Ultrasonographic Evaluations of Tendons/Fascia in Lower Limb Lymphedema and Lipedema

OBJECTIVE: To evaluate ultrasonographic changes in lower extremity tendons and plantar fascia of patients with chronic edema and their relationship with edema volume, pain, function, and quality of life. DESIGN: This observational case-control study included 53 patients with chronic lower extremity edema and 55 age- and sex-matched controls. Ultrasonography assessed the Achilles, tibialis posterior, peroneal, and patellar tendons and plantar fascia. Edema volume was calculated from limb circumferences. Outcomes included the Lower Extremity Functional Scale (LEFS), Lymphedema Quality of Life Questionnaire-Leg (LYMQOL-Leg), and Visual Analogue Scale (VAS). RESULTS: All tendons (except the patellar tendon) and plantar fascia were thicker in the edema group than controls ( P <0.05). Differences in Achilles tendon and plantar fascia thickness remained significant after BMI adjustment (all P <0.01) and correlated positively with edema volume ( P <0.05). Plantar fasciitis (50.9%) and Achilles tendinopathy (22.6%) were more frequent in the edema group ( P <0.05). Patients had lower LEFS and higher LYMQOL-Leg and VAS scores (all P <0.01). CONCLUSION: Chronic lower extremity edema was associated with alterations in tendon and fascial morphology, particularly the Achilles tendon and plantar fascia. Musculoskeletal ultrasonography may complement clinical evaluation by providing information regarding tendon and fascial involvement.