ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1639270
This article is part of the Research TopicInnovative Therapeutic Strategies for Managing Diabetic Foot Ulcers and Mitigating Associated ComplicationsView all 7 articles
Assessment of Extensor Hallucis Brevis Stiffness and Microcirculation in Diabetes: Shear Wave Elastography and Contrast-Enhanced Ultrasound
Provisionally accepted
- 1Jinjiang Municipal Hospital, Quanzhou, China
- 2The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Background: Diabetic foot complications, driven by microvascular dysfunction, remain a leading cause of morbidity and amputations. Early detection of microcirculatory and biomechanical alterations in vulnerable muscles, such as the extensor hallucis brevis (EHB), may contribute to risk stratification. However, noninvasive tools for quantifying these changes are lacking.: This cross-sectional study enrolled 90 participants stratified into healthy controls, uncomplicated type 2 diabetes (T2DM), and T2DM with microvascular complications (MC). Shear wave elastography (SWE) measured EHB stiffness (mean Young's modulus, Emean), while contrastenhanced ultrasound (CEUS) assessed perfusion dynamics (transcapillary transit time [ΔAT], net enhancement intensity [ΔPI]). Diagnostic accuracy and reproducibility were evaluated via ROC analysis and intra-class correlation coefficients (ICC).Results: Emean increased progressively across groups (control: 11.88 kPa; T2DM: 15.78 kPa; T2DM+MC: 18.57 kPa; P < 0.01). T2DM+MC exhibited prolonged ΔAT (89.5 s vs. 50.5 s in controls) and reduced ΔPI (5.0 dB vs. 7.0 dB; P < 0.01). ROC analysis demonstrated high diagnostic accuracy for ΔAT (AUC = 0.970), Emean (AUC = 0.947), and ΔPI (AUC = 0.931) in detecting MC.Both SWE and CEUS showed excellent reproducibility (ICC > 0.80).SWE and CEUS provide robust, noninvasive biomarkers for early diabetic microvascular complications. The EHB's unique susceptibility to stiffness and perfusion deficits highlights its clinical value, which may facilitate diabetic foot risk assessment and guide timely interventions to mitigate ulceration and amputations.
Keywords: diabetes, skeletal muscle, Microcirculation, Elasticity, Ultrasound diagnosis
Received: 01 Jun 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Yan, Cai, Li, Huang, Guo, Lin and Lyu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guorong Lyu, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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