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Hello,

I have a diabetic patient with unilateral foot pain, which is worse at night. No indication of charcot. He can't tolerate the pressure of bedsheets on it at night. His description sounds like it's neuropathy related, but my understanding was that painful diabetic neuropathy would be bilateral. Any thoughts on the main alternative diagnoses to consider? I'd thought of perhaps lumbar radiculopathy or tarsal tunnel syndrome.

Many thanks

Josh

 

Hi Josh. What's the distribution pattern on the foot?

 

Hi,

He was unable to be specific in the pain location, but the intolerable pressure from bed sheets affected dorsum of foot and toes (right side). I didn't mention that on sensory testing with 10g monofilament, he detected 1/5 plantar sites on right, and 5/5 on left.

Josh

 

It does sound like a typical diabetic painful neuropathy. Even though it is generally symmetric, it is not unusual for the initial symptoms to develop asymmetrically

 

Hi Josh
Is there pain when the dorsum of the foot and toes are palpated?
Any signs of vascular issues or pitting oedema in the foot?

 

Hi,

Symptoms weren't recreated by palpation. I don't think there are any signs of vasular issues and there is no oedema.

Josh