Diabetic Foot Doctor Michigan | Balance Foot & Ankle

Table of Contents

• Why Diabetic Patients Need Specialized Foot Care
• Our Diabetic Foot Services
• The Annual Diabetic Foot Exam
• Diabetic Wound Care
• Medicare Diabetic Shoes
• Diabetic Foot Risk Categories
• When to Call Us Immediately
• Frequently Asked Questions

Michigan has one of the highest rates of diabetes in the United States — and one of the highest rates of diabetes-related lower extremity complications, including foot ulcers, infections, and amputations. These outcomes are largely preventable with proper preventive care and early intervention.

At Balance Foot & Ankle, diabetic foot care is one of our core practice areas. Dr. Tom Biernacki has performed thousands of foot and ankle procedures, including complex diabetic wound care and reconstructive surgery. Our Howell and Bloomfield Hills offices are equipped to provide the full spectrum of diabetic foot care — from annual preventive exams to urgent wound management.

Why Diabetic Patients Need Specialized Foot Care

Diabetes damages the feet through two primary mechanisms: peripheral neuropathy (nerve damage) and peripheral arterial disease (poor circulation). These two processes often coexist and amplify each other’s effects:

Peripheral neuropathy causes loss of protective sensation. You may not feel a pebble in your shoe, a blister forming, a cut, or a burn. Without pain as a warning signal, minor injuries go unnoticed and progress. Studies show that 70–90% of diabetic foot ulcers occur at pressure points in patients with neuropathy — areas of high mechanical stress that a sensate patient would naturally offload.

Peripheral arterial disease (PAD) reduces blood flow to the foot. Healing requires oxygen and nutrients delivered by blood. When circulation is compromised, wounds heal slowly or not at all. A small cut that would heal in a week for a non-diabetic person may persist for months and become infected in a diabetic patient with PAD.

The combination of undetected injury (from neuropathy) and impaired healing (from PAD) is what drives the diabetic foot ulcer → infection → amputation cascade. Approximately 85% of diabetes-related amputations are preceded by a foot ulcer. Preventing ulceration is the most powerful way to prevent amputation.

Our Diabetic Foot Services

• Annual diabetic foot exams — comprehensive evaluation of sensation, circulation, skin, nails, and structural foot deformities
• Neuropathy evaluation and management — monofilament testing, vibration assessment, referral for NCS/EMG when indicated, medical management of painful neuropathy
• Diabetic wound care — debridement, offloading, advanced wound dressings, biologics, infection management
• Nail and callus care — therapeutic nail trimming and callus debridement in high-risk patients (Medicare covers this for qualifying diabetic patients)
• Medicare diabetic shoe program — prescription, custom molding, and fitting of diabetic therapeutic footwear
• Charcot neuroarthropathy management — immobilization, total contact casting, surgical reconstruction for advanced Charcot
• Limb salvage surgery — reconstructive procedures to avoid more proximal amputation when possible
• Vascular referral coordination — when PAD requires revascularization, we coordinate with vascular surgery for comprehensive care

The Annual Diabetic Foot Exam

The American Diabetes Association recommends a comprehensive foot examination at least once per year for all diabetic patients, and more frequently for higher-risk patients. Our annual diabetic foot exam includes:

• Sensory testing — 10-gram Semmes-Weinstein monofilament (loss of protective sensation), 128 Hz tuning fork (vibration), and temperature discrimination
• Vascular assessment — dorsalis pedis and posterior tibial pulse palpation; ankle-brachial index (ABI) measurement if pulses are diminished or absent
• Skin assessment — inspection for wounds, fissures, maceration, tinea pedis (athlete’s foot), and pressure areas
• Nail assessment — ingrown nails, onychomycosis (nail fungus), nail thickness, and subungual pathology
• Structural assessment — deformities (bunions, hammertoes, Charcot changes) that create high-pressure zones
• Footwear assessment — evaluation of current shoes for appropriateness, fit, and potential pressure points
• Risk stratification — categorizing your foot risk level to determine follow-up frequency and preventive interventions

This exam is covered by Medicare and most insurance plans as part of diabetic care. It takes about 30 minutes and provides a complete picture of your current foot risk status.

Diabetic Wound Care

Diabetic foot ulcers require specialized wound care that goes beyond standard wound dressings. The core principles:

• Debridement — removing devitalized tissue, callus, and biofilm from the wound bed. Sharp debridement (scalpel) is the most evidence-backed approach for preparing a wound for healing. We perform this in-office at each wound care visit.
• Offloading — redistributing pressure away from the wound. Total contact casting (TCC) is the gold standard for plantar forefoot and midfoot ulcers; it reduces plantar pressure by 80–90%. Removable cast walkers are a practical alternative when TCC is not tolerated.
• Infection management — diabetic foot infections range from superficial (localized redness, warmth) to deep space infections and osteomyelitis (bone infection). We probe wounds for bone involvement, obtain appropriate cultures, and manage infections with targeted antibiotic therapy. Osteomyelitis often requires surgical bone resection and/or extended antibiotic courses.
• Advanced wound therapies — for wounds that fail to progress with standard care, we employ platelet-rich plasma (PRP) injections, cellular and/or tissue-based products (skin substitutes), negative pressure wound therapy (wound VAC), and hyperbaric oxygen therapy referral.
• Vascular assessment — any wound that fails to progress within 4–6 weeks requires re-evaluation for underlying ischemia. We refer to vascular surgery for angioplasty or bypass when indicated — revascularization dramatically improves wound healing outcomes.

