The Diagnostic Value of Measurement of Achilles Tendon Thickness by Skin Fold Caliper for Descrimination of Familial Hypercholesterolemia and Non-Familial Hypercholesterolemia

Abstract

Achilles tendon xanthoma is an early clinical feature of familial hypercholesterolemia. The radiographic measurement of achilles tendon thickness provides a method for the detection of achilles tendon xanthoma. In routine examination, however, achilles tendon xanthoma can be detected by inspection or palpation without radiographic examination in the majority of cases.
To assess the diagnostic value of examination of achilles tendon thickness by palpation rather than radiographic examination, we measured achilles tendon thickness of 36 familial hypercholesterolemias (FH), 27 normolipidemic subjects, 8 mixed hyperlipidemic subjects, 12 non-FH hypercholesterolemic subjects, 11 hypertriglyceridemic subjects by skin fold caliper at the point of maximal thickning of achilles tendon.
The results were as follows.
1) Achilles tendon thickness measured by skin fold caliper (ATT) was thicker in FH (28.3±2mm) than in normolipidemic (22.5±2mm), mixed hyperlipidemic (22±1mm), non-FH hypercholesterolemic (20±1mm), hypertriglyceridemic (25±2mm) subjects.
2) In non-FH subjects, ATT was thicker in obese subjects (percent ideal weight≥120%) (25.3±4mm) than in non obese subjects (percent ideal weight<120%) (19.3±3mm).
A significant positive correlation was found between ATT and percent ideal weight in non-FH, but was not in FH.
3) A significant positive correlation was found between ATT and achilles tendon thickness measured by radiographycally in FH.
4) ATT/percent ideal weight ratio was higher in FH (0.26±0.05) than in normolipidemic (0.2±0.03), mixed hyperlipidemic (0.2±0.01), non-FH hypercholesterolemic (0.18±0.01), hypertriglyceridemic (0.2±0.01) subjects.
5) ATT/percent ideal weight ratio was found a significant positive correlation with cholesterol levels, but not with triglyceride levels.
From these data, it was concluded that the measurement of achilles tendon thickness by skin fold caliper seemed to be as useful as by radiographycally for descrimination of FH and non-FH.