The most important clinical decision with Heel Pain Without Plantar Fasciitis isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Dr. Tom’s Top Insole & Orthotic Picks
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases.
Dr. Tom’s Top Bob and Brad Massage Guns (2026)
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Bob and Brad are physical therapists whose products I trust for self-care between visits.
Dr. Tom’s Top Pain Relief Picks — Dr. Hoy’s (2026)
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. I personally use Dr. Hoy’s in my practice for patients who need topical relief.
| Product | Best For | Dr. Tom’s Take | Get It |
|---|---|---|---|
| Dr. Hoy’s Natural Pain Relief Gel 3.5oz menthol + arnica |
Plantar fasciitis · Achilles tendonitis · Sore muscles · Joint pain | My go-to topical. Cooling-then-warming sensation. No greasy residue. Non-NSAID alternative. | Buy Now |
| Dr. Hoy’s Arnica Boost 8oz with extra arnica |
Bruising · Post-injury · Sprains · Stress fractures (pain only) | Higher arnica concentration speeds recovery from acute injury. Use 4x daily for first 7 days. | Buy Now |
| Dr. Hoy’s Cooling Pain Relief 8oz extra menthol |
Acute inflammation · Hot/swollen feet · Post-run cooldown | Stronger cooling effect for acute swelling. Pair with ice for first 48 hours after injury. | Buy Now |
| Dr. Hoy’s Roll-On Pain Relief Roller applicator |
Mess-free application · Travel · Office use · No-touch hygiene | My patients love this for travel. Glides on without hand contact — cleanest application available. | Buy Now |
| Dr. Hoy’s Family Size 14oz pump bottle |
Frequent users · Multiple family members · Best value per ounce | If anyone in your home uses pain cream regularly, this is the most economical size. Same formula. | Buy Now |
Why I recommend Dr. Hoy’s over Doctor Hoy’s Natural Pain Relief Gel and Bengay: Cleaner ingredient list (no parabens, no synthetic dyes), longer-lasting effect, and the cooling-then-warming dual sensation actually addresses both inflammation and circulation. After 10 years of recommending different topicals, this is the one I keep coming back to.
Quick Compare: Dr. Tom’s Top Running Shoes
| Shoe | Best For | Watch Out For | Buy | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hoka Bondi 9 | Plantar fasciitis, max cushion | Heavy, tall stack | Buy | ||||||||||||||||||||||||
| Brooks Ghost 17 | Neutral runners, first running shoe | Not for 200+lb runners | Buy | ||||||||||||||||||||||||
| Brooks Adrenaline GTS 23 | Flat feet, overpronation | Snug toe box | Buy | ||||||||||||||||||||||||
| Altra Torin 8 | Wide feet, bunions, Morton’s toe | Zero-drop transition | Buy | ||||||||||||||||||||||||
| Hoka Clifton 10 | Daily training, lighter Hoka | Less cushion than Bondi | Buy | ||||||||||||||||||||||||
| NB 990v6 | Senior fall prevention, 6E width |
Dr. Tom’s Top Pain Relief Picks — Dr. Hoy’s (2026)Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. I personally use Dr. Hoy’s in my practice for patients who need topical relief.
Why I recommend Dr. Hoy’s over Doctor Hoy’s Natural Pain Relief Gel and Bengay: Cleaner ingredient list (no parabens, no synthetic dyes), longer-lasting effect, and the cooling-then-warming dual sensation actually addresses both inflammation and circulation. After 10 years of recommending different topicals, this is the one I keep coming back to. | Buy |
For full detailed reviews with pros/cons/Dr. Tom’s tips, see our complete shoe guide.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Related Conditions
Quick Answer
Heel Pain That Is Not Plantar Fasciitis: Other Causes and Ho relates to plantar fasciitis — typically caused by tight calves and arch overload. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Plantar fasciitis is inflammation where the plantar fascia attaches to the heel, causing sharp morning heel pain that eases after 10-15 minutes of walking. Most cases respond to stretching plus arch support within 6-12 weeks. See a podiatrist if pain persists beyond 6 weeks, worsens, or prevents walking.
