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

Dear Editor, In the January–March 2024 issue of the fabulous Journal of Medical Ultrasound, Oduola-Owoo et al.1 reported that the ultrasonographic left posterior tibial nerve (TN) cross-sectional area (PTNCSA) was significantly larger among Type 2 diabetes mellitus (T2DM) patients with diabetic peripheral neuropathy (DPN) than T2DM patients without DPN and healthy controls. It revealed the greatest sensitivity for detecting DPN at 5 cm proximal to the medial malleolus. The PTNCSA was associated with the DPN severity. They recommended PTN ultrasonography as a further tool for screening and monitoring DPN in T2DM patients. We believe that the clinical applicability of that recommendation in practice is debatable. This is based on the fact that DPN might be asymmetrical.2 Moreover, anatomical variations of the TN at the ankle are often encountered, and the TN variation in its branching point and cross-sectional area at the ankle is commonly correlated with certain clinical conditions such as foot neuropathy and pain.3,4 Therefore, relying solely upon the left PTNCSA ultrasonography might miss a significant number of DPN patients and delay instituting proper therapy. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.