Numb

A 60 year old man presents with stabbing pains in all toes and both shins for several months.

He feels as if he is stepping on broken glass when walking, and experiences burning pains in both feet at night. Further questioning reveals the presence of erectile dysfunction.

He was diagnosed with type 2 diabetes 8 years ago, and is currently on maximum daily doses of oral Metformin and Glipizide.

Select Relevant Investigations
HbA1c

Performed

The HbA1c level is 9%
Monofilament test

Performed

Five sites are tested on each foot. Of these, 6 sites test negative.
Electrodiagnostic Studies

Performed

A length dependent sensorimotor axonal polyneuropathy is noted.
Sural Nerve biopsy

Performed

The nerve biopsy will be arranged next week.

Select Relevant Management
Gabapentin
Start Insulin
Tramadol
Sildenafil