Pains in the feet and legs which is predominantly nocturnal and of a burning or shooting nature is very often due to a painful diabetic neuropathy (PDN). These symptoms may be present even in the absence of overt loss of sensation or objective signs of peripheral neuropathy.

If there is doubt, electrophysiological investigations sometimes help but these should not be performed routinely and in most cases a clinical diagnosis of PDN can be made and treatment started.

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