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Plantar fascia thickness, measured by ultrasound, is an independent predictor of future microvascular complications in adolescents with type 1 diabetes, an Australian research team reports in the June issue of Diabetes Care.

Plantar fascia thickness, measured by ultrasound, is an independent predictor of future microvascular complications in adolescents with type 1 diabetes, an Australian research team reports in the June issue of Diabetes Care.

"In patients with diabetes, hyperglycemia-mediated synthesis of new collagen and accumulation of glycation products accelerate age-related changes to the skin, connective tissue, and joints," explain Dr. Maria E. Craig at the Children's Hospital at Westmead, Sydney, and colleagues. Such changes include decreased elasticity, increased collagen cross-linking, and loss of enzymatic digestibility of the extracellular matrix.

The researchers point out that direct measurement of collagen glycation requires skin biopsy, which limits its use in the clinical setting. Because the plantar fascia is often thickened in diabetics, is rich in collagen and susceptible to damage from chronic hyperglycemia and oxidative stress, Dr. Craig's group hypothesized that ultrasound measurement of plantar fascia thickness could provide a noninvasive indicator of microvascular disease.

They tested their theory in a prospective, longitudinal study of adolescents and young adults conducted between 1997 and 2006. The study cohort included 344 patients, median age 15.1 years at first assessment, with type 1 diabetes for a median duration of 8.5 years.

Plantar fascia thickness (PFT) was measured by placing the ultrasound transducer longitudinally over the center of the arch at least 3 cm from the calcaneus insertion of the plantar aponeurosis. An abnormal PFT was defined as plantar aponeurosis thickness > 1.7 mm.

During a median follow-up of 3.2 years, abnormal PFT at baseline was significantly associated with the subsequent development of retinopathy on seven-field fundal photography (odds ratio 2.37, p = 0.03), and early elevation of albumin excretion rate > 5 µg/min (OR 2.24, p = 0.02).

Abnormal PFT was also associated with peripheral nerve abnormality (OR 2.30, p = 0.01), cardiac autonomic nerve abnormality (OR 4.93, p = 0.02), and a small resting pupil diameter (OR 4.94, p < 0.001).

The elevated risk associated with PFT measured by ultrasound "remained significant after adjusting for A1C and other variables (including diabetes duration, sex, and BMI)," Dr. Craig and colleagues report. "These findings suggest that glycation and oxidation of collagen in soft tissues may be independent risk factors for microvascular complications."