The Stakes of Diabetic Foot Disease

Diabetes is the leading cause of non-traumatic lower extremity amputation in the United States — approximately 70,000 amputations occur annually in diabetic patients, and the vast majority are preventable with appropriate preventive care. The progression from diabetes to ulceration to infection to amputation follows a predictable pathway — and annual podiatric foot examinations exist specifically to interrupt this progression before it reaches its most devastating stages.

At Balance Foot & Ankle in Howell and Bloomfield Township, comprehensive diabetic foot exams are among the most important services we provide. Every diabetic patient should receive one annually at minimum, regardless of current symptoms.

What Diabetic Peripheral Neuropathy Does to the Foot

Peripheral neuropathy affects the nerves supplying sensation, motor control, and autonomic function to the foot. Sensory neuropathy eliminates protective sensation — the ability to feel pain, temperature, pressure, and vibration. Without this warning system, patients sustain injuries (from ill-fitting shoes, small stones in their shoe, stepping on objects) that go unnoticed and progress to infected ulcers.

Motor neuropathy weakens the intrinsic foot muscles, causing hammertoe deformities and abnormal weight distribution that create focal pressure hotspots. Autonomic neuropathy reduces sweating, leading to dry, cracked skin that provides an entry point for bacteria. Together, these components create the “diabetic foot” — one that cannot feel, has deformed pressure points, and heals poorly.

Components of the Annual Diabetic Foot Exam

The 10-gram monofilament test is the cornerstone of sensory neuropathy assessment. A standardized monofilament is pressed at specific sites on the plantar foot until it bends (this represents 10 grams of pressure). Inability to feel the monofilament at any site indicates significant sensory loss — the patient has lost protective sensation at that location. This is the single most important predictor of ulceration risk.

Vibration testing using a 128 Hz tuning fork at the great toe dorsum detects large-fiber neuropathy — loss of vibration sensation precedes loss of pain and pressure sensation in many patients. The ankle reflex (which is reduced or absent in peripheral neuropathy) is assessed bilaterally. Vascular assessment includes palpation of dorsalis pedis and posterior tibial pulses and, when clinically indicated, measurement of the ankle-brachial index (ABI) to screen for peripheral arterial disease.

Skin and nail examination assesses for dry skin, calluses (which are pre-ulcerative lesions), fissures, ulcers (present or healed), and nail abnormalities. Foot deformity (hammertoes, bunions, Charcot deformity) is documented as it creates risk for pressure injuries in footwear.

Risk Stratification

Based on examination findings, patients are stratified by risk: Low Risk (normal sensation, pulses, no deformity): annual exam. Moderate Risk (neuropathy or vascular disease without ulceration): every 3–6 months. High Risk (neuropathy with deformity or vascular disease): every 1–3 months. Very High Risk (previous ulceration or amputation): monthly. Higher-risk patients need more frequent monitoring and more intensive preventive interventions.

What Happens After the Exam

Findings guide management recommendations: callus debridement, prescription for diabetic footwear (covered by Medicare for qualifying patients), wound care initiation for early ulcers, vascular surgery referral for patients with significant PAD, and patient education reinforcement. The visit is also an opportunity to reinforce daily foot inspection habits, footwear compliance, and glycemic control goals.

If you have diabetes and haven’t had a podiatric foot exam in the past year, please schedule one now. Medicare covers this examination. Contact Balance Foot & Ankle — a single exam could prevent months of wound care, surgery, and potentially limb loss.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

📅 Book Online
📞 (810) 206-1402

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

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.