Watch: Dr. Tom Biernacki, DPM
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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Podiatrist Recommended Shoes 2026: Dr. Tom’s Top Picks for Every Condition
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See Dr. Tom’s Top Shoe Picks →When Heel Pain Is Not Plantar Fasciitis
Plantar fasciitis is the most common cause of heel pain in adults, but it is not the only cause. Misdiagnosis is common—patients with other heel pathology are often treated for plantar fasciitis for months without improvement because the real diagnosis was never properly evaluated. The key to distinguishing these conditions is precise localization of the pain, the timing pattern (first-step morning pain vs. activity-related vs. constant), and associated symptoms. If your heel pain has not improved with plantar fasciitis treatment after 6–8 weeks, a re-evaluation to consider alternative diagnoses is appropriate.
Alternative Diagnoses by Location and Pattern
Calcaneal stress fracture: Pain throughout the heel (rather than focal plantar pain) that worsens progressively with activity and may be present even at rest in advanced cases. The squeeze test (compressing the heel from both sides) reproduces pain. Common in runners who have increased mileage rapidly, military recruits, postmenopausal women, and patients on bisphosphonates or with osteoporosis. X-rays may miss early stress fractures—MRI is diagnostic. Treatment is rest and protected weight-bearing for 6–8 weeks.
Insertional Achilles tendinopathy: Pain at the back of the heel at the Achilles tendon attachment—not plantar. Often with a visible bony prominence (Haglund deformity). Worsens with activity and improves with low-heeled shoes. Separate condition from mid-plantar heel pain.
Tarsal tunnel syndrome: Compression of the posterior tibial nerve as it passes through the tarsal tunnel (behind and below the medial malleolus) causes burning, tingling, numbness, or shooting pain in the heel and into the arch and sole—often worse at night or with prolonged standing. Unlike plantar fasciitis, the Tinel sign is positive (tapping over the tarsal tunnel reproduces the tingling). Nerve conduction studies confirm the diagnosis.
Baxter nerve entrapment: Compression of the inferior calcaneal nerve (Baxter nerve, the first branch of the lateral plantar nerve) as it passes between the abductor hallucis muscle and the calcaneus. This nerve entrapment causes medial heel pain that is clinically identical to plantar fasciitis—same location, similar first-step pain—but fails to improve with standard plantar fasciitis treatment. It may coexist with plantar fasciitis. Diagnosis is clinical; ultrasound-guided injection at the nerve can be both diagnostic and therapeutic.
Fat pad atrophy: The heel fat pad naturally thins with age, high BMI history followed by weight loss, and corticosteroid use. The result is inadequate cushioning of the calcaneus during impact, causing diffuse heel bruising with every step—worse on hard surfaces. Cushioned heel cups or custom orthotics with deep heel cups are the treatment.
In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your plantar fasciitis, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
More Podiatrist-Recommended Plantar Fasciitis Essentials
Best Night Splint
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Top Podiatrist-Recommended Insole
Deep heel cup + arch support unloads the plantar fascia all day.
Plantar Fasciitis Compression Sock
Arch support + circulation boost — reduces morning heel pain and swelling.
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
If morning heel pain has persisted more than 6 weeks, home care alone rarely fixes it. At Balance Foot & Ankle, we combine in-office ultrasound diagnostics, custom orthotics, and — when needed — shockwave or PRP to resolve plantar fasciitis that hasn’t responded to stretching and inserts. Most patients are walking pain-free within 4-8 weeks of starting a structured plan.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
How do I know if I have plantar fasciitis or a calcaneal stress fracture?
