Background: Sonographic evaluation of the Achilles tendon can reveal morphological changes associated with diabetes, potentially indicating diabetic musculoskeletal involvement and aiding early detection of tendon pathologies. Objective: To compare the sonographic thickness and cross-sectional area of the Achilles tendon between diabetic and non-diabetic individuals. Methodology: This case-control study was conducted at the University Ultrasound Clinic, Green Town, Lahore, Pakistan, over 7 months. A total of 60 diabetic and 66 non-diabetic patients aged 18-85 years were included through convenience sampling. Results: Among 126 participants, the mean left Achilles tendon cross-sectional area was 51.70 +22.81mm2 for diabetics and 49.37 +- 12.85mm2 for non-diabetics (P 5 0.004). The right Achilles tendon area was 51.34 +- 23.67mm2 for diabetics and 49.19 +- 14.09mm2 for non-diabetics (P 5 0.007). Thickness was also greater in diabetics, with left and right tendon measurements averaging 5.03mm compared to 4.25 and 4.21 mm, respectively, in non-diabetics (P < 0.01). Conclusion: The study demonstrates a significant increase in the Achilles tendon cross-sectional area and thickness in diabetic patients, suggesting a predisposition to tendinopathy. Males exhibited greater tendon dimensions than females, and both dimensions increased with age.  Kulcsszavak: Achilles tendon thickness, Achilles tendon cross sectional area, body mass index, case-control study, diabetes, sonography