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Understanding the Link Between Type 2 Diabetes and Achilles Tendinopathy
Abstract   Peer reviewed

Understanding the Link Between Type 2 Diabetes and Achilles Tendinopathy

Timothy Fleagle, Zahra Amerian, Micah Wong, Laura Frey Law, Mary Hastings and Ruth Chimenti
The journal of pain, Vol.41(Supplement), 105986
03/2026
DOI: 10.1016/j.jpain.2025.105986

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Abstract

Achilles tendinopathy is a common musculoskeletal pain condition which is characterized by pain during movement, reduced function and decreased quality of life. For individuals living with type 2 diabetes mellitus (T2DM) the odds of developing Achilles tendinopathy are increased three times. However, the biologic drivers of this increased risk of Achilles tendinopathy remain unknown. The objective of this study was to assess the relationship between T2DM (glycemic control) and Achilles tendinopathy symptoms (pain and disability) and tendon pathology (structure, stiffness). 16 individuals with Achilles tendinopathy with T2DM (n=12) and without T2DM (n=4) participated in a cross-sectional study (56% Female, 75% T2DM, Age: 58.1(9.4) years, BMI: 34.4(8.8) kg/m2). Hemoglobin A1c (HbA1c) was measured to quantify glycemic control. Achilles tendinopathy pain was assessed during single leg heel raises and disability was self-reported using the Victorian Institute of Sport Assessment - Achilles (VISA-A). Quantitative ultrasound imaging was used to measure tendon structure (e.g., thickness) and stiffness (e.g., shear wave speed). In these preliminary results of an ongoing study higher HbA1c was associated with higher pain during a single leg heel raise (Pearson r (95% CI), r=0.52 (0.03 to 0.80) and with lower VISA-A scores (r=-0.50(-0.01 to -0.86)). HbA1c was not associated with tendon thickness (r=-0.17(-0.35 to 0.61) or shear wave speed (r=-0.16(-0.61 to 0.35)). Our preliminary findings suggest that glycemic control influences Achilles tendinopathy related pain and disability but not tendon structure or mechanical properties, suggesting a more complex systemic biologic driver between T2DM and Achilles tendinopathy symptoms and tendon pathology.

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