A 60 year old diabetic complains of pain in the thigh and gluteal region on exertion. What is the most appropriate diagnosis?

In this scenario, the most appropriate diagnosis for a 60-year-old diabetic patient experiencing pain in the thigh and gluteal region during exertion is atherosclerosis. This condition is characterized by the buildup of plaques in the arterial walls, leading to reduced blood flow, particularly during physical activity when the muscles require increased oxygen.

The patient's age, diabetes, and presentation of pain on exertion suggest intermittent claudication, a common symptom of peripheral artery disease (PAD) caused by atherosclerosis. In PAD, the narrowing of arteries can lead to muscle ischemia, which manifests as pain during exercise due to insufficient blood supply.

While conditions like thromboangitis obliterans (often related to smoking) and deep vein thrombosis (DVT) can cause leg pain, they typically have different clinical presentations and risk factors. Sciatica usually involves radicular pain due to nerve compression and would often be associated with neurological symptoms such as numbness or tingling rather than exertional pain directly related to activity.