch; it
can be affected by several pathologies that can alter foot biomechanics. The present study aims at
investigating the mechanical behavior of PF and evaluating possible correlations between mechanical
properties and specific pathologies, namely diabetes and plantar fibromatosis (Ledderhose syndrome).
PF samples were obtained from 14 human subjects, including patients with Ledderhose syndrome,
patients affected by diabetes and healthy subjects. Mechanical properties of PF tissues were evaluated
on three samples from each subject, by cyclic uniaxial tensile tests up to 10% of maximum strain
and stress relaxation tests for 300 s, in hydrated conditions at room temperature. In tensile tests, PF
exhibits non-linear stress–strain behavior, with a higher elastic modulus (up to 25–30 MPa) in patients
affected by Ledderhose syndrome and diabetes with respect to healthy subjects (elastic modulus
10 ÷ 14 MPa). Stress-relaxation tests show that PF of patients affected by Ledderhose syndrome and
diabetes develop more intense viscous phenomena. The results presented in this work represent the
first experimental data on the tensile mechanical propertied of PF in subjects with foot diseases and
can provide an insight on foot biomechanics in pathological conditions
Click to expand...

NewsBot · Oct 5, 2021

Lower Limb Enthesopathy in Patient with Diabetes
Mellitus without Clinical Signs of Arthropathy
FatemaTuj Johora, et al
The Planet Volume 05 No. 01 January-June 2021

Background: Diabetes mellitus is a leading cause of death and disability worldwide. Its global
prevalence was about 8% in 2011 and is predicted to rise to 10% by 2030. DM has great impact
on the connective tissue and prolongation of diabetes period increases the degree of
complications. Musculoskeletal ultrasonography using the Glasgow Ultrasound Enthesitis
Scoring System (GUESS) is a validated and useful tool to quantify articular and periarticular
changes of lower extremity.
Objectives: The objective of this study is to findout the correlation between Glasgow Ultrasound
Enthesitis Score in diabetic patients and duration of DM.
Materials and Methods: This Cross sectional study was carried out in the Department of
Radiology and Imaging, BIRDEM, Dhaka, during July 2017 to June 2019 period. For this purpose,
a total of 120 diabetic patients were included in this study.
Observation and Results: Results revealed the mean age (±SD) was 49.46±7.99 years ranging
from 35-64 years. Male to female ratio was 1:1.1. There was positive significant correlation
found between duration of DM with the suprapatellar bursitis (r=0.637; p=0.001), infrapatellar
bursitis (r=0.319; p=0.001) retrocalcaneal bursitis(r=0.715;p=0.001), quadriceps tendon
thickness (r=0.583;p=0.001), proximal patellar ligament thickness(r=0.441;p=0.001) and
Achilles tendon thickness (r=0.343;p=0.001).
On the other hand, there was a negative correlation (r=-0.176; p=0.055) was found between the
plantar aponeurosis thickness with duration of DM. There was a significant positive correlation
(r=0.941; p=0.001) was found between the total GUESS score with duration of DM
Click to expand...

NewsBot · Nov 26, 2021

Irregularity in Plantar Fascia, Muscle Edema and Tendon Thickness in Patients with High-Risk for Diabetic Foot
Busra Yurumez Korkmaz et al
Exp Clin Endocrinol Diabetes. 2021 Nov 15

Aim: To investigate the alterations in the plantar fascia (PF), intrinsic muscles, and tendons in the feet of patients at high risk for developing diabetic foot.

Methods: The healthy feet of 22 patients with type 2 diabetes, who had developed diabetic foot ulcers on a single foot without any pathology on the contralateral extremity, and those of 22 healthy volunteers were evaluated by magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF, and edema of intrinsic foot muscles were examined.

Results: Nineteen patients (86%) had irregularity in the PF, whereas none of the healthy controls had any (p<0.001). Intrinsic muscle edema was more common in the group with diabetes (p=0.006). The volume of AT and the surface area of PF were decreased in patients with peripheral arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but without PAD had a larger surface area of PF than that of controls (p<0.05). There were no differences in the volume of AT, the surface area of the PF, and other tendon thickness between the groups.

Conclusion: Irregularity in the PF and muscle edema may indicate a high risk for the diabetic foot. The presence of PAD may lead to regression in the structure of AT and PF.
Click to expand...

