A 60-year-old woman comes to the office due to 'balance proble | Surgery collections Videos and quizez 2021

A 60-year-old woman comes to the office due to "balance problems while walking." The patient has had 2 falls over the last 2 months associated with tingling in her feet and dull pains in her back and legs. Medical history is notable for type 2 diabetes mellitus; her most recent hemoglobin A1c was 7.6%. Neurological examination reveals decreased muscle strength in both legs, diminished proprioception peripherally in the feet, decreased pain sensation in the feet and ankles, a hyperactive right knee jerk, and an upgoing plantar reflex on the right side.