Nervous about your first visit? Here is exactly what happens at the appointment so you can come prepared.
You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — serves patients here. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
Quick answer: First Podiatry Appointment What To Expect Michigan is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
The most important clinical decision with First Podiatry Appointment What To Expect Michigan isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
What to Expect at Your First Podiatry Appointment in Michigan
The 5 things we do at every new-patient visit — and how to make the hour count.
Every product in this guide was selected by a board-certified podiatrist based on clinical outcomes in real patients — not based on affiliate commission rates. We've ranked them based on biomechanical design, durability, patient compliance, and cost-to-benefit ratio. All picks are personally recommended in our Michigan clinics every week.
Biofreeze Professional Pain Relief Gel
The #1 clinician-recommended topical for musculoskeletal pain
Biofreeze Professional (4% menthol, 16oz pump) is the version of Biofreeze that physical therapy clinics and chiropractors actually stock, as opposed to the consumer tube sold at CVS. The mechanism is counter-irritation: menthol activates cold-sensing TRPM8 receptors in the skin, which overrides pain signals from deeper tissues via gate-control theory. It’s not fixing inflammation — it’s interrupting the nervous system’s pain report for roughly 4 hours per application. I recommend it for the nighttime plantar fasciitis flare that wakes patients at 3am, and for post-activity muscle soreness where you just need to sleep. Do not use on broken skin, do not apply heat over it, and wash hands before touching eyes.
- Plantar fasciitis flare
- Tendonitis
- Post-walk soreness
- Open wounds
- Skin sensitivity to menthol
- ✔ #1 clinician-recommended brand
- ✔ 16oz pump lasts 4-6 months
- ✔ 4-hour pain interruption
- ✔ Evidence-based counter-irritation
- ✖ Doesn’t treat underlying cause
- ✖ Skin sensitivity in 2-3% of users
Voltaren Arthritis Pain Gel (OTC diclofenac 1%)
The only OTC true anti-inflammatory topical
Voltaren (diclofenac sodium 1%) became OTC in 2020, and it’s the only topical NSAID the FDA has approved for OTC sale — which means it’s the only over-the-counter product that actually reduces inflammation rather than just masking pain. The diclofenac penetrates about 3-4mm through the skin into superficial tendons and joint capsules, which is why it works well for foot joints (small and close to the skin) but less well for deep muscle pain. Apply 4 times daily for 7 days; most patients notice reduced morning stiffness by day 3-4. Respect the NSAID side effect profile: don’t use if you have kidney disease, are on blood thinners, or are in the third trimester of pregnancy.
- Arthritis in foot joints
- Big-toe joint pain (hallux rigidus)
- Chronic tendon overuse
- NSAID allergy
- Kidney disease
- Pregnancy 3rd trimester
- ✔ Only OTC true anti-inflammatory topical
- ✔ Works for superficial joints and tendons
- ✔ FDA-approved for OTC
- ✔ Non-narcotic
- ✖ NSAID side effect profile applies
- ✖ 7-day maximum continuous use
Penetrex Joint & Muscle Therapy
Best budget menthol + arnica option
Penetrex is the broad-spectrum value pick: menthol (counter-irritation), arnica (traditional anti-bruise herb with modest evidence), MSM, and vitamin B6. The marketing is aggressive but the formula is reasonable and the price is fair. Patients who don’t want prescription-strength medication but want more than plain menthol tend to like it for evening-foot-fatigue complaints. Doesn’t smell strong like Biofreeze. Non-greasy absorption. Not FDA-approved for any specific condition — it’s a topical supplement, not a drug — so treat claims accordingly.
- General muscle soreness
- Restless legs
- Evening foot fatigue
- Acute injury (ice first)
- ✔ Multi-ingredient formula
- ✔ Doesn’t smell medical
- ✔ Non-greasy
- ✔ Lasts 3-4 months with daily use
- ✖ Less rigorous evidence than Biofreeze/Voltaren
- ✖ Aggressive marketing claims
Products Not Enough? See Michigan's Top Foot Doctors.
Same-week appointments in Howell and Bloomfield Hills. Most insurance accepted. 3,000+ surgeries performed. Patient-first practice — we listen.
Head-to-Head Comparison
Quick reference across all picks. Click any product name to jump to its full review above.
Frequently Asked Questions
What should I bring to my first visit?
Photo ID + insurance card, a list of all medications (including supplements), any prior X-rays or MRI reports on CD or via patient portal, the shoes you wear most (work shoes, running shoes, daily shoes), a written list of your symptoms (when they started, what makes them worse/better, what you've tried). Wear clothing that allows exam above the knee.
Will I get X-rays at the first appointment?
Usually yes — we have digital X-ray on-site and can image weight-bearing views in under 5 minutes. Weight-bearing images are critical (standing shows what sitting doesn't). If you have outside imaging from an ER or urgent care, bring the CD or request records 5+ days before your appointment.
How long is the first appointment?
45 to 60 minutes, sometimes 75 for complex cases (e.g., diabetic multi-system evaluation, revision surgery consultation). Follow-up appointments are shorter (20-30 minutes). Schedule a morning appointment if your symptoms worsen with activity — we want to see what's actually happening.
Will I leave with a diagnosis and plan?
In 85% of cases, yes. The remaining 15% need additional imaging (MRI, CT, bone scan), vascular studies, or specialty referrals to complete the workup. Either way, you'll leave with concrete next steps, expected timeline, and cost transparency — no one should leave confused about what happens next.
Sources & References
Related Guides
How to Choose the Right Podiatrist
Related podiatrist-written guide from Balance Foot & Ankle.
5 Signs You Need a Podiatrist
Related podiatrist-written guide from Balance Foot & Ankle.
Podiatrist vs Orthopedist
Related podiatrist-written guide from Balance Foot & Ankle.
First visit = 45-60 minutes, on-site X-ray, treatment plan with options. Bring meds, shoes, imaging. Wear shorts or loose pants. You'll leave with a clear next step. Most patients ask why they waited.
Products Not Enough? See Michigan's Top Foot Doctors.
Same-week appointments in Howell and Bloomfield Hills. Most insurance accepted. 3,000+ surgeries performed. Patient-first practice — we listen.
Balance Foot & Ankle — Michigan's Most-Trusted Podiatry Group
4.9★ · 1,123+ patient reviews · 3,000+ surgeries · 950K+ YouTube subscribers
When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, CURREX, Spenco, Vionic, and Tread Labs — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- APMA-accepted with superior cushioning versus rigid alternatives
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than most premium alternatives for 90% of patients, which is why it’s the first orthotic I reach for in the clinic. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
Tread Labs Pace insole with firm orthotic arch support for flat feet and plantar fasciitis relief. The replaceable top cover design makes it one of the most durable picks in this guide — backed by a million-mile guarantee and recommended for tight-fitting athletic footwear.
✓ Pros
- Firm orthotic arch support shell (podiatrist-grade)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
Visit Balance Foot & Ankle — Same-Day Appointments Available
Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.
Same-day appointments available. (810) 206-1402
Doctor Hoy’s Natural Pain Relief Gel
Natural topical pain relief I use in our clinic. Arnica + camphor formula — apply directly to the area 3–4x daily. ($20–25)
Shop Doctor Hoy’s →Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
Our podiatrists treat the underlying cause, not just the symptom. Same-week appointments at our Howell and Bloomfield Hills, Michigan 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.
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.