A case of burning feet

CASE A man, aged 71 years, presented with a three-month history of new onset bilateral distal lower limb paraesthesia. He described a burning sensation on the plantar surface of his feet. It had begun to disrupt his sleep as it was worse at night. He did not have any weakness or gait disturbances. This was on a background of hypertension and osteoarthritis, adequately managed with amlodipine/valsartan and meloxicam. He consumed a balanced diet and denied any major changes to his lifestyle. Inspection of the lower limbs revealed no signs of peripheral vascular disease or infection. A lower limb neurological examination revealed impaired temperature sensation bilaterally below the ankles with normal sensation to proprioception, vibration and light touch. There were no neurological deficits in tone, power and reflexes.