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 — the most common complication of diabetes mellitus, affecting 50% of patients with diabetes of 25+ years duration — is the principal risk factor for diabetic foot ulceration and lower extremity amputation. Loss of protective sensation in the feet eliminates the pain signal that normally triggers patients to offload an area of excessive pressure before tissue breakdown occurs. A systematic approach to neuropathy assessment, foot risk classification, and preventive care reduces amputation rates by up to 85% in high-risk patients.
Semmes-Weinstein Monofilament Testing
The 10-gram (5.07 Semmes-Weinstein) monofilament is the standard clinical instrument for identifying clinically significant loss of protective sensation (LOPS) in diabetic patients. Technique: the monofilament is applied perpendicular to the skin at standardized sites (plantar aspect of the hallux, first, third, and fifth metatarsal heads, plantar heel — 10 sites total per foot) with enough pressure to buckle the filament; the patient indicates whether they feel the touch with eyes closed. Interpretation: inability to feel the 10-gram monofilament at any single site indicates loss of protective sensation — the threshold below which patients cannot perceive pressure sufficient to cause tissue damage. Additional neuropathy testing: vibration sensation with a 128Hz tuning fork at the hallux IP joint; ankle reflexes; proprioception. Nerve conduction studies: the gold standard for confirming and characterizing peripheral neuropathy — distinguishes sensory, motor, and autonomic involvement and identifies focal entrapments superimposed on diffuse neuropathy.
Foot Risk Classification and Care Protocols
International Working Group on the Diabetic Foot (IWGDF) risk classification: Category 0 — no neuropathy (monofilament felt at all sites, intact reflexes) — annual foot exam, general footwear education. Category 1 — LOPS but no peripheral arterial disease and no foot deformity — foot exam every 6 months, therapeutic footwear guidance, patient education on daily foot inspection. Category 2 — LOPS with PAD or foot deformity — foot exam every 3 months, custom therapeutic footwear, high-risk foot care. Category 3 — history of foot ulcer or lower extremity amputation — foot exam every 1–3 months, intensive preventive care, specialized wound care team. Autonomic neuropathy contribution: anhidrosis (loss of sweating) from autonomic neuropathy produces dry, fissured skin that is highly susceptible to skin breakdown — daily moisturizing of plantar skin is a Category 1+ intervention. Dr. Biernacki at Balance Foot & Ankle performs comprehensive diabetic foot risk assessment including monofilament testing, ABI measurement, and deformity evaluation at every diabetic patient visit. Call (810) 206-1402 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.
In-Office Treatment at Balance Foot & Ankle
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.
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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
Frequently Asked Questions
What is the best treatment for peripheral neuropathy in the feet?
Treatment depends on the cause. For diabetic neuropathy, blood sugar control is most important. Other options include B12 supplementation, MLS laser therapy, topical creams (capsaicin, lidocaine), and prescription medications like gabapentin or duloxetine. Our podiatrists tailor treatment to each patient’s specific type and severity.
Can neuropathy be reversed?
In some cases — particularly when caused by vitamin deficiencies or early-stage diabetes with good glucose control. However, long-standing nerve damage is often permanent. Treatment focuses on slowing progression, managing symptoms, and preventing dangerous foot complications like ulcers.
How often should I see a podiatrist if I have neuropathy?
Patients with peripheral neuropathy should have comprehensive foot exams every 3–6 months, or more frequently if they have diabetes, poor circulation, or a history of foot ulcers.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Diabetic Neuropathy Foot Testing in Michigan
Balance Foot & Ankle performs monofilament testing and comprehensive neuropathy screening to identify diabetic patients at risk for foot ulcers. Early detection saves limbs.
Schedule Your Diabetic Foot Screening → | Book Your Appointment | Call (810) 206-1402
Clinical References
- Boulton AJ, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31(8):1679-1685.
- Feng Y, et al. The Semmes-Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg. 2009;50(3):675-682.
- Singh N, et al. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-228.
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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 AppointmentDifferential 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.
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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