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.
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
The Perfect Storm: Diabetes Plus Kidney Failure
End-stage renal disease (ESRD) requiring dialysis, when combined with diabetes, creates the highest-risk foot health scenario in all of medicine. The combination of diabetic peripheral neuropathy, peripheral arterial disease (which is dramatically accelerated in renal failure), impaired immunity from uremia, fluid imbalance causing edema, and calcium-phosphate dysregulation leading to arterial calcification creates a patient population where minor foot problems can progress to limb-threatening complications within days. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we provide intensive preventive foot care for this highest-risk patient population as a priority of our diabetic foot program.
Why Dialysis Accelerates Foot Risk
End-stage renal disease independently creates foot complications beyond those from diabetes alone. Uremic peripheral neuropathy: kidney failure itself causes a uremic neuropathy that compounds diabetic neuropathy — patients may have complete loss of protective sensation in both feet. Medial arterial calcification (Mönckeberg sclerosis): the calcium-phosphate dysregulation of renal failure causes arterial wall calcification independent of atherosclerosis, making the ABI unreliable (falsely elevated) and requiring toe pressure measurement for vascular assessment. Fluid shifts: dialysis causes dramatic fluid shifts — significant pedal edema between sessions followed by fluid removal — stressing foot skin and creating environments where infections can develop rapidly. Immune dysfunction: uremia impairs white blood cell function, reducing the ability to fight infections that penetrate the foot.
Preventive Care Protocol for Dialysis Patients
Diabetic dialysis patients require the most intensive preventive foot care protocol available. Frequency: minimum every 6-8 weeks for professional nail care, callus management, and wound inspection — more frequently for patients with active issues. Nail care: in this population, even routine nail trimming requires professional skill and appropriate instruments to avoid skin microtrauma that can serve as infection entry points. Skin assessment: checking between toes, under calluses, and around heels for any skin breakdown at every visit. Footwear assessment: ensuring adequate width, depth, and cushioning to prevent pressure injury. Patient education: daily self-inspection of the feet (or assisted inspection for patients with vision problems), immediate reporting of any new redness, wound, or discoloration.
Emergency Response Protocol
Diabetic dialysis patients must know that foot infections are medical emergencies — not wounds to treat at home with antibiotic ointment and a bandage. Any of the following requires same-day emergency evaluation: new redness extending more than 2cm from a wound, any purulent drainage, fever or chills with foot pain, any dark discoloration of a toe (suggesting vascular compromise), or any new foot wound that the patient did not notice forming. The window between minor foot wound and life- or limb-threatening infection in this population can be measured in days. Contact Balance Foot & Ankle at (810) 206-1402 to establish preventive care for high-risk diabetic patients, including those on dialysis.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
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📞 (810) 206-1402
When to See a Podiatrist for Diabetic Foot Care on Dialysis
Patients with diabetes on dialysis face the highest risk of foot ulcers and amputation. At Balance Foot & Ankle, Dr. Tom Biernacki provides comprehensive diabetic foot care including regular exams, advanced wound management, vascular assessment coordination, and protective footwear to prevent limb-threatening complications.
Learn About Our Diabetic Wound Care Services | Book Your Appointment | Call (810) 206-1402
Clinical References
- Ndip A, Lavery LA, Boulton AJ. Diabetic foot disease in people with advanced nephropathy and those on renal dialysis. Curr Diab Rep. 2010;10(4):283-290.
- Lavery LA, Hunt NA, Ndip A, et al. Impact of chronic kidney disease on survival after amputation in individuals with diabetes. Diabetes Care. 2010;33(11):2365-2369.
- Game FL, Attinger C, Hartemann A, et al. IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):75-83.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
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 AppointmentIn 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.
More Podiatrist-Recommended Diabetic Essentials
Diabetic-Approved Walking Shoe
Orthofeet Sprint — seamless, extra-depth, designed for neuropathic feet.
Seamless Diabetic Sock
OS1st FS4 — non-binding, moisture-wicking, protects fragile diabetic skin.
Recovery Slide for Indoor Wear
HOKA Ora 3 — protects diabetic feet from barefoot injury at home.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
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
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
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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
Can a podiatrist help with neuropathy?
What does neuropathy in feet feel like?
Is foot neuropathy reversible?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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