Quick Answer
Diabetic peripheral neuropathy is nerve damage from prolonged hyperglycaemia, causing burning, tingling, numbness, or loss of protective sensation in the feet. It will not reverse without addressing glucose control. Daily foot checks, proper footwear, and annual monofilament testing prevent ulceration.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Watch: Dr. Tom Biernacki, DPM
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 →
Diabetic heel ulcers — full-thickness wounds of the posterior and plantar heel in patients with peripheral neuropathy and/or peripheral arterial disease — carry a dramatically worse prognosis than forefoot diabetic ulcers due to the minimal soft tissue coverage over the calcaneus, the high peak pressure during ambulation and bed positioning, and the direct proximity to the calcaneal bone (osteomyelitis risk is highest at the heel). Understanding the distinctive offloading requirements, wound care hierarchy, and surgical indications for diabetic heel ulcers is essential for achieving healing and limb salvage in this high-risk wound.
Pathophysiology and Wound Classification
Heel ulcer etiology: plantar heel ulcers from repetitive pressure during ambulation (associated with equinus deformity and heel strike loading); posterior heel ulcers from pressure in bed-ridden patients (positioning pressure over the calcaneal tuberosity); both ulcer types are exacerbated by peripheral neuropathy (loss of protective sensation) and peripheral arterial disease (impaired healing). Wagner classification for diabetic foot ulcers: Grade 1 — superficial ulcer without subcutaneous tissue involvement; Grade 2 — deep ulcer penetrating to tendon, capsule, or bone; Grade 3 — deep ulcer with abscess, osteomyelitis, or joint sepsis; Grade 4 — partial foot gangrene; Grade 5 — extensive gangrene. Osteomyelitis diagnosis: calcaneal osteomyelitis complicates up to 60% of Grade 3 heel ulcers; MRI is the gold standard — T1 hypointensity and T2 hyperintensity within the calcaneal marrow; the ‘probe-to-bone’ test (a positive result with a metal probe contacting bone through the ulcer) has 89% specificity for osteomyelitis. Vascular assessment: ABI, toe pressures, and TcPO2 at the heel level for all non-healing heel ulcers; TcPO2 <20 mmHg at the ulcer site predicts non-healing; revascularization (PTA or bypass) before wound care in ischemic ulcers.
Offloading and Wound Care
Total contact casting (TCC): the gold standard for diabetic plantar forefoot ulcers but CONTRAINDICATED for posterior heel ulcers — TCC places the heel in direct contact with the cast padding at the posterior aspect, increasing not decreasing heel pressure. Heel ulcer offloading: specialized heel offloading devices (DH Pressure Relief Shoe, Darco OFD, custom total contact insert with heel cutout); total contact boot with integral heel reliever; for non-ambulatory patients — heel float positioning devices, pressure-redistributing mattresses, frequent repositioning protocols. Sharp debridement: weekly sharp debridement of all non-viable tissue maintains wound healing momentum; infected calcaneal osteomyelitis requires debridement of infected bone — partial calcanectomy preserves residual heel function when posterior calcaneus is preserved. Wound care hierarchy: 1) offloading (mandatory); 2) debridement; 3) infection control; 4) moisture management (non-adherent foam dressings; silver-containing dressings for bioburden control); 5) advanced wound care (NPWT/VAC for granulation promotion; biologic dressings for healing plateau). Dr. Biernacki at Balance Foot & Ankle manages diabetic heel ulcers with comprehensive wound care, offloading, and surgical debridement at our Bloomfield Hills and Howell offices. Call (810) 206-1402.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
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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
Frequently Asked Questions
How often should diabetics have their feet checked by a podiatrist?
People with diabetes should have a comprehensive foot examination by a podiatrist at least once per year, and more frequently (every 1–3 months) if they have neuropathy, poor circulation, history of foot ulcers, or active foot problems.
What is the biggest foot danger for diabetics?
Loss of protective sensation (neuropathy) combined with poor circulation creates a dangerous combination — minor injuries can go unnoticed and become infected. Foot ulcers affect 15–25% of diabetics over their lifetime and are the leading cause of non-traumatic amputations.
Does Medicare cover diabetic foot care?
Yes. Medicare covers annual diabetic foot exams for patients with peripheral neuropathy, as well as therapeutic shoes and inserts under the Diabetic Shoe Bill. Balance Foot & Ankle accepts Medicare.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Diabetic Heel Ulcer Treatment in Michigan
Balance Foot & Ankle provides expert wound care for diabetic heel ulcers using offloading, debridement, and advanced dressings. Our podiatrists specialize in limb salvage and healing chronic wounds.
Learn About Our Diabetic Wound Care → | Book Your Appointment | Call (810) 206-1402
Clinical References
- Armstrong DG, et al. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-2375.
- Bus SA, et al. IWGDF guidance on offloading foot ulcers in persons with diabetes. Diabetes Metab Res Rev. 2020;36(S1):e3274.
- Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care. 2015;4(9):560-582.
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 AppointmentDifferential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Diabetic Neuropathy and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Tarsal tunnel syndrome. Burning radiating into the arch with positive Tinel’s at the medial ankle.
- Peripheral artery disease. Pain with walking that resolves with rest, weak pulses, hair loss on toes.
- Lumbar radiculopathy. Symptoms following a dermatome, often with back pain — MRI of spine, not foot.
If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
In 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.
Most Common Mistake We See
The most common mistake we see is: Stopping B-vitamin supplementation as soon as symptoms improve. Fix: maintain supplementation for 6-18 months alongside strict glucose control.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Sudden loss of sensation on one side
- Wound on the foot not felt by the patient
- One-sided symptoms (rule out compression)
- Back pain plus leg symptoms (possible radiculopathy)
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
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 I see a podiatrist for heel pain without a referral?
How long does plantar fasciitis take to heal?
Should I walk on my heel if it hurts?
What does a podiatrist do for heel pain?
- 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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