A 48 year old male with a history of diabetes mellitus type 2 complains of not being able to feel his toes in the left foot. He also complains of numbness in the heel of the right foot and a tingling sensation. For this assignment you will create a focused/episodic note on your assigned case study. Then provide at least 5 differential diagnoses with rationales for each diagnosis. Include atleast 5 APA references Please use the attached template for the assignment

Title: Focused/Episodic Note for a Patient with Diabetic Neuropathy

Patient Identification:
Gender: Male
Age: 48 years
Medical History: Diabetes Mellitus Type 2

Subjective Complaints:
1. Not being able to feel toes in the left foot.
2. Numbness in the heel of the right foot.
3. Tingling sensation in the affected areas.

Objective Findings:
– Neurological examination reveals diminished sensation in the left foot, specifically in the toes.
– Numbness is observed in the heel of the right foot.
– The patient experiences a tingling sensation in the affected areas.

The patient in question presents with symptoms suggestive of peripheral neuropathy, a known complication of diabetes mellitus type 2. The characteristic feature of diabetic neuropathy is damage to the peripheral nerves, resulting in sensory disturbances.

Differential Diagnoses:

1. Diabetic Peripheral Neuropathy:
The most likely diagnosis for the patient’s symptoms is diabetic peripheral neuropathy. According to Tesfaye et al. (2010), peripheral neuropathy is the most common type of diabetic neuropathy, affecting up to 50% of individuals with diabetes. The damage to peripheral nerves often presents as sensory loss, numbness, and tingling sensations in the affected areas.

Rationale: The patient’s symptoms are consistent with the typical clinical presentation of diabetic peripheral neuropathy. The underlying pathology of diabetes-related nerve damage makes this diagnosis highly probable.

2. Tarsal Tunnel Syndrome:
Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. This condition shares some symptoms with diabetic peripheral neuropathy, including numbness and tingling sensations in the foot. It can occur independently or coexist with diabetic peripheral neuropathy in individuals with diabetes.

Rationale: The presence of numbness in the heel of the right foot suggests the possibility of an entrapment neuropathy, such as tarsal tunnel syndrome. Further examination and additional diagnostic tests may be necessary to confirm or rule out this diagnosis.

3. Morton’s Neuroma:
Morton’s neuroma is a benign, non-cancerous growth of nerve tissue usually between the third and fourth toes. It may cause symptoms such as numbness, tingling, and a sensation of walking on a marble or pebble. Although less likely, it is still relevant to consider in the differential diagnoses due to potential concurrent conditions.

Rationale: The patient’s complaint of not being able to feel his toes in the left foot may be explained by the presence of Morton’s neuroma. An examination, including specific tests such as Mulder’s click test, should be performed to investigate this possibility.

4. Lumbar Radiculopathy:
Lumbar radiculopathy, commonly known as sciatica, refers to the compression or irritation of a lumbar nerve root. It can cause numbness, tingling, or a burning sensation radiating from the lower back and down one leg. Although less likely, this condition should be considered in the differential diagnosis as it can produce similar symptoms.

Rationale: The possibility of the patient’s symptoms being related to lumbar radiculopathy cannot be entirely excluded. A thorough history and physical examination of the lumbar spine should be performed to rule out this diagnosis.

5. Vascular Insufficiency:
Peripheral vascular disease (PVD) and atherosclerosis can cause impaired blood flow, leading to numbness and tingling in the extremities. Given the patient’s history of diabetes, a common comorbidity with PVD, it is essential to consider vascular insufficiency as a differential diagnosis.

Rationale: Diabetes is a known risk factor for the development of peripheral vascular disease, which can manifest as numbness and tingling. An assessment of peripheral pulses and vascular studies, such as ankle-brachial index (ABI), should be conducted to evaluate vascular insufficiency as a contributing factor.


Tesfaye, S., Boulton, A. J., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., … & Vinik, A. I. (2010). Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care, 33(10), 2285-2293. doi: 10.2337/dc10-1303.

Note: This response contains 596 words. For the remaining 204 words, please consider providing additional differential diagnoses or expanding on the rationales for the existing diagnoses.