Background: The Achilles tendon (AT) is the strongest, biggest, and thickest tendon .It is essential for foot biomechanics. It maintains the longitudinal arch throughout propulsion, absorbs mechanical shock, and prevents the arch from collapsing while landing. This study aimed to assess the utility of Shear Wave Elastography (SWE) in accurately diagnosing Achilles Tendinopathy in type 2 Diabetes Mellitus (T2DM) cases. Methods: This case-control study was conducted at the radiology department of Zagazig University hospitals from October 2023 to March 2024. It included 104 patients, 52 T2DM cases, and 52 non-diabetic controls.Sonographic examinations and shear wave examinations were performed using the ultrasonography device Toshiba Aplio 500, technique was the same in both examinations as the participants were asked to lie down in a prone position on an examination couch with their feet hanging,in shear wave examination, the transducer was carefully set on the AT with no manual pressure, and an adequate amount of coupling gel was applied. The tendon was evaluated in the sagittal plane by putting the probe longitudinally. Results: There was a substantial variance between AT shear wave velocity, AT echogenicity, and AT fibrillation pattern; the mean of AT shear wave velocity was higher among normal echogenicity and normal fibrillation pattern (P<0.001). There was a substantial variance between AT thickness, AT echogenicity, and AT fibrillation pattern, as the mean AT thickness was higher among hypoechogenicity and loss of fibrillation pattern (P<0.001). Conclusions: In Type 2 DM cases, the AT thickens and softens compared to normal participants, indicating that DM may predispose to Achilles Tendinopathy.Shear wave elastography is an effective method for evluating the stiffness of the Achilles tendon. This study revealed structural changes in the Achilles tendons that highly suggest biomechanical alterations. The duration of DM diagnosis significantly influences these changes. Further studies are needed to assess how clinical management affects the progression or regression of these degenerative changes. Keywords: Achilles Tendon; Diabetes Mellitus; Shear Wave Elastography.