Thank you for trusting us with your patient. Balance Foot & Ankle provides podiatric care across Livingston and Oakland County from offices in Howell and Bloomfield Township. Referred patients — especially diabetic foot and wound cases — receive priority scheduling, and your office receives a consult note after the visit.
Three ways to refer
1. Fax the referral — (833) 450-6201. Include the patient’s demographics, insurance, your callback number, and where to send the consult note.
2. Have the patient self-schedule 24/7 — fastest, and no phone tag for your staff: Howell online booking · Bloomfield Township online booking. We verify insurance before the visit — including Medicare, Medicare Advantage, and Michigan Medicaid health plans.
3. Call (810) 206-1402 and ask for our referral coordinator. Tell our team it is a provider referral — urgent diabetic wound and infection referrals are prioritized.
When to refer: urgency tiers
If you are deciding how fast a foot problem needs to move, this is how we triage it.
Refer immediately — call us, or send to the ER
- Any open wound on a diabetic foot — amputation risk rises sharply without specialized intervention
- Red streaking (lymphangitis), fever, or purulent drainage — spreading infection
- Suspected fracture with visible deformity
- Charcot foot — hot, swollen, erythematous foot in a neuropathic patient; deformity risk without urgent offloading
- Absent or newly lost pedal pulses — possible acute arterial occlusion
Send to the emergency room instead of to us if there is bone through skin, uncontrolled bleeding, severe deformity after trauma, or a diabetic foot that has suddenly gone cold, blue, or numb. Those can be limb-threatening and should not wait for any outpatient appointment.
Refer within 1–2 weeks
- Infected or recurrent ingrown toenails
- Non-healing blister, callus with underlying breakdown, or early pressure injury
- New foot or ankle injury needing imaging — we have in-office digital X-ray and musculoskeletal ultrasound at both locations
- Acute gout flare not responding to first-line management
- New or progressive neuropathy symptoms
Routine referral
- Annual diabetic foot exam and at-risk foot surveillance
- Heel pain that has failed conservative care
- Bunion, hammertoe, or other deformity for surgical evaluation
- Custom orthotics and biomechanical assessment
- Qualifying routine nail and callus care for at-risk patients
- Second opinions on foot and ankle surgery
Patients we can take off your plate
- Diabetic foot ulcers and wounds — debridement, offloading, infection management, and ongoing wound care
- At-risk diabetic feet — annual comprehensive foot exams, neuropathy evaluation, qualifying routine nail care, and the diabetic shoe program
- Infected or recurrent ingrown toenails — same-day and next-day procedure slots
- Foot and ankle injuries — in-office X-ray and ultrasound, fracture care, sprain management
- Heel pain that has failed conservative care — EPAT shockwave, MLS laser, injections, custom orthotics
- Surgical evaluations — bunions (including minimally invasive and Lapiplasty), hammertoes, soft-tissue masses
- Complex and revision cases — failed prior surgery, flatfoot reconstruction, Charcot reconstruction
- Residents of the care facilities we already visit — our doctors continue to see patients at the assisted living, skilled nursing and adult foster care facilities on our schedule.
What your office can expect
- We contact the patient within 1 business day of receiving the referral
- A consult note back to your office after the visit, and direct communication on co-managed patients
- Priority access for provider referrals; urgent wound and infection cases are seen as soon as possible
- Insurance handled — we verify benefits with the patient before the visit, so referrals do not bounce back over coverage confusion
- Conservative-first care — surgery is recommended only when appropriate, and we report the treatment rationale back to you
- We never take over the patient relationship. We work alongside you and send the patient back to your care.
Which of our surgeons fits your patient
| Physician | Refer for |
|---|---|
| Dr. Tom Biernacki, DPM, FACFAS Board-Certified, ABFAS Board-Certified, ABPM Fellow, ACFAS NPI 1821330051 |
Minimally invasive (MICA) bunion correction, Lapiplasty, sports medicine, peripheral nerve surgery, general and surgical podiatry |
| Dr. Carl Jay, DPM Board-Certified, ABFAS (Reconstructive Rearfoot & Ankle) Board-Certified, ABPM NPI 1376981290 |
Complex foot and ankle reconstruction, revision of failed prior surgery, flatfoot and Charcot reconstruction, foot and ankle trauma, cases declined elsewhere |
| Dr. Daria Gutkin, DPM Board-Certified, ABPM NPI 1023532587 English & Russian |
Diabetic foot and neuropathy care, pediatric foot care, women’s foot health, anxiety-sensitive patients, minimally invasive in-office procedures |
If you are unsure, refer to the practice and we will route internally. Complex reconstruction and revision cases go to Dr. Jay.
Medical-legal and expert review
Separately from clinical referrals, Dr. Tom Biernacki accepts foot and ankle medical-legal work — record review, standard-of-care opinions, independent medical examinations, and expert testimony for plaintiff and defense counsel. Common matters include diabetic foot ulceration and amputation, missed fractures and Lisfranc injuries, bunion and hammertoe complications, Achilles rupture and repair, and foot drop or peroneal nerve injury.
Attorney inquiries and case submissions go through podiatrymedlegal.com, not this office — please do not send case materials to our clinical fax.
Our practice
Affiliated with Trinity Health Michigan, Corewell Health, and Henry Ford Health. In-office digital X-ray and musculoskeletal ultrasound at both locations, plus MLS laser, EPAT shockwave, EMTT, and 3D-scanned custom orthotics.
We co-manage regularly with local practices including Vassallo Medical Group (Howell) and Grunberger Diabetes Institute (Bloomfield Township).
Howell
4330 E Grand River Ave, Howell, MI 48843
(810) 206-1402 · Fax (833) 450-6201
Mon–Thu 9:00 AM – 4:30 PM, Fri 9:00 AM – 2:30 PM · ground-floor, wheelchair accessible, free parking in front
Bloomfield Township
43494 Woodward Ave #208, Bloomfield Township, MI 48302
(810) 206-1402 · Fax (833) 450-6201
Mon–Thu 9:00 AM – 4:30 PM, Fri 9:00 AM – 2:30 PM · free parking on site
Medical-legal and expert review
Separately from clinical practice, Dr. Biernacki accepts foot and ankle medical-legal work for plaintiff and defense counsel — record review, standard-of-care opinions, independent medical examinations, and testimony. Case types, engagement terms, and case submission are at Podiatry Med Legal. A summary of the foot and ankle expert witness services Dr. Biernacki provides is also on this site.
Referring a patient today?
Fax (833) 450-6201 — or send your patient to book online, 24/7, with no phone tag for your staff.