Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
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When “Waiting It Out” Makes Things Worse
Not all foot conditions are self-limiting. Some progressively worsen — causing permanent deformity, joint destruction, or even life-threatening infection — when neglected. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we regularly see patients who’ve waited too long on conditions that had excellent treatment options in their early stages. Here are the five most important foot problems that require timely evaluation.
1. Posterior Tibial Tendon Dysfunction (PTTD) / Adult Flatfoot
PTTD is the progressive failure of the posterior tibial tendon — the main arch-supporting structure. It advances through four distinct stages, from tendon inflammation (Stage I, manageable with orthotics and PT) to rigid flatfoot with ankle involvement (Stage IV, requiring complex surgical reconstruction).
Why it gets worse: Every step you take without proper support accelerates tendon degeneration and ligamentous stretching. Stage I and II PTTD can often be managed without surgery. Stage III and IV almost always require significant surgical intervention. The difference between managing with an orthotic versus needing a triple arthrodesis (fusion of three foot joints) is determined by how quickly you seek evaluation.
Warning signs: Inner ankle pain, arch flattening that’s new or worsening, difficulty standing on tiptoe on one leg, heel drifting outward when standing.
2. Bunion Deformity
Bunions (hallux valgus) don’t reverse themselves. Without treatment, they progress — the big toe drifts farther toward (and eventually under) the second toe, the metatarsal head becomes more prominent, and secondary deformities develop in the lesser toes as space is compromised.
Why it gets worse: Every step in footwear reinforces the deforming forces on the MTP joint. The longer a bunion is untreated, the more the sesamoid bones beneath the joint drift out of position, the worse the X-ray alignment becomes, and the more complex the surgical correction required. An early-stage bunion corrected in one’s 30s typically requires a simpler procedure than a severe bunion with dislocation and claw toe changes in one’s 60s.
Warning signs: Visible bump at the big toe base that is growing, increasing angle between the big toe and second toe, difficulty fitting into shoes that previously fit.
3. Untreated Ankle Instability
Ankle sprains that repeatedly occur without appropriate rehabilitation lead to chronic ankle instability. Each additional sprain damages the ligaments further and — critically — damages the cartilage surface of the ankle joint, setting the stage for post-traumatic ankle arthritis.
Why it gets worse: Every unstable ankle event causes cumulative ligament laxity and osteochondral (cartilage and bone) injury inside the ankle joint. Studies show that up to 80% of patients with chronic ankle instability develop osteochondral lesions of the talus, and long-term instability is a major contributor to ankle arthritis. Surgical ligament reconstruction (Broström procedure) is highly effective — but it cannot reverse cartilage damage that’s already occurred.
Warning signs: History of multiple sprains on the same ankle, giving-way sensation with walking or during sports, ankle that “never felt quite right” after an injury.
4. Diabetic Foot Wounds (Any Open Sore)
In diabetic patients, any break in the skin of the foot is a potential cascade trigger — from wound to infection to osteomyelitis to amputation. Without prompt expert wound care, diabetic foot ulcers progress through Wagner stages with disturbing speed.
Why it gets worse: Diabetic impairs every mechanism the body uses to heal wounds: sensation (neuropathy prevents pain warning), circulation (PAD reduces healing oxygen), and immunity (hyperglycemia impairs white blood cells). A wound that would heal in days in a healthy person can become a bone infection within weeks in a diabetic patient. The statistics are sobering: 50% of diabetic foot infections result in amputation when inadequately treated.
Warning signs: Any open area, blister, or break in the skin of a diabetic foot — regardless of size or apparent severity.
5. Plantar Warts (Untreated)
Plantar warts are caused by human papillomavirus (HPV) infecting the plantar skin. Left untreated, they enlarge, multiply (form mosaic wart plaques), and become increasingly difficult to eradicate. A single wart treated early typically responds to first-line treatment in 1–2 sessions. Mosaic wart plaques covering much of the heel or ball of foot may require multiple treatment modalities over months.
Why it gets worse: HPV spreads autoinoculation — scratching a wart plants virus on adjacent skin, creating satellite lesions. Pressure-induced callus formation over warts makes topical penetration harder. The longer the virus establishes itself in the skin, the more treatment-resistant it becomes.
Warning signs: Painful plantar lesion that doesn’t resolve in 2–3 months, multiple small lesions appearing near the original, callus formation over a painful spot that doesn’t resolve with pumice stone treatment.
The Common Thread: Earlier Is Better
All five of these conditions share a critical characteristic — earlier treatment is dramatically more effective and less invasive than later treatment. The temptation to “wait and see” is understandable, but for PTTD, bunions, ankle instability, diabetic wounds, and plantar warts, waiting has real costs. If you’re experiencing any of the warning signs above, schedule an evaluation at Balance Foot & Ankle. Early diagnosis means simpler, less expensive, and more effective treatment.
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Balance Foot & Ankle — Howell & Bloomfield Township, MI
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Howell, MI 48843
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When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)