Foot Problems After a Spinal Cord Injury: Comprehensive Podiatric Care

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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Foot Care After Spinal Cord Injury

Spinal cord injury (SCI) dramatically alters foot health through multiple mechanisms: loss of protective sensation below the injury level removes the warning system that normally prevents foot damage, paralysis eliminates the normal muscular support and movement that prevents deformity, autonomic dysfunction affects circulation and skin health, and the mechanical demands of wheelchair use, bracing, and transfers create unique pressure and friction patterns. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we provide specialized podiatric care for SCI patients throughout their recovery and long-term management.

Insensate Foot: The Core Challenge

The complete or partial loss of protective sensation below the injury level means that pressure, friction, temperature extremes, and wounds go undetected. This creates catastrophic potential for injury accumulation — what would be painful and immediately corrected in a sensate person becomes a chronic, progressive wound in an insensate patient. Daily foot inspection — by the patient when upper extremity function permits, or by a caregiver — is the most important preventive measure. Mirror inspection of the sole, systematic checking of all pressure-bearing surfaces including heel and malleoli, and immediate attention to any area of skin breakdown are non-negotiable.

Pressure Injuries: Prevention and Management

Pressure injuries (formerly called pressure ulcers or decubitus ulcers) develop over bony prominences where tissue is compressed between skin and hard surfaces — the heel is particularly vulnerable in bedridden or wheelchair-bound SCI patients. Prevention: heel-offloading boots for at-risk patients in bed, pressure-redistributing mattresses and seat cushions, regular repositioning, and meticulous skin inspection. Any heel or foot pressure injury in an SCI patient requires immediate offloading and professional wound care — insensate tissue heals poorly and infection can spread rapidly without the warning of pain.

Spasticity and Foot Deformity

Spasticity — the hyperreflexive muscle activity below the injury level — creates powerful and persistent forces that deform the foot over time. Equinus (plantarflexed foot position) from calf spasticity, inversion from tibialis anterior and posterior spasticity, and toe deformity from intrinsic imbalance all develop without appropriate management. Ankle-foot orthoses (AFOs) worn consistently prevent equinus contracture. Intramuscular botulinum toxin injection reduces spasticity in specific muscle groups. Surgical tendon lengthening addresses fixed contractures that AFOs cannot manage.

Coordinated Care

SCI foot care is best delivered as part of a coordinated team including physiatry, physical and occupational therapy, and podiatry. Regular podiatric visits — more frequent than the annual exam recommended for the general population — monitor developing pressure areas, manage nail care safely, and provide ongoing assessment of deformity and circulation status. Contact Balance Foot & Ankle at (810) 206-1402 to establish podiatric care after spinal cord injury.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist After Spinal Cord Injury

Spinal cord injury creates unique foot care challenges including sensory loss, muscle imbalance, spasticity, and skin breakdown risk. At Balance Foot & Ankle, Dr. Tom Biernacki provides specialized foot care for SCI patients including pressure-relieving orthotics, spasticity management, wound prevention, and deformity correction.

Learn About Our Specialized Foot Care Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. McKinley WO, Jackson AB, Cardenas DD, et al. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999;80(11):1402-1410.
2. Garber SL, Rintala DH. Pressure ulcers in veterans with spinal cord injury: a retrospective study. J Rehabil Res Dev. 2003;40(5):433-441.
3. Betz RD, Mulcahey MJ, D’Andrea LP, et al. Orthopaedic issues in spinal cord injury. In: Vaccaro AR, et al, eds. Spine surgery: techniques, complication avoidance, and management. Philadelphia: Churchill Livingstone; 2005.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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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.