Two clinical tests help distinguish them. First, pain location: plantar fasciitis pain is most focal at the anteromedial heel—specifically at the plantar fascia insertion on the calcaneus, just inside the center of the heel bottom. Calcaneal stress fracture pain is more diffuse throughout the heel. Second, the squeeze test: with a calcaneal stress fracture, squeezing the heel from both sides (medial and lateral compression) reproduces the pain—the mechanical forces of the squeeze load the fracture line. Plantar fasciitis pain is not reproduced by side-to-side heel compression. A calcaneal stress fracture also tends to have more pain with initial weight-bearing after rest and increasing pain throughout activity without the warm-up improvement typical of plantar fasciitis. MRI confirms stress fracture if clinical suspicion is high and X-rays (which frequently miss early stress fractures) are negative.
What causes heel pain that is worse at night or at rest?
Heel pain that is worse at night or at rest—rather than with first steps in the morning that improves with walking—suggests nerve-related pain rather than mechanical tendon or fascia pathology. Tarsal tunnel syndrome commonly causes nocturnal heel burning, tingling, and aching. Baxter nerve entrapment can cause rest pain in advanced cases. Systemic inflammatory arthritis (rheumatoid, spondyloarthropathy) affecting the heel can cause night pain. In rare cases, bone tumors or metastatic disease cause rest and night pain. Constant heel pain not related to activity, pain that progressively worsens, or pain with constitutional symptoms (fever, weight loss) warrants evaluation rather than empiric plantar fasciitis treatment.
Can heel pain be caused by a pinched nerve?
Yes—nerve entrapment is an underrecognized cause of heel pain that mimics or coexists with plantar fasciitis. Tarsal tunnel syndrome (posterior tibial nerve compression behind the medial malleolus) and Baxter nerve entrapment (inferior calcaneal nerve compression at the abductor hallucis muscle) are the most common nerve-related causes of heel pain. Both can produce medial heel pain with first-step morning symptoms nearly identical to plantar fasciitis. The distinction: nerve pain often has a burning, tingling, or shooting quality; it may radiate into the toes or arch; the Tinel sign may be positive over the nerve compression site; and standard plantar fasciitis treatment (stretching, orthotics) provides little relief. Electrodiagnostic studies (EMG/nerve conduction) and ultrasound-guided nerve blocks can confirm the diagnosis. Nerve entrapments may require surgical decompression when conservative measures fail.
Medical References & Sources
- PubMed Research — Heel Pain Differential Diagnosis
- PubMed Research — Baxter Nerve Entrapment and Heel Pain
- American Podiatric Medical Association — Heel Pain
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He evaluates complex heel pain including plantar fasciitis, nerve entrapments, stress fractures, and insertional Achilles pathology, providing accurate diagnosis and targeted treatment.
Dr. Tom’s Recommended Products for Plantar Fasciitis & Heel Pain
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
These are products I personally use and recommend to my patients at Balance Foot & Ankle.
- PowerStep Pinnacle Insoles — Firm arch support with dual-layer cushioning — the #1 podiatrist-recommended OTC insole for plantar fasciitis
- PowerStep Pinnacle Insoles — High-profile biomechanical stabilizer cap controls overpronation and reduces fascia tension at the insertion
- Brooks Adrenaline GTS 24 — GuidRails support system with 12mm heel drop — the most-prescribed running shoe for plantar fasciitis in our practice
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
Dr. Tom’s Pick: Women’s Shoe Comfort Inserts
For women who want comfort without giving up their shoes — Foot Petals cushions work in heels, flats, and sandals.
- Foot Petals Heavenly Heelz — Cushioned heel insert for pumps and heels — eliminates slipping and ball-of-foot pain in dress shoes.
- Foot Petals Tip Toes — Metatarsal cushion for the toe box — stops forefoot pain in heels and narrow shoes.
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Subscribe on YouTube →Medically Reviewed by: Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists
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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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Book Your AppointmentDifferential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Plantar Fasciitis and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Baxter’s neuropathy. Compressed first branch of lateral plantar nerve — burning medial heel pain rather than first-step sharpness.
