✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

For Endocrinologists: Our Diabetic Foot Care Protocol at Balance Foot & Ankle

Diabetic foot complications represent one of the most preventable yet devastating consequences of diabetes. Our protocol is designed to integrate seamlessly with your endocrinological management for comprehensive, coordinated patient care.

Our Diabetic Foot Exam Protocol

Every diabetic patient receives a comprehensive assessment covering four domains:

1. Neurological: 10-gram Semmes-Weinstein monofilament testing at 10 plantar sites, 128Hz tuning fork for vibratory threshold, deep tendon reflexes
2. Vascular: Pedal pulse assessment (dorsalis pedis, posterior tibial), capillary refill, skin temperature gradient, ABI if indicated
3. Musculoskeletal: Gait analysis, range of motion assessment, deformity documentation (hammertoes, bunions, Charcot changes), pressure mapping
4. Dermatological: Skin integrity assessment, ulceration screening, callus documentation, nail health evaluation

Risk Stratification & Visit Frequency

Our Wound Care Protocol — Including MLS Laser Therapy

For non-healing diabetic wounds, our protocol includes:

1. Sharp debridement at each visit to remove necrotic tissue and stimulate wound bed
2. Appropriate offloading: Total contact casting (gold standard), removable cast walkers, or custom offloading footwear
3. MLS dual-wavelength laser therapy 2x/week: Accelerates microcirculation, reduces chronic wound inflammation, stimulates cellular ATP production — proven to accelerate wound closure
4. Advanced wound care products: Selected based on wound stage (dry/moist, infected/non-infected)
5. Glycemic coordination: We communicate directly with your office when wound healing appears limited by glycemic control

Medicare-Covered Diabetic Foot Benefits

Many of your patients are not receiving benefits they’re entitled to. We ensure full utilization of:

• Annual diabetic foot exam (G0245/G0246) — covered for all Medicare diabetic patients
• Therapeutic footwear — shoes + 3 inserts annually for high-risk patients (A5500-A5513)
• Routine foot care (Class Findings) — nail care for patients with qualifying risk conditions
• Wound care services — covered under various codes depending on wound complexity

Contact Us for Coordinated Care

We’d welcome the opportunity to establish a formal care coordination relationship with your practice. Call (810) 206-1402 or have your referral coordinator reach out to discuss our workflow.

Clinical Foot Care Beyond Products: Michigan’s Balance Foot & Ankle

Michigan patients using foot care products — wound care supplies, topical treatments, foot supplements, compression garments, orthotics, or stretching devices — as part of their foot health routine benefit from occasional clinical evaluation to ensure the products they are using are appropriate for their specific condition and that no developing pathology requires professional intervention. At Balance Foot & Ankle, our clinical evaluation confirms the diagnosis, assesses whether current product-based management is adequate, and identifies cases where professional treatment would produce better outcomes than continued self-management.

For Michigan patients managing chronic conditions — diabetic foot care, neuropathy management, post-surgical recovery, or persistent tendinopathy — regular podiatric check-ins at appropriate intervals ensure that small changes are caught before they become significant complications. The right interval varies by condition and risk level: high-risk diabetic patients benefit from quarterly visits; stable patients using products for minor chronic conditions may need only annual check-ins. At Balance Foot & Ankle, we help patients identify the appropriate visit frequency for their specific situation. Livingston and Oakland County patients can call (810) 206-1402 to schedule at our Howell or Bloomfield Hills office.

Michigan patients can access expert diabetic foot care in Michigan at Balance Foot & Ankle. Our board-certified podiatrists serve Howell (4330 E Grand River) and Bloomfield Hills (43494 Woodward Ave #208). Schedule an appointment online or call (810) 206-1402 for same-week availability.

Related Patient Guides

• Diabetic Foot Care Daily Routine
• Neuropathy Exercises for Feet
• Neuropathy in Feet: Relief Guide
• PAD & Foot Symptoms: Circulation Warning Signs
• 12 Signs You Need to See a Podiatrist

Medical References & Sources

• American Diabetes Association — Foot Complications
• PubMed Research — Diabetic Foot Care
• American Podiatric Medical Association — Diabetic Foot

Clinical References

1. Boulton AJ, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31(8):1679-1685.
2. Bus SA, et al. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):16-24.
3. American Diabetes Association. Standards of medical care in diabetes — foot care. Diabetes Care. 2023;46(Suppl 1):S203-S215.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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.