Review Question - QID 210679

A 75-year-old man presents to his primary care physician for foot pain. He has had chronic foot pain, which has finally caused him to come and see the doctor. The patient's medical history is unknown and he has not seen a doctor in over 50 years. The patient has led a healthy lifestyle, consumes a plant-based diet, exercises regularly, and avoids smoking. The patient lives alone as his wife died recently. His temperature is 98.1°F (36.7°C), blood pressure is 128/64 mmHg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. The patient's BMI is 19 kg/m^2 and he appears healthy. Physical exam demonstrates a right foot that is diffusely swollen, mildly tender, and deformed. The patient's gait is abnormal and seems off balance. Which of the following is associated with the underlying cause of this patient's presentation?