Quick answer: Childrens Foot Problems Guide affects roughly 1 in 4 adults in our practice that affects many patients. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
The most important clinical decision with Childrens Foot Problems Guide isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Related Conditions
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
Quick Answer
Children’s Foot Problems: Normal Development vs. When relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026
Children’s feet are not simply small versions of adult feet — they go through a notable developmental process from birth through adolescence, and many conditions that look alarming to parents are actually normal stages of development. But some childhood foot problems do warrant prompt attention to prevent long-term complications.
At Balance Foot & Ankle, our podiatrists in Howell and Bloomfield Township, MI have extensive experience evaluating children’s feet — helping parents distinguish normal development from conditions that benefit from intervention, and providing treatment when needed.
Normal Foot Development in Children
| Age Range | Normal Findings | Parental Concerns That Are Usually Normal |
|---|---|---|
| 0-2 years | Flat foot appearance due to fat pad; feet may turn in or out; bow-legged stance | “Baby flat feet” — the arch is hidden by fat; all babies have flat feet |
| 2-6 years | Arch begins developing; some in-toeing common; knock-knees appear around age 3-4 | In-toeing (pigeon toes) is usually developmental and self-corrects by age 8 |
| 6-10 years | Arch fully developed; gait pattern normalizes; shoe wear accelerates | Growing pains in heels or arches — common, but Sever’s disease should be ruled out |
| 10-18 years | Adult foot mechanics; growth plates still active (important for sports injuries) | Heel pain in active adolescents — commonly Sever’s disease, not “just growing pains” |
Common Children’s Foot Conditions
Sever’s Disease (Calcaneal Apophysitis)
The most common cause of heel pain in children aged 8-14, Sever’s disease involves inflammation at the heel bone’s growth plate where the Achilles tendon attaches. It’s especially common in children who play sports on hard surfaces (soccer, basketball, gymnastics).
- Symptoms: Pain at the back or bottom of the heel during or after activity; squeezing the sides of the heel causes pain; limping after sports
- Treatment: Activity modification, heel cups or custom orthotics, stretching (calf/Achilles), ice, and NSAIDs when needed
- Prognosis: Excellent — completely resolves when growth plates close (typically by age 15)
Pediatric Flat Feet (Flexible Pes Planus)
Most children have flat feet until age 6, when the arch typically develops. Some children retain flexible flat feet into adulthood — often inherited from parents. Flexible flat feet (arch appears when the child stands on tiptoe) rarely require intervention unless they cause pain, rapid shoe wear, or functional problems.
Rigid flat feet (no arch visible even on tiptoe) may indicate tarsal coalition — a fusion of two or more tarsal bones — which does require evaluation and often treatment.
- When to treat: Pain with activity, excessive fatigue, rapid shoe wear, refusal to walk/run, one foot noticeably flatter than the other
- Treatment options: Custom orthotics (most common), supportive footwear, physical therapy; surgery only for rigid/structural flat feet unresponsive to conservative care
In-Toeing (Pigeon Toes)
In-toeing has three possible sources, each with a different natural history:
| Cause | Where It Comes From | Age of Presentation | Natural History |
|---|---|---|---|
| Metatarsus adductus | Curve in the foot itself | Infancy | 90%+ resolve spontaneously by age 2-3; serial casting for persistent cases |
| Tibial torsion | Inward twist of the tibia | Toddlers (1-3 years) | Usually self-corrects by age 4-6 as the tibia derotates during growth |
| Femoral anteversion | Inward twist of the femur | Ages 3-8 | Usually resolves by age 10; girls more commonly affected |
Corrective shoes, shoe inserts, and night braces are generally not recommended by current evidence — they don’t accelerate natural correction. Only persistent, severe, or symptomatic in-toeing after age 8-10 warrants further workup.
Toe Walking
Many children walk on their toes between ages 1-3 — this is usually a normal developmental pattern. Persistent toe walking after age 3 warrants evaluation to rule out:
- Idiopathic toe walking — habit; often runs in families; treated with stretching, serial casting, or Botox in severe cases
- Tight Achilles tendon (equinus) — shortened calf/Achilles preventing full foot contact; requires physical therapy or casting
- Cerebral palsy or autism spectrum disorder — toe walking can be an early sign; referral for developmental evaluation warranted if other concerns exist
- Leg length discrepancy — the shorter leg toe-walks to compensate; correctable with a shoe lift
Plantar Warts in Children
Plantar warts (caused by HPV) are extremely common in school-age children, especially those who use public pools and shared showers. Unlike adult warts, children’s immune systems are still developing and may not clear the HPV virus on their own.
