Burning Foot Pain in a 68-Year-Old Man With Diabetes: Red Flag?

At 68 years old, Mr Thomas has osteoarthritis, hypertension, and a 10-year history of type 2 diabetes mellitus (T2DM). He presents to your office complaining of limited exercise tolerance. When questioned further, he reports that he is limited mostly by pain in his right foot, which he describes as a burning sensation that improves when he rests. His medications include aspirin, rosuvastatin, hydrochlorothaizide, lisinopril, diclofenac, and metformin. Cardiac examination demonstrates a regular rhythm with a II/VI midsystolic murmur heard best at the left sternal border. ECG today demonstrates normal sinus rhythm. His last urine microalbumin was 2 years ago and demonstrated no proteinuria.
 

Which of the following is/are appropriate to order at this time (select all that apply):

A. Urine microalbumin

B. ECG-treadmill stress test

C. Ankle-brachial Index

D. Transthoracic echocardiogram

E. CT angiography and coronary calcium score

F. Referral to a podiatrist for comprehensive examination

Please leave your answers/comments below.

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