Ultrasound Evaluations of Ankle and Foot Muscles in Diabetic Peripheral Neuropathy Systematic Review with Meta-Analysis

Background: Diabetic peripheral neuropathy (DPN) is the prevalent microvascular complication of diabetes mellitus (DM). 30-50% of diabetics are likely to be affected by DPN. It significantly impacts the skeletal muscles, resulting in an accelerated loss of muscle mass. The objective of this systematic review was to evaluate the ankle and foot muscle changes in diabetic peripheral neuropathy using ultrasound. Methods: A comprehensive search was conducted in Scopus, Embase, and PubMed databases, which yielded 64 studies, out of which 5 studies are included in this meta-analysis. Results: The meta-analysis shows that the thickness and cross-section area of the extensor digitorum brevis muscle are reduced in DPN as compared to the control group with p-value<0.004 and p-value<0.001, respectively. The thickness of MIL muscle was also smaller in DPN p-value=0.02. Similarly, the thickness and CSA of AH muscle are also reduced in DPN patients compared to the control group, with p-values of 0.21 and 0.14. Conclusion: Meta-analysis reveals that diabetic peripheral neuropathy (DPN) patients have reduced foot muscle thickness and cross-sectional area (CSA) compared to controls without neuropathy. This highlights the importance of ultrasound in detecting muscle atrophy early in diabetic patients since it provides objective measures beyond traditional screening with its real-time and non-invasive nature.