Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
Background
A 60-year-old man presents with pain of recent onset in both feet. He initially thought that he might have cut his toenails too close to the skin, but the pain has persisted for over a month. He has intermittent joint pain in his hands; however, he has not received a diagnosis of arthritis. Occasionally, he takes over-the-counter nonsteroidal anti-inflammatory drugs for pain.
The patient works as an accountant with his parents and sister in the family company that his parents established. He says that he works long hours and is always trying to get additional business. He notes that sometimes the work can be stressful, but he does not want to make any changes because he enjoys being busy.
He has a family history of obesity and type 2 diabetes; however, he has never received a diagnosis of diabetes. Nevertheless, he is concerned that his symptoms could be caused by diabetic neuropathy, because his mother and brother both have this condition.
The patient has smoked since he was about 25 years old. Initially, he started smoking as a way to manage stress, and then he continued because he thought it might be an effective method of preventing weight gain and subsequent type 2 diabetes. He does not specifically pay attention to his dietary intake in terms of calories or nutrients.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Heidi Moawad. A Smoker With New-Onset Pain in Both Feet - Medscape - Mar 28, 2024.
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