Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Quick answer: Diabetic foot care is essential for preventing ulcers, infections, and amputations. Our Michigan podiatrists perform thorough diabetic foot exams, monitor circulation and nerve function, and provide personalized care plans — catching and treating problems early before they become serious complications.
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
| Neuropathy Type | Fiber Type Affected | Symptoms | Clinical Test | Foot Risk |
|---|---|---|---|---|
| Distal Symmetric Polyneuropathy (DSPN) | Small fiber (pain/temp) first → large fiber (vibration/proprioception) | Burning, numbness, tingling in stocking-glove pattern; worse at night | 10g monofilament; vibration (128Hz tuning fork); pinprick | Highest — ulceration, Charcot, amputation |
| Autonomic Neuropathy | Autonomic fibers (sweat glands, blood vessels) | Dry, cracked skin; loss of sweating; dependent edema; anhidrosis | Heart rate variability; orthostatic BP | High — cracked skin = entry point for infection |
| Motor Neuropathy | Motor neurons → intrinsic foot muscles | Intrinsic minus foot; hammertoes; claw toes; prominent metatarsal heads | Grip strength; foot deformity assessment | Moderate-high — pressure points from deformity |
| Mononeuropathy / Entrapment | Single nerve (peroneal, tarsal tunnel) | Focal weakness or sensory loss; asymmetric | Nerve conduction study (NCS/EMG) | Moderate — depends on nerve affected |
| Intervention | Category | Evidence Level | Benefit | Notes |
|---|---|---|---|---|
| Glycemic Optimization (A1c <7%) | Disease-modifying | Level I | Prevents progression; may partially reverse early neuropathy | Primary prevention strategy — all other treatments are symptomatic |
| Pregabalin (Lyrica) | Neuropathic pain (symptom) | Level I — FDA approved | 30–50% pain reduction in responders | Side effects: sedation, weight gain, edema; first-line with duloxetine |
| Duloxetine (Cymbalta) | Neuropathic pain (symptom) | Level I — FDA approved | 30–50% pain reduction; also treats depression comorbidity | SNRI; start low; first-line alongside pregabalin |
| Topical Capsaicin 8% Patch | Neuropathic pain (symptom) | Level II | Up to 30% pain reduction; localized effect | Single application q3 months; local burning during application |
| Custom Diabetic Insoles + Therapeutic Footwear | Ulcer prevention | Level I | Reduces plantar pressure 50–60%; lowers re-ulceration 60% | Medicare covers therapeutic shoes + 3 insoles annually for diabetic patients |
| MLS Laser Therapy | Symptom + circulation | Level II–III | Pain reduction; improved microcirculation; nerve regeneration signal | Non-invasive; 6–9 sessions typical; no systemic side effects |
| Annual Comprehensive Foot Exam | Surveillance | Level I | Early ulcer detection; reduces amputation 45–85% | ADA recommends annual exam for all diabetics; more frequent if neuropathy present |
Diabetic peripheral neuropathy is rarely curable but is highly manageable. The right combination of glucose control, medication, supplements, and daily inspection prevents most of the serious complications.
You’re in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what diabetic peripheral neuropathy treatment means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
Watch: Peripheral Neuropathy Home Remedies [Leg & Foot Nerve Pain Treatment] — MichiganFootDoctors YouTube
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Diabetic peripheral neuropathy causes burning, tingling, and numbness in the feet due to high blood sugar damaging nerves. Dr. Biernacki treats neuropathy with glucose control support, pain management, protective footwear, and advanced therapies like MLS laser to reduce symptoms and prevent ulceration.
Diabetic peripheral neuropathy is one of the most common complications of diabetes, affecting nerves in the feet and causing burning, tingling, numbness, and loss of protective sensation. At Balance Foot & Ankle, Dr. Tom Biernacki specializes in managing diabetic neuropathy and preventing serious complications like foot ulcers and amputations through comprehensive foot care and advanced treatments.
Understanding Diabetic Neuropathy
Prolonged high blood sugar damages the small nerves in the feet, leading to loss of sensation and increased risk of injury. Neuropathy often goes unnoticed until significant nerve damage has occurred. Regular foot exams are critical to catch neuropathy early and prevent irreversible complications. Dr. Biernacki uses advanced testing including monofilament testing and vibration sense assessment to detect neuropathy and track progression.
Prevention and Early Detection
The best treatment for diabetic neuropathy is prevention through tight glucose control and regular foot care. Dr. Biernacki recommends daily foot inspections, proper footwear, and professional foot care at least annually. Early detection of neuropathy allows for aggressive management before permanent nerve damage occurs.
Treatment for Neuropathic Pain
For patients experiencing neuropathic pain, Dr. Biernacki offers multiple treatment options: topical pain relief creams, oral neuropathy medications, MLS laser therapy to improve nerve function and reduce pain, and custom diabetic orthotics. These therapies work together to control pain and improve quality of life while protecting the foot from further injury.
Ulcer Prevention and Management
Patients with neuropathy lose protective sensation and may not feel foot injuries. Dr. Biernacki emphasizes preventive footwear including diabetic shoes with rocker bottoms and custom insoles to redistribute pressure. If ulcers develop, prompt professional treatment prevents infection and serious complications including amputation.
Dr. Tom's Product Recommendations
Diabetic Foot Care Kit
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Essential daily foot inspection and care tools for diabetic patients.
Dr. Tom says: “This kit helps me monitor my feet daily like Dr. Biernacki recommended.”
Daily diabetic foot inspection and care
Not a substitute for professional foot exams
Disclosure: We earn a commission at no extra cost to you.
Neuropathy Pain Relief Cream
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Topical neuropathy relief cream with capsaicin and menthol.
Dr. Tom says: “This cream takes the burning edge off my neuropathy pain.”
Neuropathic pain relief
Use with caution and follow label directions
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Early detection prevents serious complications
- Multiple pain management options available
- MLS laser therapy effective for neuropathy
- Preventive footwear and orthotics reduce ulcer risk
❌ Cons / Risks
- Neuropathy damage is often irreversible
- Requires ongoing glucose management and foot care
- Some patients have poor pain control responses
Dr. Tom Biernacki’s Recommendation
Diabetic neuropathy scares me more than any other condition because it silently causes permanent nerve damage. The feet become vulnerable to injury that the patient can’t feel. That’s why I’m aggressive about prevention—regular monitoring, education about foot care, and early intervention when I detect neuropathy. Amputations are preventable with proper management.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How do I know if I have diabetic neuropathy?
Early signs include tingling or numbness in the feet, burning pain, or loss of temperature sensation. If you have diabetes, ask Dr. Biernacki for a neuropathy screening at your next visit. Early detection is key.
Can diabetic neuropathy be reversed?
Unfortunately, once nerves are damaged, the damage is usually permanent. However, tight glucose control can slow progression, and treatments can reduce pain and prevent complications. Early intervention is critical.
How often should I see a podiatrist if I have neuropathy?
Patients with diabetic neuropathy should see Dr. Biernacki at least annually, or more frequently if complications develop. Some high-risk patients benefit from quarterly visits and careful monitoring.
What kind of shoes should I wear if I have neuropathy?
Look for diabetic shoes with a rocker bottom, extra depth, padded insoles, and wide toe box. Avoid tight shoes, high heels, and rough seams. Dr. Biernacki can recommend specific shoes and custom orthotics for your feet.
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DASS Compression SocksGraduated compression for circulation & comfort
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If home treatment isn’t providing relief for your neuropathy, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
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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
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Is foot neuropathy reversible?
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