A 62-year-old woman comes to the office due to tingling and nu | Uworld | Step 1

A 62-year-old woman comes to the office due to tingling and numbness in her feet over the last several months. The patient has also noticed a small ulcer on her right foot that "doesn't seem to be healing." Medical history is significant for long-term diabetes, hypertension, and gout. Physical examination shows decreased pain sensation over both feet and bilateral absence of ankle reflexes.