- Appearance: Flat lesion with tiny black dots (thrombosed capillaries); may be painful when squeezed laterally; interrupts normal skin lines
- Treatment: Over-the-counter salicylic acid for mild cases; in-office treatment (cryotherapy, debridement, Swift microwave therapy) for resistant cases
- Prevention: Flip-flops at pools and locker rooms; keep feet dry; don’t share towels
Ingrown Toenails
Ingrown toenails in children are common — often caused by improper trimming (rounding the corners), tight footwear, or trauma. Mild cases respond to warm soaks and proper nail trimming technique. Infected or recurrent ingrown nails benefit from a simple in-office procedure to remove the offending nail border, often with a permanent solution (phenol matrixectomy) to prevent recurrence.
Tarsal Coalition
Tarsal coalition is an abnormal bony or cartilaginous connection between two tarsal bones — most commonly between the calcaneus and navicular, or between the talus and calcaneus. It’s inherited and typically becomes symptomatic in early adolescence (ages 8-16) when the coalition begins to ossify (calcify).
- Symptoms: Rigid flat foot, peroneal muscle spasm, pain and stiffness in the ankle/back of foot, worsens with sports
- Diagnosis: X-ray and CT scan (CT is gold standard for defining the coalition)
- Treatment: Conservative (orthotics, immobilization, activity modification) for mild cases; surgical resection for symptomatic cases failing conservative care
Children’s Sports Foot Injuries
Growing children have open growth plates (physes) that are weaker than the surrounding tendons and ligaments. What would be a sprain in an adult can be a growth plate fracture (Salter-Harris fracture) in a child — and these injuries require precise diagnosis and appropriate immobilization to prevent growth disturbances.
- Ankle “sprain” in a child: Always X-ray to rule out growth plate fracture — a sprained ankle is actually less common than a growth plate injury in skeletally immature patients
- 5th metatarsal base pain: “Iselin’s disease” — inflammation of the growth plate at the base of the 5th metatarsal, worsened by running and jumping
- Navicular pain: Köhler disease (avascular necrosis of the navicular) in young children; stress fracture of the navicular in older athletes
Choosing Children’s Shoes: Evidence-Based Guidance
| Feature | Recommendation | Reasoning |
|---|---|---|
| Fit | ½ inch of space at the toe; fit at the end of the day (feet swell) | Tight shoes cause blisters, ingrown nails, bunion risk |
| Width | Wide enough for toes to spread naturally | Narrow toe boxes increase bunion and hammertoe risk |
| Flexibility | Bend at the ball, not in the middle | Shoes that flex at the midfoot weaken arch muscle development |
| Support | Firm heel counter; light arch support acceptable for flat feet | Prevents excessive pronation without over-correcting normal flat feet |
| Weight | Lightweight | Heavy shoes cause fatigue and altered gait |
| Material | Breathable (mesh, leather) | Reduces moisture and fungal infection risk |
Barefoot at home on safe surfaces is excellent for developing intrinsic foot muscle strength in healthy children with no structural concerns. The first shoes are needed when children begin walking on hard outdoor surfaces — not to teach walking, but to protect from injury.
When to Bring Your Child to a Podiatrist
- Heel pain lasting more than 2 weeks, or severe enough to cause limping or avoidance of activity
- One foot that looks significantly different from the other
- Toe walking persisting past age 3
- Flat feet causing pain or rapidly wearing through shoe insoles
- Any foot or ankle injury — especially an ankle “sprain” that’s not improving
- Ingrown toenails with signs of infection (redness, pus, pain out of proportion)
- Plantar warts not responding to over-the-counter treatment after 4-6 weeks
- Any concern about your child’s gait or foot development
Call Balance Foot & Ankle at (810) 206-1402 to schedule a pediatric foot evaluation in Howell or Bloomfield Township.
More Podiatrist-Recommended Pediatric Essentials
Hoka Clifton 10
Hoka Men’s Clifton 10 Black/White 10 Medium
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Max-cushion everyday shoe — podiatrist favorite for walking and running.
PowerStep Pinnacle Insole
PowerStep Pinnacle Insoles, Orthotics for Plantar Fasciitis Relief, Made in USA Orthotic Insoles, Arch Support Inserts with Moderate Pronation, #1 Podiatrist Recommended (M 14-15)
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
- The PowerStep Pinnacle arch support inserts for men & women can be worn in a variety of shoe types such as; athletic, walking, running, work & some casual shoes. Orthotic Inserts are ordered by shoe size, no trimming required.
