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.

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

Diabetic Foot Ulcers: Expert Wound Care from Michigan Podiatrists

Name: Diabetic Foot Ulcer Wound Care Guide | Podiatrist
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-23T08:00:48-04:00

A diabetic foot ulcer is one of the most serious and costly complications of diabetes. Approximately 15% of people with diabetes will develop a foot ulcer during their lifetime, and diabetic foot problems account for more hospital admissions than any other complication of diabetes. At Balance Foot & Ankle, wound care is a core part of our diabetic care program.

Why Diabetics Get Foot Ulcers

Two diabetes complications work together to create the conditions for ulcers:

Peripheral Neuropathy (Loss of Sensation)

Elevated blood glucose damages small nerve fibers, eliminating protective sensation. Diabetic patients may step on a nail, develop a blister, or have their shoe rubbing for days without feeling any pain. By the time the wound is noticed (often during bathing or inspection), infection may already be present.

Peripheral Artery Disease (Reduced Circulation)

Diabetes accelerates atherosclerosis, reducing blood flow to the feet. Without adequate circulation, even small wounds cannot heal — oxygen and immune cells cannot reach the wound site.

Motor Neuropathy and Deformity

Motor neuropathy weakens intrinsic foot muscles, causing hammertoes, claw toes, and Charcot foot deformity. These deformities create new pressure points that become ulcer sites.

Classification of Diabetic Foot Ulcers (Wagner Scale)

Grade 0: Pre-ulcerative lesion (callus, blister, skin breakdown without open wound)
Grade 1: Superficial ulcer not penetrating tendon, capsule, or bone
Grade 2: Deeper ulcer — penetrates to tendon, capsule, or joint
Grade 3: Deep ulcer with abscess, osteomyelitis (bone infection), or joint sepsis
Grade 4: Partial foot gangrene
Grade 5: Whole foot gangrene

Grade 1–2 ulcers are primarily outpatient podiatric care. Grade 3+ require hospital admission.

Treatment of Diabetic Foot Ulcers

Offloading — The Most Critical Element

Pressure is the primary driver of ulcer formation and delayed healing. Total contact casting (TCC) is the gold standard — a custom-molded plaster or fiberglass cast that distributes pressure across the entire plantar surface. Removable walking boots are convenient but only effective if the patient actually wears them (compliance is a significant issue). Non-weight-bearing on crutches is occasionally needed for severe ulcers.

Wound Debridement

Regular debridement (removal of dead, infected, or callused tissue) is essential for wound healing. Debridement removes bacterial biofilm and stimulates the wound to progress through normal healing stages. At Balance Foot & Ankle, we perform sharp debridement in office.

Infection Management

Signs of infection: increasing redness, warmth, swelling, purulent drainage, systemic fever, elevated white blood cell count. Superficial infections are treated with oral antibiotics; deep infections require IV antibiotics and often surgical debridement or amputation of infected tissue.

Osteomyelitis (bone infection) requires a minimum 6 weeks of antibiotics, often with surgical bone removal.

Advanced Wound Care Products

Modern wound care has a wide range of evidence-based products for appropriate wound stages:

Moisture-retentive dressings (hydrocolloids, foams, alginates)
Bioengineered skin substitutes (Apligraf, Dermagraft) for chronic, stalled wounds
Platelet-rich plasma (PRP) application
Negative pressure wound therapy (vacuum-assisted closure, VAC therapy)
Hyperbaric oxygen therapy for refractory wounds with confirmed arterial involvement

Vascular Assessment and Revascularization

Any diabetic foot ulcer that fails to improve in 2–4 weeks with appropriate care requires vascular evaluation. ABI testing, duplex ultrasound, and vascular surgery referral are essential when arterial insufficiency is present — revascularization (angioplasty or bypass) may be needed to provide sufficient blood flow for healing.

Prevention: The Most Important Intervention

Daily foot inspection: Use a mirror; check between toes; feel for temperature differences
Never go barefoot — even indoors
Medicare-covered diabetic footwear: Extra-depth shoes and custom molded inserts significantly reduce ulcer recurrence
Regular podiatric visits: Every 3–6 months for comprehensive foot exams; more frequently with active problems
Blood sugar control: HbA1c below 7% dramatically reduces neuropathy progression and improves wound healing
Callus management: Regular professional debridement of calluses (which can conceal underlying ulcers)

Ready to Get Relief? We’re Here to Help.

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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📞 (810) 206-1402

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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.

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