Rationale of the Week | Thick calluses coupled with leg pain?

Our August 24th Question of the week quizzed test takers on thick calluses coupled with leg pain. 61% of respondents chose the correct answer. We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR has lived with type 1 diabetes for over twenty years. JR arrived in the clinic with thick calluses on both feet and complaints of calf pain when walking for more than 10 minutes. JR’s pulses are difficult to palpate.

What diagnosis best matches JR’s presentation?

Answer Choices:

  1. Peripheral polyneuropathy.
  2. Diabetes venous stasis syndrome.
  3. Peripheral arterial disease.
  4. Charcot foot.

As shown above, the most common choice was option 3, the second most common answer was option 1, then option 2, and finally option 4.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer. If you want to learn more about lower extremities, we invite you to join our Virtual Course or check out our Level 2 Online Courses.

Answer 1 is incorrect. 15.33% chose this answer, “Peripheral polyneuropathy.” This juicy answer is tempting, however it does not match the symptoms detailed by JR. A person with peripheral polyneuropathy will typically complain of numbness, tingling and leg pain at night. They may also have thick calluses. However, there are two clues that indicate a mismatch between question and answer. JR is “complaining of calf pain when walking for more than 10 minutes with difficulty locating pulses.” These chief complaints indicate a different pathology. Keep reading to find out more.

Answer 2 is incorrect. 14.50% of you chose this answer, “Diabetes venous stasis syndrome.” This is another juicy answer with a made up condition that is designed to sound familiar. In general, with venous disease, pulses are still palpable since there is adequate blood flow to lower extremities. There are two clues that indicate a mismatch between question and answer. “JR is complaining of calf pain when walking for more than 10 minutes with difficulty locating pulses.” These chief complaints indicate a different pathology. Keep reading to find out more.

Answer 3 is correct. 60.64% of respondents chose this answer, “Peripheral arterial disease.” YES, this is the BEST answer. Great job. JR is exhibiting the classic signs of inadequate arterial blood flow to the lower extremities, or peripheral arterial disease. JR’s complaints of “calf pain when walking for more than 10 minutes with difficulty locating pulses” indicate poor arterial circulation and warrant referral to a provider for complete CV risk assessment.

Finally, Answer 4 is incorrect. 9.53% chose this answer, “Charcot foot.” This answer is tempting. Charcot foot is characterized by severe foot inflammation and structural collapse. Since JR is “complaining of calf pain when walking for more than 10 minutes with difficulty locating pulses”, these symptoms do not match the usual complaints associated with Charcot foot. Good try, see answer 3 for more info.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!


Want to learn more about this question and more?

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Team of expert faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

CEs: Includes over 30 CEs
Program Info: 2021 Diabetes Educator Course Flyer & Schedule (subject to change)
Speakers: View Conference Faculty.
Dates: October 6-8. Don’t worry if you can’t make it live, your registration fee includes access to FREE podcast and all recorded webinars for one year.

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2021 Diabetes Educator Course Flyer & Schedule (subject to change)


Virtual DiabetesEd Specialist Conference Basic | Oct. 6-8 | 30+ CEs

Basic virtual program for $399 includes:

  • Presentations by our team of experts
  • Q & A Session with the instructor after each webinar
  • State-of-the-art review of current diabetes care and technology.
  • Resources for each session
  • Access to FREE podcast and recorded webinars within a week of each live session for one full year.

2021 Diabetes Educator Course Flyer & Schedule (subject to change)


Team of Experts: Our team of expert faculty has been fine-tuning this course for over fifteen years and we know what you need to succeed! In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!


Bonus Courses worth 12 + CEs, FREE

When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!

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  • Level 2 – Setting up a Successful Diabetes Program 1.5 CEs
  • Level 2 – Pregnancy and Diabetes 1.5 CEs
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