Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Diabetic Peripheral Neuropathy: Foot Care Protocols and Comp relates to diabetic foot care — typically caused by reduced circulation + neuropathy. Most patients improve in ongoing daily inspection with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Diabetic peripheral neuropathy (DPN) affects 50% of people with diabetes over the course of their disease and is the primary driver of lower extremity ulceration, infection, and amputation — the most devastating diabetes complications. DPN impairs sensation (protective sensory loss), motor function (intrinsic muscle atrophy producing hammertoe and claw toe deformities), and autonomic regulation (anhidrosis producing dry, fissured skin). Comprehensive podiatric foot care and patient education directly reduce amputation risk by 45–85% in high-risk diabetic feet.
Neuropathy Screening and Risk Classification
The 10-gram monofilament test (Semmes-Weinstein 5.07 monofilament) is the primary screening tool for loss of protective sensation — inability to perceive the monofilament at any of the tested plantar sites indicates high ulceration risk. Vibration perception threshold testing (128 Hz tuning fork or biothesiometer) and ankle reflex assessment complete the neuropathy examination. The International Working Group on the Diabetic Foot (IWGDF) risk classification stratifies patients: Category 0 (no neuropathy, no deformity, normal perfusion), Category 1 (loss of protective sensation or PAD), Category 2 (loss of protective sensation plus PAD or foot deformity), and Category 3 (prior ulceration or lower extremity amputation). Higher-category patients require more frequent professional foot care visits (every 1–3 months for Category 3 versus annual screening for Category 0).
Daily Foot Inspection Protocol
Patients with loss of protective sensation cannot rely on pain as an early warning system — a significant ulcer may develop and advance to deep infection without the patient’s awareness. Daily foot inspection with a mirror (examining the plantar surface, between toes, and around the heel) is the cornerstone of self-management. Key warning signs requiring immediate podiatric evaluation include: any skin breakdown, blister, or wound regardless of size; redness, swelling, or warmth in any area; new callus formation or change in callus location; nail color changes, paronychia, or subungual hematoma; and any change in foot shape or new toe deformity.
Professional Foot Care Protocols
Regular podiatric foot care visits include assessment of protective sensation (monofilament, vibration), vascular status (ankle-brachial index, toe pressure, waveform analysis), dermatological examination (callus formation, fissures, maceration, interdigital tinea), nail assessment (onychomycosis, subungual hematoma, ingrown nails), biomechanical evaluation (deformity progression, pressure points), and footwear inspection. Callus debridement is critical — thick subkeratotic callus acts as a foreign body, concentrating plantar pressure and causing tissue necrosis before ulceration is visible through the skin surface. Custom orthotic therapy with extra-depth diabetic shoes (Medicare HCPCS codes A5500 and A5512) offloads high-pressure areas and is covered by Medicare Part B for eligible diabetic patients.
Wound Prevention and Early Intervention
Diabetic foot ulcer prevention requires identifying pre-ulcerative lesions — callus with subcutaneous hemorrhage, erythematous pressure areas, blistering under callus — and intervening before skin breakdown occurs. Extra-depth diabetic shoes with custom insoles reduce ulceration recurrence by 60% compared to standard footwear in high-risk patients. Nerve decompression surgery (Dellon procedure: tarsal tunnel release with decompression of the superficial peroneal, deep peroneal, and common peroneal nerves) may reduce ulceration risk in patients with superimposed nerve entrapment on diabetic neuropathy. Early ulcer intervention with total contact casting achieves 90%+ healing rates for Grade 1–2 neuropathic ulcers.
Diabetic Foot Care at Balance Foot & Ankle
Dr. Biernacki at Balance Foot & Ankle provides comprehensive diabetic foot care including monofilament and vascular screening, callus debridement, nail care, custom orthotic fabrication with Medicare-covered diabetic shoe fitting, and wound care for active ulcerations. Patients with diabetes qualify for Medicare-covered preventive foot care visits — call (810) 206-1402 to schedule your diabetic foot evaluation today.
Diabetes and Foot Problems? Get Preventive Care.
Medicare diabetic foot care visits accepted. Bloomfield Hills and Howell.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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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.
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Podiatrist-recommended products
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Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
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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
In-Office Treatment at Balance Foot & Ankle
When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Peripheral Neuropathy Treatment Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
Pros & Cons of Conservative Care for diabetic foot care
Advantages
- ✓ Daily inspection prevents amputation
- ✓ Most insurance covers DME
- ✓ Custom orthotics help
Considerations
- ✗ Daily commitment required
- ✗ Slow wound healing
- ✗ Charcot risk if neuropathy
Dr. Tom’s Recommended Products for diabetic foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Drew Moonwalker Diabetic Shoe Dr. Tom’s Pick
Best for: Medicare-covered diabetic footwear
Diabetic Compression Socks Dr. Tom’s Pick
Best for: Daily protection + circulation
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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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