Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus

Latifat Tunrayo Oduola-Owoo; Adekunle Ayokunle Adeyomoye; Olubukola Abeni Omidiji; Bukunmi Michael Idowu; Badmus Babatunde Oduola-Owoo; Ifedayo Adeola Odeniyi

doi:10.4103/jmu.jmu_13_23

Posterior Tibial Nerve Ultrasound Assessment of Peripheral Neuropathy in Adults with Type 2 Diabetes Mellitus

J Med Ultrasound. 2023 Aug 3;32(1):62-69. doi: 10.4103/jmu.jmu_13_23. eCollection 2024 Jan-Mar.

Authors

Latifat Tunrayo Oduola-Owoo¹, Adekunle Ayokunle Adeyomoye², Olubukola Abeni Omidiji², Bukunmi Michael Idowu³, Badmus Babatunde Oduola-Owoo⁴, Ifedayo Adeola Odeniyi⁵

Affiliations

¹ Department of Radiology, Federal Medical Centre, Lagos, Nigeria.
² Department of Radiation Biology, Radiotherapy and Radiodiagnosis, College of Medicine, University of Lagos, Lagos, Nigeria.
³ Department of Radiology, Union Diagnostics and Clinical Services PLC, Lagos, Nigeria.
⁴ Department of Obstetrics and Gynaecology, Federal Medical Centre, Lagos, Nigeria.
⁵ Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.

Abstract

Background: Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of type 2 diabetes mellitus (T2DM). Early detection and prompt institution of appropriate therapy could prevent undesirable outcomes such as paresthesia, pain, and amputation. Although the gold standard for diagnosing DPN is nerve conduction studies, high-resolution peripheral nerve ultrasonography may serve as a noninvasive and low-cost alternative for diagnosing and staging DPN. This study investigated the clinical utility of sonographic posterior tibial nerve cross-sectional area (PTN CSA) for diagnosing DPN in individuals with T2DM.

Methods: Eighty consecutive adults with T2DM and 80 age-/sex-matched controls were recruited. Clinical information was obtained, including symptoms, disease duration, Toronto clinical neuropathy score (TCNS), and biochemical parameters. The left PTN CSA at 1 cm, 3 cm, and 5 cm above the medial malleolus (MM) was measured with a high-frequency ultrasound transducer and compared to the detection of DPN using the TCNS.

Results: Based on the TCNS, 58 (72.5%) of the T2DM group had DPN. Of these, 14 (24.1%), 16 (27.6%), and 28 (48.3%) participants had mild, moderate, and severe DPN, respectively. All the mean PTN CSA (aggregate, 1 cm, 3 cm, and 5 cm above MM) of the participants with T2DM and DPN (T2DM-DPN) were significantly higher than those of T2DM without DPN (WDPN) and controls. All the PTN CSA increased significantly with increasing severity of DPN. The PTN CSA at 3 and 5 cm levels correlated weakly but significantly with fasting plasma glucose and glycated hemoglobin levels.

Conclusion: The PTN CSA is significantly larger in T2DM-DPN than in T2DM-WDPN and healthy controls. PTN ultrasonography can be an additional tool for screening DPN in patients with T2DM.

Keywords: Diabetes mellitus; neuropathy; posterior tibial nerve; ultrasonography.