A 60-year-old man presents to the clinic with a 6-month history of progressive numbness and “burning” pain in both feet. He reports the sensation started in his toes and has gradually ascended to his ankles. The pain is worse at night and interferes with his sleep. He also notes feeling unsteady when walking in the dark. He denies back pain, leg weakness, or bowel/bladder incontinence. His medical history is significant for type 2 diabetes mellitus diagnosed 10 years ago and hypertension. His current medications include metformin 1000 mg twice daily and lisinopril 20 mg daily. He admits to missing doses occasionally. He smokes half a pack of cigarettes per day and drinks alcohol socially.

He is afebrile. His blood pressure is 148/92 mmHg with a heart rate of 78 bpm. His BMI is 32 kg/m². He appears well-nourished but anxious about his symptoms.