Diabetes creates a complex set of foot risks — peripheral neuropathy removes protective sensation, peripheral artery disease impairs healing, and immune dysfunction allows infections to spread rapidly. The result: diabetic patients account for 60–70% of all non-traumatic lower limb amputations in the United States, with the vast majority of these amputations preceded by a foot ulcer. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki provides comprehensive diabetic foot care — from annual prevention exams to complex wound management — with the goal of keeping every patient’s feet intact and functional.

The Diabetic Foot Risk Triad

Three converging conditions drive diabetic foot complications: Peripheral neuropathy — diabetic sensorimotor polyneuropathy damages the nerve fibers that transmit pain, temperature, and position sense from the foot to the brain. Without these signals, pressure wounds, burns, and injuries go undetected. By the time most diabetic foot wounds are discovered, the damage has been developing for days or weeks. Peripheral artery disease (PAD) — diabetes accelerates atherosclerosis in the tibial and peroneal arteries. Reduced blood flow means wounds heal slowly or not at all, and minor infections become limb-threatening. An ABI (ankle-brachial index) less than 0.9 indicates significant PAD warranting vascular assessment. Deformity — bunions, hammertoes, Charcot foot, and claw toes create focal pressure points where neuropathic ulcers concentrate. A callus under a metatarsal head in a neuropathic patient is a pre-ulcer — not a cosmetic issue — and requires professional debridement and pressure offloading.

Medicare Diabetic Footwear Program

Medicare Part B provides eligible diabetic patients with one pair of therapeutic depth-inlay shoes and three pairs of custom-molded inserts per calendar year under the Therapeutic Shoe Program (TSP). This benefit requires: diagnosis of diabetes, prescription from your treating physician, fitting and dispensing by a qualified podiatrist or other qualified provider, and evidence of diabetic peripheral neuropathy, prior foot ulcer, callus formation, foot deformity, or poor circulation. The TSP is severely underutilized — fewer than 10% of eligible Medicare diabetic patients receive it annually. Balance Foot & Ankle is a Medicare TSP provider. Ask Dr. Biernacki at your next diabetic foot exam.

Related Resources

Diabetic Foot Ulcer Prevention Michigan | Charcot Foot Treatment Michigan | Neuropathy Shoes & Socks Michigan | Foot Neuropathy Complete Guide | Burning Feet at Night

Don’t wait for a foot wound to start diabetic foot care. Contact Balance Foot & Ankle in Southeast Michigan for your Medicare diabetic foot exam with Dr. Biernacki.

Dr. Tom Biernacki, DPM

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.