Question of the Week # 60

A middle aged man presents with a history of foot pain on walking for a few weeks. The patient has a history of long standing diabetes mellitus for more than 15 years. He has been on Metformin and Glyburide combination. His HGBA1C that was obtained 3 months ago revealed inadequate control  at 9%. He reports pain and swelling in his right foot for about one month.  On examination the foot is swollen & tender to touch. Neurlogical examination reveals loss of vibratory sensation and position sensation in bilateral feet. There is also impaired light touch until the level of knees bilaterally. Joint motion at the level of ankle is within normal limits. Complete blood count , creatinine and ESR are with in normal limits. Most likely working diagnosis for his right foot pain  is :

a)      Chronic  Gout

b)       Septic arthritis

c)        Peripheral Neuropathy

d)       Charcot arthropathy

e)       Reflex Sympathetic Dystrophy

3 Responses

  1. E

  2. D..

  3. D

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