Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
| Exam Component | Tool / Method | What It Detects | Significance |
|---|---|---|---|
| Monofilament (10g Semmes-Weinstein) | Nylon filament applied to 4 plantar sites per foot | Loss of protective sensation (LOPS) | Inability to feel filament = 7x higher ulcer and amputation risk |
| Tuning Fork (128 Hz) | Applied to bony prominences | Vibration sense; large fiber neuropathy | Loss of vibration precedes pain loss in small fiber neuropathy |
| Ankle-Brachial Index (ABI) | Doppler + blood pressure cuff | Peripheral arterial disease (PAD) | ABI less than 0.9 = PAD; less than 0.5 = limb-threatening ischemia |
| Dermal Temperature Assessment | Infrared thermometer or clinical palpation | Charcot neuroarthropathy; infection; inflammation | Asymmetric warmth (greater than 4 F difference) = active Charcot or infection |
| Joint Mobility Assessment | Manual ROM of subtalar, midtarsal, MTP joints | Limited joint mobility (LJM) from glycosylation | LJM increases plantar pressure; contributes to ulcer formation |
| Foot Structure / Deformity Survey | Weight-bearing inspection; X-ray if indicated | Hammertoes, bunions, Charcot deformity, flat foot, cavus | Deformity = Category 2 risk; higher pressure areas require protective footwear |
| Skin and Nail Assessment | Visual inspection; probe-to-bone test if ulcer present | Callus, fissures, fungal infection, ulcer, pre-ulcer | Callus over pressure area = impending ulcer; fungal nail = portal of entry |
| A1C Range | Average Blood Glucose | Neuropathy Risk | Wound Healing | Podiatric Visit Frequency |
|---|---|---|---|---|
| Less than 7% (well controlled) | Approximately 154 mg/dL | Low | Good – normal wound healing capacity | Annual (Category 0-1) |
| 7-8% (borderline) | Approximately 183 mg/dL | Moderate | Mildly impaired | Every 6 months |
| 8-10% (poorly controlled) | Approximately 212-240 mg/dL | High | Significantly impaired; infection risk elevated | Every 3 months |
| Greater than 10% (very poorly controlled) | Greater than 240 mg/dL | Very high; neuropathy rapidly progressing | Severely impaired; high amputation risk | Every 1-3 months; wound care team if active ulcer |
Quick answer: Diabetic Foot Exam Podiatrist is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper 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 | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
![Diabetes Peripheral Neuropathy Treatment [Diabetic Nerve Pain Remedy]](https://www.michiganfootdoctors.com/wp-content/cache/flying-press/83886306c119511909f4e50d00e25908.jpg)
Watch: Diabetes Peripheral Neuropathy Treatment [Diabetic Nerve Pain Remedy] — MichiganFootDoctors YouTube
The most important clinical decision with Diabetic Foot Exam Podiatrist isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
The most important clinical decision with Diabetic Foot Exam Podiatrist isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Why the Annual Foot Exam Saves Limbs
85% of lower extremity amputations in diabetics begin with a foot ulcer. Most foot ulcers develop from a combination of peripheral neuropathy (inability to feel damage), peripheral arterial disease (impaired healing), and repetitive mechanical trauma from improperly fitting footwear or callus. The annual diabetic foot exam is designed to identify each of these risk factors before an ulcer develops — and intervene before the sequence from callus to wound to infection to amputation is set in motion.
What Dr. Biernacki Checks at the Diabetic Foot Exam
Protective sensation testing: The Semmes-Weinstein 10-gram monofilament is applied to 10 points on each foot. Inability to feel the monofilament at any site indicates loss of protective sensation — the single most important risk factor for ulceration. Vascular assessment: Dorsalis pedis and posterior tibial pulse palpation; ankle-brachial index (ABI) if vascular compromise is suspected. Skin assessment: callus formation (pre-ulcer lesion), maceration, dryness and fissuring, any open areas. Nail assessment: fungal infection, ingrown nails, thickening. Deformity assessment: bunions, hammertoes, Charcot changes. Footwear evaluation: appropriate fit and protective cushioning.
Medicare Coverage for Diabetic Foot Care
Medicare Part B covers comprehensive diabetic foot exams twice yearly (every 6 months) for patients with diabetes-related peripheral neuropathy. Medicare also covers: therapeutic footwear and 3 pairs of custom inserts annually (for qualifying diabetics with documented foot pathology), routine nail care for diabetics with qualifying conditions, and wound care for diabetic foot ulcers. Patients must be seen by their primary care physician for diabetes management within the preceding 6 months for the foot exam to be covered. Our office handles the coverage verification process.
