Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
Foot pain isn't resolving?
Same-week appointments at Howell & Bloomfield Hills
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Diabetic Foot Care: Prevention, Surveillance, and Intervention
Diabetes mellitus is the leading cause of non-traumatic lower extremity amputation in the United States — accounting for more than 70,000 amputations annually. Yet the vast majority of these amputations are preventable with regular podiatric surveillance, appropriate footwear, and early intervention when complications begin to develop.
At Balance Foot & Ankle, Dr. Tom Biernacki provides comprehensive diabetic foot care — from annual preventive exams and neuropathy screening to active wound management and coordination with the vascular surgery and infectious disease teams when complex complications arise.
The Annual Diabetic Foot Exam: What We Assess
Neurological Assessment
The Semmes-Weinstein 10-gram monofilament test is the clinical standard for detecting loss of protective sensation (LOPS). Inability to feel the monofilament at designated foot sites indicates LOPS — the single most important risk factor for diabetic ulceration. Vibration testing with a 128Hz tuning fork and assessment of Achilles and plantar reflexes complete the neurological exam. Patients with LOPS are counseled on daily foot inspection, appropriate footwear, and ulceration warning signs.
Vascular Assessment
Peripheral arterial disease (PAD) coexists with diabetes at dramatically elevated rates — 20–30% of diabetic patients have significant PAD versus 5–7% of the general population. PAD impairs wound healing and dramatically worsens the prognosis of diabetic foot ulcers. Ankle-brachial index (ABI) measurement and digital pulse assessment are performed at every annual exam. Abnormal findings trigger vascular surgery referral for further evaluation including arterial duplex ultrasound and consideration of revascularization.
Foot Structure and Deformity Assessment
Structural deformities — bunions, hammertoes, Charcot foot arthropathy, prominent metatarsal heads — create pressure points where neuropathic ulcers preferentially develop. Identifying and offloading these high-pressure areas with custom orthotics, rocker-bottom footwear, or appropriate surgical intervention is essential for ulcer prevention in patients with established neuropathy.
Skin and Nail Assessment
Dry, cracked heel skin from autonomic neuropathy is a direct portal of entry for bacteria — a seemingly minor heel fissure in a patient with LOPS and PAD can progress to a limb-threatening infection within days. Fungal toenails (onychomycosis) thicken and traumatize adjacent nail folds, providing another entry point for infection. Regular nail care and skin moisturization are preventive services we provide at every visit.
Footwear Evaluation
Improperly fitting footwear is the initiating factor in 90% of diabetic foot ulcerations. Shoes that are too tight, too narrow, or with internal seams create the focal pressure that drives ulceration in neuropathic feet. Medicare-covered diabetic footwear (custom-molded or depth shoes with custom inserts) is prescribed for appropriate patients as a covered preventive service.
Charcot Neuroarthropathy
Charcot foot — a devastating complication of diabetic neuropathy — involves progressive bone destruction and joint dislocation in the midfoot driven by undetected trauma in the insensate foot and pathological bone remodeling from neuropathic bone metabolism. The active phase presents as a warm, swollen, red foot — frequently mistaken for cellulitis. Early recognition and immediate total contact casting to offload the foot is the single most important intervention to prevent permanent rocker-bottom deformity and future ulceration risk.
Diabetic Foot Ulcer Management
Diabetic foot ulcers are classified by the Wagner or University of Texas grading systems assessing depth, infection, and ischemia. Superficial clean ulcers (Wagner Grade 1) are managed with aggressive offloading (total contact casting, surgical shoes), sharp wound debridement, and moist wound healing dressings. Deep or infected ulcers require systemic antibiotics, surgical debridement, probe-to-bone testing for osteomyelitis, and MRI when bone infection is suspected. Ischemic wounds require vascular surgery evaluation before healing can be achieved.
Medicare-Covered Diabetic Footwear Program
Medicare Part B covers therapeutic footwear for diabetic patients with documented neuropathy, vascular disease, or foot deformity under the Therapeutic Shoe Bill. This provides one pair of custom-molded or depth shoes plus three pairs of custom inserts per calendar year as a covered preventive benefit. Dr. Biernacki provides the physician certification required for this program for eligible patients.
Dr. Tom's Product Recommendations
Orthofeet Stretch Knit Diabetic Shoes
⭐ Highly Rated
Extra-depth diabetic shoes with seamless stretch interior, cushioned orthopaedic footbed, and wide toe box — eliminates pressure points that cause neuropathic ulcers in patients who can’t feel developing wounds. Medicare reimbursable with prescription.
Dr. Tom says: “After losing sensation in my feet my podiatrist required me to switch to diabetic shoes. These have no seams, no pressure, and I’ve had zero ulcers in two years wearing them.”
