A 62-year male with H/o hypertension and type 2 diabetes mellitus for 15 years visited Laser Clinic. On initial examination, B.P was 170/88 mmHg, BMI 31.1, FBS was 181mg/dl, and PPBS was found to be 198 mg/dl. The ankle-brachial index (ABI) test suggested mild arterial disorder with the value of 0.82. The tests for diabetic peripheral neuropathy indicated severe symmetrical polyneuropathy.
Motor neuropathy was revealed with frequent episodes of slipping of slippers while walking. Clinically, manual muscle testing for extensor hallucis longus suggested poor strength. Autonomic neuropathy was confirmed with dryness and discolouration of skin and nail pathology. The patient experienced pain and burning sensations in the plantar and dorsum aspect of the foot. The reduced sense was reported in 1/3 lower limb bilaterally. Frequent sleep disturbance was reported due to itching at night. Discolouration of the foot could be seen extending to the anterior shin. Reddish patches on the anterior thigh and scratches with a superficial wound around the knee was found, as shown in the figure.
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