Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Quick answer: Diabetic Foot Examination 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 Hills practices. Call (810) 206-1402.
The most important clinical decision with Diabetic Foot Examination isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
What a Diabetic Foot Exam Includes
A comprehensive diabetic foot examination is far more than a quick visual check. Your podiatrist systematically evaluates every system that affects your foot health and healing capacity. The exam takes 15–30 minutes and produces a risk stratification that guides how frequently you need to be seen.
Neurological Assessment: Semmes-Weinstein monofilament testing (10g filament at 10 sites on each foot) identifies loss of protective sensation. Vibration threshold with a 128Hz tuning fork. Achilles reflex testing. The monofilament test is the single most important screening tool for neuropathy risk stratification.
Vascular Assessment: Palpation of the posterior tibial and dorsalis pedis pulses. Ankle-Brachial Index (ABI) measurement for suspected peripheral arterial disease. Capillary refill time. Skin temperature comparison between feet.
Dermatological Assessment: Inspection of all skin surfaces including between toes and under the foot. Evaluation of calluses (pre-ulcerative), blisters, wounds, discoloration, hair loss, and skin texture (dry, atrophic skin indicates autonomic neuropathy).
Nail Assessment: Onychomycosis, ingrown nails, subungual hematoma, and nail hypertrophy all pose infection risk in diabetic patients. Podiatric nail care is a preventive service.
Musculoskeletal/Biomechanical Assessment: Deformities (hammer toes, bunions, Charcot deformity), gait analysis, range of motion, and footwear inspection.
Risk Categories and Visit Frequency
Category 0 (No neuropathy, no PAD): Annual exam. Category 1 (Neuropathy present): Every 6 months. Category 2 (Neuropathy + PAD or deformity): Every 3–4 months. Category 3 (Prior ulcer or amputation): Every 1–2 months. These are minimum recommendations — actual visit frequency is individualized based on glycemic control, activity level, and social support.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your diabetic foot, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Frequently Asked Questions
Does Medicare cover diabetic foot exams? Medicare Part B covers foot care for qualifying diabetics (Class A–C findings on examination). Routine nail care is covered every 60 days. Therapeutic footwear is covered annually. Your podiatrist can verify your Medicare coverage and ensure proper documentation.
What is a monofilament test? A 10-gram Semmes-Weinstein monofilament is pressed against the skin of the foot until it bends. If the patient cannot feel this pressure at 4 or more sites, protective sensation is lost — the highest-risk finding for future ulceration.
When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
⚕ Doctor Recommended
DASS Compression SocksGraduated compression for circulation & comfort
View Product →Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Hills, MI
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
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.