Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Diabetic peripheral neuropathy is nerve damage from prolonged hyperglycaemia, causing burning, tingling, numbness, or loss of protective sensation in the feet. It will not reverse without addressing glucose control. Daily foot checks, proper footwear, and annual monofilament testing prevent ulceration.
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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Charcot neuroarthropathy — a devastating progressive destruction of foot and ankle bones and joints driven by neuropathic loss of protective sensation — is a medical and surgical emergency when first presenting in the acute inflammatory phase. The window for preventing irreversible structural collapse is the first 6–12 weeks of the acute Charcot process; failure to recognize acute Charcot and initiate offloading results in midfoot or hindfoot collapse, a rocker-bottom deformity, and chronic ulceration that may ultimately require amputation.
Acute Phase Recognition — The Emergency
The acute Charcot foot presents with a dramatic unilateral increase in foot warmth, erythema, and swelling — often without pain (the neuropathy prevents pain sensation). The critical diagnostic challenge: acute Charcot is frequently mistaken for cellulitis, deep vein thrombosis, or gout. The distinguishing feature is bilateral temperature comparison — the involved foot is typically 3–7°C warmer than the contralateral foot (infrared thermometer measurement is highly reliable). Laboratory studies: WBC and CRP may be mildly elevated in acute Charcot but are not as dramatically elevated as in osteomyelitis/septic arthritis. X-rays may be initially normal — MRI reveals bone marrow edema and early fragmentation before structural collapse is visible on plain X-ray. The moment acute Charcot is suspected, total non-weight-bearing must be initiated before waiting for imaging confirmation.
Offloading and Surgical Reconstruction
Total contact casting (TCC): the definitive acute-phase treatment — complete non-weight-bearing TCC changed weekly (wound check, temperature monitoring) until the foot temperature normalizes to within 1°C of the contralateral foot (typically 3–6 months). Bisphosphonates (IV pamidronate or oral alendronate) during the acute phase may accelerate consolidation by inhibiting osteoclastic bone resorption — Level II evidence. Surgical reconstruction: indicated for unstable deformity that cannot be managed with accommodative bracing after consolidation — superconstructs (internal fixation using stronger than normal hardware to compensate for poor bone quality) using intramedullary beams, locked plating, and external fixation. Reconstruction is performed only during the quiescent phase (after temperature normalization) to reduce the risk of hardware failure. Dr. Biernacki at Balance Foot & Ankle performs urgent evaluation of acute Charcot foot with bilateral infrared thermometry and initiates emergency offloading to prevent deformity. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
When to See a Podiatrist
Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:
- Pain that persists for more than 2 weeks despite rest
- Swelling, redness, or warmth that isn’t improving
- Numbness, tingling, or burning in the feet
- A wound or sore that is not healing within 2 weeks
- Any foot concern if you have diabetes or poor circulation
- Nail changes that suggest fungal infection or other problems
At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.
Related Conditions & Resources
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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.
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Charcot Foot Treatment in Michigan
Charcot neuroarthropathy is a devastating complication of diabetic neuropathy that can destroy the foot’s bone structure. Our podiatrists provide early diagnosis, acute offloading with total contact casting, and surgical reconstruction when needed to prevent amputation.
Learn About Diabetic Foot Care | Book Your Appointment | Call (810) 206-1402
Clinical References
- Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care. 2011;34(9):2123-2129.
- Jeffcoate WJ, Game FL, Cavanagh PR. The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet. 2005;366(9502):2058-2061.
- Pinzur MS, Lio T, Posner M. Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast. Foot Ankle Int. 2006;27(5):324-329.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentIn-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
Differential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Diabetic Neuropathy and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Tarsal tunnel syndrome. Burning radiating into the arch with positive Tinel’s at the medial ankle.
- Peripheral artery disease. Pain with walking that resolves with rest, weak pulses, hair loss on toes.
- Lumbar radiculopathy. Symptoms following a dermatome, often with back pain — MRI of spine, not foot.
If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
In Our Clinic
Diabetic neuropathy patients in our clinic often don’t realize they have it until we put a 10-gram Semmes-Weinstein monofilament to the plantar foot and they can’t feel it. Many arrive for an unrelated concern — an ingrown toenail, a callus — and we catch the neuropathy on screening. The conversation then shifts: we need to discuss daily foot inspections, appropriate footwear, the urgency of any blister or open area, and the timing of vascular referral if pulses are diminished. Comprehensive diabetic foot exams are covered by Medicare annually. If you have diabetes, we want to see you once a year even if nothing hurts.
Most Common Mistake We See
The most common mistake we see is: Stopping B-vitamin supplementation as soon as symptoms improve. Fix: maintain supplementation for 6-18 months alongside strict glucose control.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Sudden loss of sensation on one side
- Wound on the foot not felt by the patient
- One-sided symptoms (rule out compression)
- Back pain plus leg symptoms (possible radiculopathy)
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
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)