How often should diabetics check their feet?

Diabetic patients should perform daily self-examinations of both feet, checking for cuts, blisters, redness, swelling, calluses, and temperature changes. Professional diabetic foot exams should occur at least annually, or every 3-6 months for patients with neuropathy, peripheral artery disease, or history of foot ulcers. Dr. Biernacki provides comprehensive diabetic foot care programs.

Why do diabetics have foot problems?

Diabetes causes peripheral neuropathy (nerve damage reducing sensation), peripheral artery disease (reduced blood flow), and impaired immune function. This combination means injuries go unnoticed, heal slowly, and are prone to infection. Approximately 15% of diabetics will develop a foot ulcer, and diabetic foot complications are the leading cause of non-traumatic amputation. Prevention through regular podiatric care is essential.

What are the signs of diabetic neuropathy in feet?

Early signs include tingling, burning, or numbness starting in the toes and progressing upward. Other symptoms include sensitivity to touch, muscle weakness, balance problems, and loss of reflexes. If you experience any of these symptoms, schedule an evaluation with Dr. Biernacki at 810-206-1402 for nerve conduction testing and a comprehensive neuropathy management plan.

Diabetic Foot Ulcer Wagner Classification & Treatment

Name: Diabetic Foot Ulcer Wagner Classification & Treatment
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-22T08:06:04-04:00

Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.

Diabetic foot ulcers (DFU) affect approximately 15% of patients with diabetes during their lifetime and are the leading cause of non-traumatic lower extremity amputation — responsible for 85% of diabetes-related amputations. The Wagner classification provides a widely used grading system that guides treatment intensity and predicts outcomes, from superficial ulcers to full-thickness wounds with osteomyelitis and gangrene.

Wagner Classification

Wagner Grade 0: pre-ulcerative lesion — healed ulcer, bony prominence under intact skin, or callus over a pressure point. Treatment: aggressive preventive care with callus debridement, custom orthotics, and diabetic foot surveillance. Grade 1: superficial full-thickness skin ulcer without subcutaneous tissue involvement. Treatment: local wound care, off-loading (total contact cast is the gold standard), infection surveillance. Grade 2: deep ulcer penetrating to tendon, capsule, or bone without infection. Treatment: aggressive local wound care, imaging (MRI) to rule out osteomyelitis, off-loading, vascular assessment. Grade 3: deep ulcer with osteomyelitis, joint sepsis, or deep space abscess. Treatment: IV antibiotics, surgical debridement or partial amputation, vascular surgery consultation for revascularization if perfusion is inadequate. Grade 4: partial gangrene of the forefoot — localized necrosis of toes or forefoot. Grade 5: full-foot gangrene requiring major amputation. Advanced grades require a multidisciplinary team approach with podiatry, vascular surgery, infectious disease, and endocrinology.

Total Contact Casting and Off-Loading

Total contact casting (TCC) — the application of a well-molded, minimally padded below-knee cast that distributes plantar pressure over the entire plantar surface — is the most effective off-loading device for neuropathic DFU and is superior to removable cast walkers and therapeutic footwear for plantar forefoot and midfoot ulcer healing. Healing rates with TCC are 65–90% for Wagner Grade 1–2 ulcers. The primary limitation is patient compliance with removable devices — TCC addresses this by eliminating patient choice. Dr. Biernacki at Balance Foot & Ankle provides comprehensive diabetic foot ulcer care including wound debridement, total contact casting, and coordination with vascular surgery for complex wounds. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Why Regular Podiatric Care Is Essential for Diabetics

Diabetes affects the feet in two critical ways that work together to create risk: neuropathy (loss of protective sensation) and peripheral arterial disease (reduced circulation). Together, these mean that small injuries can go unnoticed and heal poorly — creating a pathway to serious infection.

The Numbers That Matter for Your Feet

HbA1c below 7%: The ADA goal for most diabetics — higher levels accelerate neuropathy and circulation damage
Annual comprehensive foot exam: Standard of care for all diabetics
Daily foot inspections: Check for cuts, blisters, redness, swelling, or changes in skin color
Never barefoot: Loss of sensation means you may step on something without feeling it

At Balance Foot & Ankle, we see diabetic patients for comprehensive foot care including neuropathy screening, nail care, wound assessment, and diabetic orthotics.

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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Dr. Tom Biernacki, DPM

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.