Diabetic Wound Care Michigan 2026: Preventing Amputations | DPM

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Reviewed by Dr. Tom Biernacki, DPM, FACFAS

Board-certified foot & ankle surgeon · 3,000+ surgeries · @MichiganFootDoctors (950K+ subscribers)

Last reviewed May 11, 2026 · (810) 206-1402

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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 Township

Frequently Asked Questions

What do I do if I find a blister or cut?

Clean with soap and water, apply a thin layer of antibiotic ointment and a clean bandage. Then call your podiatrist the same day — not in 2 days, not “if it doesn't get better.” Diabetic wounds deteriorate faster than they improve; the clock starts as soon as the skin breaks. Do NOT soak the foot (maceration worsens). Do NOT use hydrogen peroxide or iodine (both kill healing cells).

What’s the difference between offloading and rest?

Rest = staying off the foot. Offloading = actively redirecting pressure away from the wound while still walking. A walking boot, total contact cast, or specialized shoe distributes load to areas away from the ulcer. Ulcers cannot heal while weight-bearing on them — offloading is the single most important treatment. Patients who try to heal ulcers while walking normally rarely succeed.

How often should I see a podiatrist if I have diabetes?

No history of ulcer, no neuropathy: annual exam. Neuropathy but no ulcer history: every 6 months. Prior ulcer: every 2-3 months indefinitely. Current ulcer: weekly until healed. Medicare typically covers these visits. Ongoing surveillance is the single largest factor separating patients who keep their limbs from those who don't.

What are the red flags that require ER?

Rapidly spreading redness, red streaking up the foot or leg, fever over 100.4, drainage with foul odor, deep wound exposing bone or tendon, black tissue (eschar), or severe pain out of proportion to the wound. Any of these = ER today, not tomorrow. Diabetic foot infections can progress to osteomyelitis (bone infection) or septicemia within 24-72 hours.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your diabetic foot conditions, our podiatry team at Balance Foot & Ankle can help with same-week evaluations and advanced in-office care.

Why a diabetic foot wound is not an ordinary wound

A foot ulcer comes first in up to about 85% of diabetes-related amputations — roughly eight in ten. That is what makes prevention possible: the amputation sits at the end of a chain, and the chain can be broken at several points, but only if the wound is found early.

The difficulty is that a diabetic foot wound is usually painless. Neuropathy removes the warning signal, so the symptom you would normally rely on is the one you cannot. Patients routinely arrive having walked on an open wound for weeks — not through neglect, but because nothing told them to stop. Reduced circulation then slows healing and limits how well antibiotics reach the tissue, and high glucose blunts the immune response, so an infection establishes faster than it otherwise would.

What needs care today, not in two weeks

Go to an emergency department the same day for fever or chills, redness spreading up the foot or leg, pus or a foul smell, black or grey tissue, a foot that is suddenly red, hot and swollen even with intact skin — that can be infection, or it can be a Charcot foot, where the bones of a numb foot begin to collapse, and it needs taking out of weight-bearing immediately — or blood sugars climbing for no clear reason.

An infected diabetic foot often has no fever and very little pain. Their absence does not rule infection out. Any open wound, new redness or unexplained swelling on a diabetic foot should be seen within 24 hours wherever possible, and no later than 72 hours.

What wound care actually involves

• Debridement. Callus, dead tissue and biofilm at the wound edge block healing. Removing them down to healthy margins converts a stalled wound back toward an acute one. This is usually painless where neuropathy is present and is repeated at most visits. The exception: a non-infected wound on a foot with severe, uncorrected poor circulation should not be sharply debrided — blood flow comes first.
• Offloading. Pressure is what keeps a wound on the sole open. For a wound on an otherwise uninfected, reasonably perfused foot, a total contact cast or a walker rendered non-removable are the two first-choice options; trials show little difference between them. Where there is significant infection, poor circulation or heavy drainage a removable device is used instead, because the wound has to be inspected often — sometimes daily — and the infection or circulation is treated first. A removable device only works during the hours it is actually worn.
• Infection control. Deep tissue cultures rather than a surface swab, antibiotics chosen for the likely organisms, and imaging if a sterile probe reaches bone — that raises real concern for osteomyelitis and changes the plan substantially.
• Circulation. Pulses alone are not enough. Guidelines recommend Doppler waveforms together with ankle-brachial index and toe pressures, because the ankle-brachial index can read falsely normal when leg arteries are calcified. If inflow is inadequate, revascularisation comes before more wound care.
• Dressings matched to the wound, keeping the bed clean and appropriately moist. Hydrogen peroxide and full-strength antiseptics damage the cells trying to rebuild it.

How healing is tracked, and when the plan should change

With consistent debridement and genuine offloading, most uncomplicated wounds on the sole close within about 6 to 12 weeks — in trials of non-removable casting close to 90% were healed by twelve weeks. Wounds complicated by poor circulation or infection take longer. The practical benchmark is earlier than that: a wound that has not reduced its area by about half after four weeks is unlikely to be healed by twelve weeks on the current plan. That is the point to re-check circulation, re-image for bone involvement, reassess how consistently the offloading device is worn, or consider advanced therapies such as skin substitutes, negative-pressure wound therapy or topical oxygen therapy. We measure at every visit for exactly that reason.

After it heals — preventing the next one

Roughly 40% of patients develop another ulcer within a year of healing and around 60% within three years. A healed ulcer is better understood as being in remission than cured, and follow-up should reflect that: every one to three months for anyone who has had an ulcer or an amputation.

• Inspect your feet daily, soles included, using a mirror or another person — looking for redness, blisters, warmth or colour change, not for pain.
• Never go barefoot, in socks alone, or in thin-soled slippers, indoors included.
• Check inside shoes before putting them on.
• Wash your feet but do not soak them; soaking macerates the skin.
• No heating pads or hot water bottles — you will not feel a burn until it is a wound.
• Have callus reduced professionally, and never use medicated corn pads or liquid removers; the acid causes wounds on insensate feet. Callus is what precedes most wounds on the sole.
• Protective footwear afterwards. Medicare’s therapeutic shoe benefit covers, once each calendar year for people who qualify, either one pair of custom-moulded shoes with two extra pairs of inserts, or one pair of extra-depth shoes with three pairs of inserts. The physician who treats your diabetes has to certify that you need them, and a podiatrist prescribes and fits them.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.