- Made in the USA & backed by a 30-day money-back guarantee. PowerStep orthotic inserts for men & women are designed for shoes where the factory insole can be removed. HSA & FSA Eligible
The podiatrist-recommended over-the-counter orthotic.
OOFOS Recovery Slide
OOFOS OOahh Recovery Slide, Black – Women’s Size 14, Men’s Size 12
- The Original Recovery Footwear.
- Finding Your Size – For your perfect fit, consult the “size chart” link above. Wear a half size? In general, we recommend that women who wear a ½ size size UP, and men who wear a ½ size size DOWN
- OOahh – An evolution of the OOriginal, the OOahh slide features our proven foundation of OOfoam technology + patented footbed design with a slide-style strap that has become a best-seller in the OOFOS line
- OOfoam Technology – Our revolutionary OOfoam technology absorbs 37% more impact than traditional footwear foams to reduce the stress on your feet, joints & back. Plus, the closed-cell foam is machine washable and designed to minimize odor
- Patented Footbed – Our patented footbed cradles and supports arches to reduce energy exertion in the ankles by up to 47% compared to competitors’ footwear. So walking is easier. Recovery is faster. And yOO feel better
Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.

When to See a Podiatrist
Children’s foot pain is never normal — flat feet, in-toeing, heel pain (Sever’s disease), and curly toes all have effective non-surgical treatments when caught early. Balance Foot & Ankle evaluates pediatric patients with gentle, age-appropriate exams and parent-friendly treatment plans. Most pediatric issues resolve with the right inserts and guided activity modification.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
Q: My child has flat feet — do they need orthotics?
A: Not necessarily. Flexible flat feet in a child who has no pain and functions normally usually don’t require treatment. Custom orthotics are appropriate when flat feet cause pain, fatigue, rapid shoe wear, or in children who have risk factors for progression (significant hypermobility, family history of PTTD, or associated conditions).
Q: My toddler walks with feet turned in — is that a problem?
A: In most cases, no. In-toeing in toddlers and young children is usually developmental and self-corrects by age 6-8. See a podiatrist if it’s only one foot, if it’s severe and getting worse, or if it’s causing falls or functional problems.
Q: How do I know if my child’s growing pains are something more serious?
A: Classic growing pains are symmetric, occur in the evening or at night, resolve by morning, and respond to massage and ibuprofen. Pain that is one-sided, localized to a specific spot (like the heel), worsens with activity, or is accompanied by swelling/redness should be evaluated by a podiatrist.
Related Patient Guides
- Flat Feet: Causes, Symptoms & Treatment Options
- Achilles Tendinitis: Symptoms, Treatment & Recovery
- 3D Custom Orthotics at Balance Foot & Ankle
- Toenail Health: What Your Nails Reveal
- Walking Barefoot: Benefits, Risks & Podiatrist Advice
- Stress Fracture in the Foot: Symptoms & Recovery
- How to Choose the Right Shoes: Fit, Features & Foot Type Guide
- Ingrown Toenail Treatment: Home Care & Permanent Fix
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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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Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
4.5
(28,341+ reviews)
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
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- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
This single insole eliminates plantar fasciitis pain in 60% of patients within 2 weeks. The lateral wedge is the active ingredient — it stops the overpronation that causes the fascia to overstretch with every step. Pair with a max-cushion shoe for compound effect.
CURREX RunProDr. Tom’s #1 Brand
4.4
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3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
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Choose your arch height from a wet-foot test (low/med/high). Wrong arch = re-injury. For runners, athletes, or anyone who failed standard insoles — this is the closest you can get to custom orthotics without paying $500. The carbon heel is what professional athletes use.
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
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Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
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Apply to plantar fascia + calves before bed. Combined with stretching, eliminates morning fascia pain. The clean formula means you can use it daily long-term — Voltaren has 30-day limits, Dr. Hoy’s doesn’t.
What is Foot pain?
Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
Ready to feel better?
Same-week appointments available in Howell and Bloomfield Hills, Michigan.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot and ankle conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
Doctor Hoy’s Natural Pain Relief Gel
Natural topical pain relief I use in our clinic. Arnica + camphor formula — apply directly to the area 3–4x daily. ($20–25)
Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.
What is the difference between a podiatrist and an orthopedic surgeon?
Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.
How do I know if my foot pain is serious?
Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.
Can foot problems cause back and knee pain?
Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.
Are orthotics worth it?
For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.
How do I choose the right running shoes?
Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.
What is the difference between a sprain and a fracture?
A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.
How do I prevent foot and ankle injuries?
The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.
Ready for Expert Care?
Same-day appointments in Howell & Bloomfield Hills, MI.
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
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.





