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.
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
Why the Annual Diabetic Foot Exam Is Non-Negotiable
The American Diabetes Association, the American Podiatric Medical Association, and CMS (Medicare) all recommend at minimum annual comprehensive foot exams for all patients with diabetes. For higher-risk patients — those with neuropathy, prior ulcers, or poor circulation — exams should occur every 1–3 months.
This isn’t bureaucratic box-checking. Research consistently shows that regular podiatric foot examinations reduce diabetic foot amputation rates by 45–85%. Every component of the exam serves a specific screening purpose.
At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, comprehensive diabetic foot exams are a core service — and we take each component seriously.
What a Complete Diabetic Foot Exam Includes
1. Neurological Assessment
Semmes-Weinstein 10-Gram Monofilament Test
A thin monofilament (calibrated to buckle under 10 grams of force) is pressed against specific plantar sites on each foot. If you cannot feel the monofilament at any site, you have lost protective sensation — the critical threshold below which injury can occur undetected. Sites tested include the heel, ball of the foot, and the great toe. A single missed site is clinically significant.
Vibration Threshold Testing
A 128 Hz tuning fork is applied to the first metatarsal head and great toe. The patient indicates when they no longer feel the vibration. Reduced vibration sense indicates early large-fiber neuropathy — often detectable before monofilament loss.
Pinprick Sensation
Assesses pain fiber (small fiber) function across the plantar surface of the foot.
Ankle Reflexes
Diminished or absent Achilles tendon reflex is an early sign of peripheral neuropathy.
2. Vascular Assessment
Pedal Pulses
The dorsalis pedis (top of foot) and posterior tibial (behind the inner ankle) pulses are palpated. Absent or diminished pulses suggest peripheral arterial disease (PAD).
Ankle-Brachial Index (ABI)
Blood pressure measured at the ankle and arm; ratio below 0.9 confirms PAD. For patients with heavily calcified vessels (common in advanced diabetes), toe-brachial index (TBI) and transcutaneous oxygen measurement (TcPO2) provide more accurate assessment.
Capillary Refill Time
The nail is blanched with pressure; time for color to return assesses microvascular perfusion. Greater than 2 seconds is abnormal.
Skin and Temperature Assessment
Color, temperature asymmetry, and skin changes (thinning, hairlessness, dependent rubor) are assessed for signs of circulatory compromise.
3. Dermatological Assessment
- Skin integrity: any breaks, ulcers, fissures, or maceration between toes
- Callus formation: calluses over pressure points are pre-ulcerative lesions
- Nail assessment: thickened, onychomycotic, or ingrown nails are managed
- Interdigital moisture and signs of fungal infection
- Skin texture and moisture (autonomic neuropathy causes dry, cracked skin)
4. Musculoskeletal Assessment
- Foot deformities: bunions, hammertoes, claw toes, Charcot arthropathy
- Range of motion: ankle dorsiflexion, subtalar motion
- Gait assessment: walking pattern, balance, and any gait abnormalities
- Limb length discrepancy and compensatory patterns
5. Footwear Evaluation
We examine the shoes you brought to the appointment for: appropriate width and depth, absence of internal seams over deformity areas, wear patterns on the outsole (reveals pressure points and gait mechanics), and overall condition. Worn, narrow, or poorly fitting footwear is one of the most correctable risk factors for diabetic foot injury.
6. Risk Classification and Care Plan
Based on exam findings, every diabetic patient is classified using the International Working Group on the Diabetic Foot (IWGDF) risk categories:
- Category 0: No neuropathy — annual exam
- Category 1: Neuropathy but no PAD or deformity — every 6 months
- Category 2: Neuropathy + PAD or foot deformity — every 3 months
- Category 3: Prior ulcer or amputation — every 1–3 months
Medicare Coverage for Diabetic Foot Care
Medicare Part B covers comprehensive diabetic foot exams once every 6 months for patients who are not receiving routine foot care from another provider. Routine nail care (trimming, callus debridement) is covered every 60 days when performed by a podiatrist in the context of documented diabetes with neuropathy. Therapeutic diabetic footwear (extra-depth shoes + insoles) is covered once per calendar year for qualifying diabetic patients.
Don’t Wait for a Problem to See a Podiatrist
The purpose of regular diabetic foot exams is early detection — before a wound, before an infection, before an amputation. At Balance Foot & Ankle, we welcome new diabetic patients for comprehensive exams, accept Medicare and most major Michigan insurance plans, and can usually schedule within 1–2 weeks. Call (810) 206-1402 today.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
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When to See a Podiatrist for Diabetic Foot Exams
Annual diabetic foot exams detect problems before they become emergencies. Dr. Tom Biernacki at Balance Foot & Ankle performs comprehensive diabetic foot screenings including vascular assessment, neuropathy testing, and skin evaluation at both the Howell and Bloomfield Hills offices.
Learn About Our Diabetic Foot Care Services | Book Your Appointment | Call (810) 206-1402
Clinical References
- Boulton AJ, et al. “Comprehensive foot examination and risk assessment.” Diabetes Care. 2008;31(8):1679-1685.
- American Diabetes Association. “Standards of medical care in diabetes — foot care.” Diabetes Care. 2023;46(Suppl 1):S203-S215.
- Armstrong DG, et al. “Diabetic foot ulcers and their recurrence.” New England Journal of Medicine. 2017;376(24):2367-2375.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
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 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.
More Podiatrist-Recommended Diabetic Essentials
Diabetic-Approved Walking Shoe
Orthofeet Sprint — seamless, extra-depth, designed for neuropathic feet.
Seamless Diabetic Sock
OS1st FS4 — non-binding, moisture-wicking, protects fragile diabetic skin.
Recovery Slide for Indoor Wear
HOKA Ora 3 — protects diabetic feet from barefoot injury at home.
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
One unnoticed blister on a neuropathic foot can become a limb-threatening ulcer in under 14 days. Medicare covers diabetic shoes (A5500) and comprehensive foot exams annually for most diabetic patients with neuropathy or circulation concerns. Balance Foot & Ankle runs a dedicated diabetic limb-preservation program — vascular screening, offloading, ulcer care, and shoe fitting — all in one visit. Schedule your annual diabetic foot exam today.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Watch: Dr. Tom explains
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When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Diabetic Foot Care Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
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.
Frequently Asked Questions
Can a podiatrist help with neuropathy?
What does neuropathy in feet feel like?
Is foot neuropathy reversible?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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