NewsBot · Feb 17, 2022

Diagnostic value of ultrasound in detection and diagnosis of plantar fasciitis in diabetic foot patient in comparison with magnetic resonance imaging
Ahmed Abdelmohsen Abdelaziz et al
Benha Medical Journal 12 February 2022 XMLPDF (790.8 K)

Background: Ultrasound has proved its ability to detect changed associated with plantar fasciitis (PF). However, magnetic resonance imaging (MRI) is still the gold standard technique for the diagnosis of such condition.
Aim of the work: This study was conducted to evaluate the diagnostic capability of ultrasonography for the detection of plantar fasciitis in comparison with MRI in diabetic foot patients.
Patients and methods: This prospective case control study was included 40 subjects; 30 cases diagnosed with PF in addition to 10 controls. All subjects were subjected to history taking, clinical examination, plantar US and MRI examination for assessment of PF signs.
Results: Basic demographics were comparable between cases and controls. By both US and MRI, plantar fascial thickness showed a significant increase, in both longitudinal and transverse planes, in cases compared to controls. US had sensitivity and specificity of 92.6 and 100% respectively, with a diagnostic accuracy of 93.3% for the detection of focal thickening and fascial abnormal signaling. US had sensitivity and specificity of 94.4 and 100% in detecting soft tissue edema, while it had poor sensitivity for calcaneal spur, and no sensitivity for bone marrow edema.
Conclusion: US could be considered as good alternative tool compared to MRI in the diagnosis of PF, as it was able to detect most signs of such pathology. However, it is recommended to be performed by an experienced radiologist.
Click to expand...

NewsBot · Oct 18, 2022

Evaluation of the plantar fascia in patients with diabetes mellitus: the role of sonoelastography
Sneha Harish C et al
Pol J Radiol. 2022 Sep 9;87

Purpose: It has been postulated that hyperglycaemic non-enzymatic glycation of proteins with subsequent accumulation of glycosylated end-products in tissues like the plantar fascia (PF) contributes to the development of foot ulcers in diabetics. The present study evaluates the spectrum of sonoelastographic findings in the plantar fascia in patients with type 2 diabetes mellitus (DM).

Material and methods: A total of 81 patients and 32 healthy volunteers were included in the study. PF thickness was registered 1 cm distal to the attachment at the calcaneus. Greyscale ultrasonographic examination was followed by strain elastography of the PF based on which PF were qualitatively categorized into 3 grades (hard, intermediate, soft) depending on their predominant colour.

Results: Patients were found to have thicker PF than healthy volunteers (p < 0.0001). Grade 2 (intermediate elasticity) PF was the most common type seen in both groups (48.44% of healthy volunteers and 57.25% of patients). However, a greater number of patients (36.64%) had grade 3, i.e. soft PF as compared to healthy volunteers (9.38%).

Conclusions: To conclude, there is thickening and softening of the PF in patients with type 2 DM, supporting the hypo-thesis that diabetes-induced changes occur in the tissues of the foot.
Click to expand...

NewsBot · Mar 30, 2023

Plantar fascia stiffness in patients with type 2 diabetes mellitus: Stiffness effect on fall risk and gait speed
Rumeysa Çakici et al
Foot (Edinb). 2023 Mar 17;56:102020

Aims: The primary objective was to compare patients with type 2 diabetes mellitus (T2DM) and healthy peers in terms of plantar fascia (PF) stiffness, fall risk, and gait speed. The second objective was to examine the relationship between stiffness of PF and fall risk, gait speed.

Methods: Fifty patients diagnosed with T2DM (mean duration = 10.74 ± 7.07 years) were included. Myotonometer was used to evaluate the stiffness of PF. To assess the risk of falling, and gait speed, the International Fall Efficiency Scale (FES-I) and the 4-Meter Gait Speed Test (4mGST) were used, respectively.

Results: Compared to healthy controls, PF stiffness (right foot mean difference = 148.99 N/m, left foot mean difference = 113.13 N/m p < .001) was higher in the T2DM group. The FES-I and 4mGST scores were worse in the group with T2DM (p < .05). 12.8 % of FES-I and 23.4 % of 4mGST variance were explained by stiffness of PF.

Conclusions: The results of the study showed that the stiffness of PF changed in patients with T2DM. There was a decrease in gait speed and an increase in the risk of falling as PF stiffness increased.
Click to expand...

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Enthesopathy of the lateral plantar fascia

Do the fasciae of the soleus have a role in plantar fasciitis?

Stiffness of plantar fascia in plantar fasciopathy

Arch Support Cushion Pads, Adhesive Backing, Poron/PPT, 12 per Pack, Plantar Fascia Control

Effects of fatigue on the plantar fascia

The plantar fascia and pressure under the toes

The extensibility of the plantar fascia influences the windlass mechanism during human running

Share This Page