Medicare Diabetic Shoe Program

Medicare Part B covers one pair of therapeutic diabetic shoes or depth-inlay shoes plus three pairs of custom-molded insoles per calendar year for Medicare beneficiaries with diabetes who have additional qualifying conditions. Qualifying conditions include peripheral neuropathy with calluses or pre-ulcerative lesions, history of prior ulceration, history of pre-ulcerative calluses, foot deformity, poor circulation, or prior amputation.

At our office, we:

• Evaluate your eligibility and document qualifying conditions in the required Certificate of Medical Necessity
• Custom-mold insoles to your specific foot shape and pressure distribution
• Fit therapeutic footwear from our selection of Medicare-approved diabetic shoes
• Educate on proper wear patterns and inspection routines

For eligible patients, the shoe and insoles are provided at no additional cost beyond the standard Medicare cost-sharing. This benefit is significantly underutilized — many diabetic patients who qualify are not receiving it.

Diabetic Foot Risk Categories

We categorize diabetic foot risk using the International Working Group on the Diabetic Foot (IWGDF) classification to guide follow-up frequency:

Category	Risk Profile	Recommended Follow-Up
Very low (0)	No neuropathy, no PAD	Annually
Low (1)	Neuropathy OR PAD, no deformity or prior ulcer	Every 6–12 months
Moderate (2)	Neuropathy + PAD or + foot deformity	Every 3–6 months
High (3)	Prior ulcer or amputation, or neuropathy + PAD + deformity	Every 1–3 months

High-risk patients (Category 3) benefit most from regular preventive podiatry visits — nail care, callus debridement, and surveillance that can identify new problems before they progress to ulceration. Medicare covers routine foot care for Category 3 patients as a covered benefit.

Frequently Asked Questions

How often should diabetics see a foot doctor?

At minimum, once per year for a comprehensive diabetic foot exam — even if you have no symptoms. Patients with neuropathy, prior ulceration, poor circulation, or foot deformities should be seen every 1–6 months depending on their specific risk category. Many Medicare-eligible diabetic patients with systemic conditions affecting the lower extremities receive routine foot care coverage for visits every 60 days.

Does Medicare cover diabetic foot care in Michigan?

Yes — Medicare Part B covers the annual diabetic foot exam, the Medicare Therapeutic Shoe Program (diabetic shoes + insoles), and routine foot care (nail care, callus debridement) when the patient has a documented systemic condition affecting the lower extremities, such as diabetic peripheral neuropathy. We are Medicare-participating providers at both our Howell and Bloomfield Hills locations and can help determine what’s covered for you specifically.

What is the most common foot problem in diabetics?

Diabetic peripheral neuropathy is the most common diabetic foot condition, affecting up to 50% of diabetic patients over their lifetime. Neuropathy is the primary risk factor for the most serious complications: foot ulcers and amputation. Onychomycosis (nail fungus) is also very common in diabetic patients and carries a higher risk of complications than in non-diabetic individuals because the nail breach can serve as a portal for bacterial infection.

The Bottom Line

Diabetic foot complications are largely preventable. The key is regular expert evaluation, protective footwear, patient education, and prompt treatment of any foot problem — however minor it appears. At Balance Foot & Ankle, we have the clinical expertise and facilities to provide comprehensive diabetic foot care that keeps Michigan patients walking, active, and out of the hospital. If you have diabetes, your feet deserve expert attention — not just from your primary care physician, but from a specialist who focuses exclusively on the foot and ankle.

The American Podiatric Medical Association recommends that patients with diabetes have a complete foot examination at least annually — including sensory testing and vascular assessment — as early detection of peripheral neuropathy reduces amputation risk by up to 85%. (APMA: Diabetic Foot Care)

Sources

1. American Diabetes Association. “Standards of Medical Care in Diabetes — 2024.” Diabetes Care. 2024;47(Suppl 1).
2. Bus SA, Lavery LA, Monteiro-Soares M, et al. “IWGDF Guidelines on the prevention of foot ulcers in persons with diabetes.” Diabetes/Metabolism Research and Reviews. 2020;36(S1):e3237.
3. Pecoraro RE, Reiber GE, Burgess EM. “Pathways to diabetic limb amputation. Basis for prevention.” Diabetes Care. 1990;13(5):513-521.
4. Lavery LA, Armstrong DG, Wunderlich RP, et al. “Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort.” Diabetes Care. 2003;26(5):1435-1438.