Diabetic neuropathy, loss of protective sensation, ulcer prevention, neuropathic foot protection
Patients without neuropathy — standard supportive footwear is appropriate
Disclosure: We earn a commission at no extra cost to you.
Medi Protect Diabetic Socks Non-Binding
⭐ Highly Rated
Seamless non-binding diabetic socks with moisture management — eliminates seam pressure that creates blisters and ulcers in neuropathic patients who cannot feel developing wounds. Essential daily-wear for all diabetic neuropathy patients.
Dr. Tom says: “As a diabetic with neuropathy I can’t feel pressure injuries forming. These seamless socks ensure there’s nothing to cause the hidden wounds that lead to serious infections.”
Diabetic peripheral neuropathy, loss of protective sensation, pressure injury prevention, daily foot protection
Patients needing active graduated compression — these are non-compressive
Disclosure: We earn a commission at no extra cost to you.
Alpha Lipoic Acid 600mg for Neuropathy
⭐ Highly Rated
Evidence-based antioxidant supplement for slowing diabetic peripheral neuropathy progression and reducing neuropathic burning and tingling. 600mg daily dosing studied in European ALADIN and SYDNEY trials for diabetic neuropathy.
Dr. Tom says: “My podiatrist recommended alpha lipoic acid alongside my HbA1c management. My neuropathic burning improved and my monofilament scores have been stable for two years.”
Diabetic peripheral neuropathy, neuropathic burning and tingling, antioxidant neuropathy support
Not a substitute for glucose control — neuropathy management requires optimal HbA1c alongside supplementation
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Annual diabetic foot exams with monofilament, vibration, and vascular assessment
- ABI measurement in-office for peripheral arterial disease screening
- Custom diabetic orthotics and Medicare-covered therapeutic footwear prescription
- Charcot foot recognition and urgent total contact casting for active Charcot
- Wound care coordination with vascular surgery and infectious disease for complex ulcers
❌ Cons / Risks
- Peripheral neuropathy from diabetes is manageable but rarely reverses in established disease
- Active Charcot foot requires months of total contact casting and complete non-weight-bearing
- Infected diabetic ulcers may require hospitalization, IV antibiotics, and surgical debridement
- PAD in diabetic patients often requires vascular surgery evaluation before wound healing is achievable
Dr. Tom Biernacki’s Recommendation
I have a rule: if you’re diabetic, I want to see your feet every year at minimum — more often if you have neuropathy, a history of ulcer, or vascular disease. The patients who get amputations are not the ones who had bad luck. They’re the ones who didn’t get their feet looked at until the wound was too deep to heal. Fifteen minutes of surveillance once a year prevents that. It’s the best return on time in all of medicine.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How often should a diabetic get their feet examined?
The American Diabetes Association recommends at least annual comprehensive foot examinations for all diabetic patients. Patients with established peripheral neuropathy, prior ulceration, or PAD should be seen every 3–6 months. High-risk patients with active wounds or Charcot are managed with visits as frequently as weekly during the active treatment phase.
What is the most important thing a diabetic can do for foot health?
Daily foot inspection — looking and feeling every surface of both feet for cuts, blisters, swelling, color changes, and unusual warmth — is the single most important self-care practice. Patients with neuropathy cannot feel developing injuries, so visual inspection substitutes for the pain sensation that would normally alert a person to a wound. Proper footwear — no bare feet, always closed-toe shoes — is the equally critical companion habit.
What does a diabetic foot exam involve?
A comprehensive diabetic foot exam includes monofilament testing at 10 sites on each foot, vibration testing with a tuning fork, reflex assessment, ABI measurement for arterial disease, inspection of all skin surfaces including between the toes and under the heel, nail assessment, evaluation of foot architecture and deformity, and footwear review. The exam takes 15–20 minutes and generates a formal risk classification that guides follow-up frequency.
Can Medicare pay for diabetic shoes?
Yes. Medicare Part B covers therapeutic footwear for diabetic patients with documented neuropathy, vascular disease, or structural deformity under the Therapeutic Shoe Bill. Coverage includes one pair of custom-molded or depth shoes plus three pairs of custom inserts per calendar year. Dr. Biernacki provides the physician certification required and coordinates with certified shoe fitters for eligible patients.
What is Charcot foot?
Charcot neuroarthropathy is a progressive bone and joint destruction process in the foot driven by undetected repetitive stress in a neuropathic foot combined with pathological bone remodeling from diabetes. The active phase looks like a red, warm, swollen foot — often mistaken for cellulitis or gout. It requires immediate total contact casting to halt bone destruction. Delayed treatment leads to permanent rocker-bottom deformity and dramatically elevated lifetime ulcer risk.
Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Hills
📞 (810) 206-1402 Book Online →Frequently Asked Questions
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.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot issues, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
American Diabetes Association: Diabetic Foot Care
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.