A 50-year-old man comes to the physician for a one-month history of swelling of his left foot. There is no history of trauma. He has a 20-year history of type II diabetes mellitus. Temperature is 98.6 F. Physical examination shows swelling of the left dorsal forefoot and no ulcerations. There is a small effusion over the ankle joint. Peripheral pulses are normal. There is no erythema, tenderness, or swelling of the leg. There is decreased touch, proprioception, and pain below the ankles bilaterally. X-ray of the ankle shows disruption and disorganization of the midtarsal and tarsometatarsal joints. Serum creatinine is 2.1 mg/dL (NR 0.7-1.2). Which of the following is the most likely explanation for these findings?
Arterial insufficiency
Buerger disease
Calcium pyrophosphate crystal deposition
Hypertrophic osteoarthropathy
Impaired joint sensation
Osteodystrophy
Venous insufficiency
