Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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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 →
What Is Diabetic Peripheral Neuropathy?
Diabetic peripheral neuropathy (DPN) is damage to the peripheral nerves caused by chronic exposure to high blood glucose levels. It’s the most common complication of diabetes, affecting approximately 50% of people with type 2 diabetes within 10 years of diagnosis and up to 60–70% over a lifetime. DPN is the primary reason diabetic feet lose protective sensation — making them vulnerable to injury, ulceration, and infection that can lead to amputation.
At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, comprehensive diabetic neuropathy assessment is a core part of every diabetic foot evaluation we perform.
How Neuropathy Develops
High blood glucose causes several damaging processes in peripheral nerves:
- Advanced glycation end-products (AGEs) accumulate in nerve tissue, impairing conduction
- Oxidative stress damages myelin sheaths and nerve cell membranes
- Microvascular damage reduces blood supply (and therefore oxygen) to nerve fibers
- Polyol pathway activation depletes nerve cell energy production
Small sensory fibers (which carry pain and temperature) are affected first, followed by large fibers (touch, vibration, position sense), then motor fibers. Autonomic fibers (controlling sweating, skin regulation) are also affected, leading to dry, cracked skin that is more vulnerable to breakdown.
Progression of Diabetic Neuropathy in the Feet
Stage 1: Subclinical (No Symptoms)
Measurable nerve conduction abnormalities without patient-reported symptoms. Detectable only with nerve conduction studies or careful clinical testing. Estimated 30–40% of diabetics are in this stage at the time of diabetes diagnosis if T2DM has been undetected for years.
Stage 2: Symptomatic Neuropathy
The patient notices symptoms — typically beginning in the toes and advancing upward in a “stocking” distribution. Common symptoms:
- Tingling, “pins and needles” sensation in the toes and feet
- Burning pain — often worse at night
- Electric shock or jabbing sensations
- Heightened sensitivity — even light touch is painful (allodynia)
- Numbness — the sensory “deadline” where sensation stops and absence begins
Stage 3: Loss of Protective Sensation
The most dangerous stage — but often the least symptomatic. The painful, burning phase passes as nerves die; the patient may feel “better” but actually has lost the protective signals that warn of injury. Monofilament testing (10-gram Semmes-Weinstein monofilament) detects this loss. A patient who cannot feel the monofilament is at high risk for painless ulceration.
Stage 4: Motor and Autonomic Involvement
Motor neuropathy causes weakness of intrinsic foot muscles — producing hammertoes, claw toes, and forefoot structural changes that create new pressure points for ulceration. Autonomic neuropathy causes dry, cracked skin (lack of sweating), increased skin fragility, and Charcot neuroarthropathy in severe cases.
Slowing Neuropathy Progression: What Works
Blood Glucose Control: The Most Important Factor
Intensive glycemic control has been proven to reduce the development of neuropathy by 60% in type 1 diabetes (DCCT trial) and 35% in type 2 diabetes (UKPDS trial). Every percentage point reduction in HbA1c matters. A1c targets should be individualized with your endocrinologist.
Blood Pressure and Cholesterol Control
Both hypertension and hyperlipidemia accelerate microvascular damage to nerves. Tight control of BP (under 130/80) and LDL cholesterol provides meaningful neuroprotection.
Smoking Cessation
Smoking significantly reduces peripheral circulation, worsening both neuropathy and PAD. Quitting smoking is one of the single most impactful actions a diabetic patient can take for their foot health.
Exercise
Regular aerobic exercise improves nerve function, reduces oxidative stress, and enhances microvascular blood flow to peripheral nerves. Even 30 minutes of walking 5 days per week produces measurable neuroprotective benefits.
Managing Neuropathic Pain
When neuropathic pain affects quality of life:
- Pregabalin (Lyrica): FDA-approved for diabetic neuropathic pain; reduces pain scores significantly in clinical trials
- Duloxetine (Cymbalta): FDA-approved; a serotonin-norepinephrine reuptake inhibitor with proven efficacy for DPN pain
- Gabapentin: Off-label but widely used; structurally similar to pregabalin
- Tricyclic antidepressants: (Amitriptyline, nortriptyline) — effective but side effect profile limits use in older patients
- Topical capsaicin or lidocaine: Useful for localized burning pain with minimal systemic effects
Podiatric Management of Diabetic Neuropathy
- Annual neurovascular assessment: monofilament, vibration, ABI, pedal pulses
- Therapeutic footwear prescription (Medicare-covered extra-depth diabetic shoes + inserts)
- Routine nail and callus care to prevent skin breakdown
- Patient education on daily foot inspection protocol
- Prompt wound evaluation and management when ulceration occurs
The Stakes Are High — But Prevention Is Possible
Approximately 80% of lower extremity amputations in diabetes are preceded by a foot ulcer. The majority of foot ulcers are preventable with adequate glycemic control, regular podiatric monitoring, proper footwear, and daily foot inspection. At Balance Foot & Ankle, we partner with diabetic patients for the long term — helping them protect their feet and maintain their quality of life through every stage of neuropathy progression.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
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When to See a Podiatrist for Diabetic Neuropathy
Diabetic neuropathy in the feet progresses silently, often causing severe damage before symptoms become obvious. Regular monitoring by a podiatrist can detect early changes and prevent complications. Dr. Tom Biernacki at Balance Foot & Ankle provides comprehensive diabetic neuropathy management.
Learn About Our Neuropathy Treatment Options | Book Your Appointment | Call (810) 206-1402
Clinical References
- Pop-Busui R, et al. “Diabetic neuropathy: a position statement by the American Diabetes Association.” Diabetes Care. 2017;40(1):136-154.
- Tesfaye S, et al. “Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments.” Diabetes Care. 2010;33(10):2285-2293.
- Boulton AJ, et al. “Diabetic neuropathies: a statement by the American Diabetes Association.” Diabetes Care. 2005;28(4):956-962.
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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 AppointmentIn 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.
More Podiatrist-Recommended Diabetic Essentials
Diabetic-Approved Walking Shoe
Orthofeet Sprint — seamless, extra-depth, designed for neuropathic feet.
Seamless Diabetic Sock
OS1st FS4 — non-binding, moisture-wicking, protects fragile diabetic skin.
Recovery Slide for Indoor Wear
HOKA Ora 3 — protects diabetic feet from barefoot injury at home.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
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
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Podiatrist-recommended products
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When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Diabetic Foot Care Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
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 a podiatrist help with neuropathy?
What does neuropathy in feet feel like?
Is foot neuropathy reversible?
- 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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