Atrophy of Foot Muscles in Diabetic Patients Can Be Detected With Ultrasonography
- Kaare Severinsen, MD1,
- Annette Obel, MD2,
- Johannes Jakobsen, MD, PHD1 and
- Henning Andersen, MD, PHD1
- 1Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- 2Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
- Address correspondence and reprint requests to Henning Andersen, Department of Neurology, Aarhus University Hospital, 8000 Aarhus C, Denmark. E-mail: hande{at}as.aaa.dk
Abstract
OBJECTIVE—To establish a bedside test with ultrasonography for evaluation of foot muscle atrophy in diabetic patients.
RESEARCH DESIGN AND 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-FMvol). 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-EDBt) was (means ± SD) 6.4 ± 2.1 vs. 9.0 ± 1.0 mm in control subjects (P < 0.001), the thickness of MIL (U-MILt) was 29.6 ± 8.3 vs. 40.2 ± 3.6 mm in control subjects (P < 0.001), and the CSA of EDB (U-EDBCSA) was 116 ± 65 vs. 214 ± 38 mm2 in control subjects (P < 0.001). The MRI-FMvol was directly related to U-EDBt (r = 0.77), U-MILt (r = 0.71), and U-EDBCSA (r = 0.74). U-EDBt and U-MILt 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.
- CSA, cross-sectional area
- EDB, digitorum brevis muscle
- MIL, muscle of the first interstitium
- MNCV, motor conduction velocity
- MRI, magnetic resonance imaging
- NIS, neurological impairment scale
- SNCV, sensory nerve conduction velocity
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 23 August 2007. DOI: 10.2337/dc07-0108.
Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-0108.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted August 17, 2007.
- Received January 25, 2007.
- DIABETES CARE