Risk Stratification: How Often Do You Need to Be Seen?
Low risk (no neuropathy, no PAD, no deformity): annual exam sufficient. Moderate risk (neuropathy or PAD present, no prior ulcer): every 3-6 months. High risk (neuropathy plus PAD or deformity): every 1-3 months. Very high risk (prior ulcer or amputation history): every 1-2 months minimum. Risk stratification ensures patients who need more frequent surveillance receive it, and prevents under-treatment of high-risk patients who falsely believe annual exams are sufficient for their situation.
Dr. Tom's Product Recommendations
DASS Medical Compression Socks
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Medical-grade compression for diabetic patients with venous insufficiency. Note: requires physician evaluation before use — ABI must confirm adequate arterial circulation before compression is applied to diabetic feet.
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Diabetic patients with confirmed venous insufficiency and adequate arterial circulation
Diabetic peripheral arterial disease — compression contraindicated without ABI evaluation
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PowerStep Pinnacle Orthotic
⭐ Highly Rated
For low-risk diabetic patients without significant deformity — reduces plantar pressure at common callus sites. High-risk diabetics should use Medicare-covered custom therapeutic footwear instead.
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Low-risk diabetic foot pressure management
High-risk diabetics, significant deformity, or post-ulcer patients — Medicare therapeutic footwear is the appropriate intervention
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Medicare covers diabetic foot exams twice yearly — routine preventive care with no out-of-pocket cost for most patients
- Monofilament sensation testing provides objective neuropathy staging for risk stratification
- Therapeutic footwear (Medicare-covered) prevents the repetitive trauma that initiates most ulcers
❌ Cons / Risks
- Many diabetics skip annual exams because feet don’t hurt — neuropathy prevents pain signals that would otherwise prompt care
- Established peripheral arterial disease significantly limits healing potential regardless of wound care quality
- Medicare therapeutic footwear requires specific documentation — not all diabetics qualify automatically
Dr. Tom Biernacki’s Recommendation
Every diabetic patient I see for an annual foot exam, I am looking for one thing above all others: the callus that is becoming a pre-ulcer. A callus on the bottom of a neuropathic foot is a wound that hasn’t happened yet. The tissue underneath is under pressure every step — it is in the process of breaking down. Debride that callus, offload that area with appropriate footwear, and you interrupt the sequence that leads to amputation. That’s the whole point of the exam.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How often should a diabetic see a podiatrist?
Low risk (no neuropathy or PAD): annually. Moderate risk: every 3-6 months. High risk (neuropathy plus deformity or PAD): every 1-3 months. Prior ulcer or amputation: every 1-2 months. Ask Dr. Biernacki to assess your risk category at your first visit.
Does Medicare cover diabetic foot exams?
Yes — Medicare Part B covers comprehensive diabetic foot exams twice yearly for patients with documented diabetes-related peripheral neuropathy. Call (810) 206-1402 to verify your specific coverage.
What should I check on my diabetic feet every day?
Daily self-exam: inspect all surfaces of both feet (use a mirror for the bottom), check between toes, look for redness, blisters, calluses, cuts, or any open areas. Any wound — no matter how small — requires same-day podiatric evaluation.
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When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
What is Diabetic foot?
Diabetic foot 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 diabetic foot 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 diabetic foot 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 diabetic foot 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.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.
More questions patients ask
What does a diabetic foot exam involve?
A diabetic foot exam includes checking circulation (pulses, capillary refill), sensation (monofilament and vibration testing), skin integrity (looking for ulcers, calluses, fissures), nail health, and structural deformities. Your podiatrist documents any changes at each visit to catch problems before they escalate.
How often should diabetics see a podiatrist?
Most people with diabetes should see a podiatrist at least once a year for a comprehensive foot exam. Those with neuropathy, poor circulation, or a history of foot ulcers may need visits every 1–3 months. Early detection of small changes prevents minor issues from becoming limb-threatening complications.
What are the warning signs of diabetic foot problems?
Warning signs include new numbness or tingling, a sore or blister that won't heal, skin discoloration (redness, darkening, or paleness), swelling in one foot, foul odor from the foot, and any break in the skin. Report these to your podiatrist immediately — do not wait for a scheduled appointment.
Can diabetic foot complications be prevented?
Yes. Daily self-exams, proper moisturizing, nail trimming straight across, wearing well-fitted diabetic-approved footwear, and controlling blood sugar are all protective. Offloading pressure from calluses with custom orthotics and eliminating barefoot walking indoors are additional strategies your podiatrist can tailor to your risk level.
Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.