A 52-Year-Old Woman Comes to the Physician Because of a 3-Month

A 52-year-old woman comes to the physician because of a 3-month history of pain and a burning sensation in both feet. She has hypertension, type 2 diabetes mellitus, and chronic knee pain. Current medications are enalapril, hydrochlorothiazide, metformin, sitagliptin, and tramadol. She does not smoke, drink alcohol, or use illicit drugs. Neurologic examination shows decreased sensation to pinprick, light touch, and vibration in both feet. Ankle reflexes are absent bilaterally. Romberg test is negative. This patient's neurological symptoms are most likely associated with which of the following features?

A) Endoneurial arteriole hyalinization
B) Endoneurial inflammatory infiltration
C) Mutation of a myelin protein gene
D) Nerve compression within an anatomic compartment
E) Poor signal transmission at the neuromuscular junction