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Unilateral pain in diabetic patient

Discussion in 'Diabetic Foot & Wound Management' started by footplant, Feb 10, 2016.

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  1. footplant

    footplant Active Member


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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
     
  2. Ian Drakard

    Ian Drakard Active Member

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

    footplant Active Member

    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
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
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    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
     
  5. manofleisure666

    manofleisure666 Welcome New Poster

    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?
     
  6. footplant

    footplant Active Member

    Hi,

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

    Josh
     
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