Painful Sensory Neuropathy

Abstract

A 67-year-old woman who had been in excellent health noticed the onset of burning pain in the left great toe two years before evaluation. The pain subsequently extended to involve both feet, from the toes to the heels, and was associated with numbness, tingling, and burning. The discomfort has become severe, is present throughout the day, and disrupts sleep. A physical examination reveals normal muscle strength, muscle-stretch reflexes, proprioception, and vibratory sensation; only pinprick sensation in the toes and feet is diminished. How should this patient be evaluated and treated?