Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
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.
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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.
Diabetic peripheral neuropathy affects approximately 50% of patients with longstanding diabetes and is the primary risk factor for diabetic foot ulceration, Charcot arthropathy, and lower extremity amputation. Most of this devastating pathology is preventable with systematic screening, patient education, and appropriate prophylactic podiatric care — making the annual comprehensive diabetic foot examination one of the highest-impact preventive medicine interventions available.
The Annual Comprehensive Diabetic Foot Examination
The American Diabetes Association and the American College of Foot and Ankle Surgeons recommend annual comprehensive foot examinations for all patients with diabetes. Components include: monofilament testing (10-gram Semmes-Weinstein monofilament at 10 plantar sites — inability to detect the monofilament identifies loss of protective sensation, the primary neuropathic risk factor); vibration perception testing with a 128 Hz tuning fork; ankle reflexes; vascular assessment (pedal pulse palpation, ABI measurement for abnormal results); inspection for deformity, callus, nail pathology, and skin breakdown; and footwear assessment. Patients who fail the monofilament test have a 7-fold increased risk of foot ulceration over the subsequent 3 years — these are the patients who require more frequent monitoring and intensive preventive care.
Neuropathic Risk Stratification
The International Working Group on the Diabetic Foot (IWGDF) stratification system is the most clinically useful risk classification: Low risk (no neuropathy, no PAD, no deformity) — annual examination; Moderate risk (neuropathy OR PAD or deformity) — every 3–6 months; High risk (neuropathy AND PAD or deformity, or prior ulceration, or amputation) — every 1–3 months. The majority of patients with prior diabetic foot ulcers fall into the high-risk category and require very frequent monitoring — the annual recurrence rate of diabetic foot ulcers in this population approaches 40%.
Preventive Care Essentials
Daily foot self-inspection (patient inspects all surfaces, including between toes, using a mirror for plantar surfaces); protective footwear (extra-depth shoes with custom-molded insoles reduce ulcer recurrence by 50–60%); professional nail and callus care by a podiatrist (self-trimming of callus in neuropathic patients frequently produces lacerations they cannot feel, creating portal-of-entry infections); glycemic optimization; and smoking cessation (which dramatically accelerates PAD progression). Dr. Biernacki at Balance Foot & Ankle provides comprehensive diabetic foot care including annual examinations, nail and callus debridement, custom orthotics, and wound care. Call (810) 206-1402 to schedule your diabetic foot exam at our Bloomfield Hills or Howell office.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Why Regular Podiatric Care Is Essential for Diabetics
Diabetes affects the feet in two critical ways that work together to create risk: neuropathy (loss of protective sensation) and peripheral arterial disease (reduced circulation). Together, these mean that small injuries can go unnoticed and heal poorly — creating a pathway to serious infection.
The Numbers That Matter for Your Feet
- HbA1c below 7%: The ADA goal for most diabetics — higher levels accelerate neuropathy and circulation damage
- Annual comprehensive foot exam: Standard of care for all diabetics
- Daily foot inspections: Check for cuts, blisters, redness, swelling, or changes in skin color
- Never barefoot: Loss of sensation means you may step on something without feeling it
At Balance Foot & Ankle, we see diabetic patients for comprehensive foot care including neuropathy screening, nail care, wound assessment, and diabetic orthotics.
Related Conditions & Resources
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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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Howell, MI 48843
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If home care isn’t resolving your diabetic foot concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
Differential 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.
More Podiatrist-Recommended Diabetic Essentials
Diabetic Compression Sock
Seamless, non-binding — improves circulation without constricting fragile skin.
Diabetic-Safe Lotion
Hydrates dry cracking feet without irritating neuropathic skin.
Diabetic Foot Mirror
Daily inspection tool — catches ulcers 3-4 weeks earlier than self-exam.
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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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?
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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