- Calcaneal stress fracture. Squeeze test of the heel reproduces pain anywhere; PF is reproduced only at the medial-plantar attachment.
- Heel spur (incidental). Spurs show on X-ray but rarely cause pain on their own — treat the fascia, not the spur.
If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
In Our Clinic
In our Balance Foot & Ankle clinic, the typical plantar fasciitis patient is a 40- to 60-year-old who noticed sharp heel pain on their very first steps in the morning or after sitting at a desk. Many arrive having already tried cheap shoe-store inserts and a week of ice without relief. On exam, we palpate the medial calcaneal tubercle, check for a positive windlass test, and rule out Baxter’s neuropathy and calcaneal stress fractures. Most of our plantar fasciitis patients respond to a custom orthotic + eccentric calf loading + night splinting protocol within 6–12 weeks — without injections or surgery.
Most Common Mistake We See
The most common mistake we see is: Stretching aggressively before the fascia warms up. Fix: apply heat or move the foot through gentle circles for 3-5 minutes before your first morning steps, then stretch.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight on the heel
- Bruising or visible swelling around the heel
- Constant rest or night pain in the heel
- No improvement after 6 weeks of home care
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Pros & Cons of Conservative Care for plantar fasciitis
Advantages
- ✓ Conservative care resolves 90%+ of cases
- ✓ Multiple home treatment options
- ✓ Strong evidence base
- ✓ Imaging often not required
Considerations
- ✗ Recovery takes 6-12 weeks
- ✗ Mistakes prolong recovery
- ✗ Untreated can become chronic
- ✗ Can mimic other conditions
In This Article
- Quick Answer
- In-Office Treatment at Balance Foot & Ankle
- Differential Diagnosis: What Else Could It Be? Several conditions share symptoms with Plantar Fasciitis and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam: Baxter’s neuropathy. Compressed first branch of lateral plantar nerve — burning medial heel pain rather than first-step sharpness. Calcaneal stress fracture. Squeeze test of the heel reproduces pain anywhere; PF is reproduced only at the medial-plantar attachment. Heel spur (incidental). Spurs show on X-ray but rarely cause pain on their own — treat the fascia, not the spur. If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment. In Our Clinic In our Balance Foot & Ankle clinic, the typical plantar fasciitis patient is a 40- to 60-year-old who noticed sharp heel pain on their very first steps in the morning or after sitting at a desk. Many arrive having already tried cheap shoe-store inserts and a week of ice without relief. On exam, we palpate the medial calcaneal tubercle, check for a positive windlass test, and rule out Baxter’s neuropathy and calcaneal stress fractures. Most of our plantar fasciitis patients respond to a custom orthotic + eccentric calf loading + night splinting protocol within 6–12 weeks — without injections or surgery. Most Common Mistake We See
- Warning Signs That Need Same-Day Care
Dr. Tom’s Recommended Products for plantar fasciitis
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
PowerStep Pinnacle Maxx Dr. Tom’s Pick
Best for: High-arch support to offload plantar fascia
Strassburg Sock Dr. Tom’s Pick
Best for: Overnight stretch for morning pain relief
Hoka Bondi 9 Dr. Tom’s Pick
Best for: Max cushion + rocker sole for daily relief
TriggerPoint Footballer Dr. Tom’s Pick
Best for: Plantar fascia release + stretching
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
CURREX RunProDr. Tom’s #1 Brand
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
What is Plantar fasciitis?
Plantar fasciitis is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of plantar fasciitis include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of plantar fasciitis respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from plantar fasciitis varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
Ready to feel better?
Same-week appointments available in Howell and Bloomfield Hills, Michigan.
Book Your Visit🏥 Dr. Biernacki’s Recommended Products (Save 30% – Foundation Wellness)
👉 PowerStep Pinnacle Insoles — #1 podiatrist-recommended for heel pain & plantar fasciitis.
👉 Doctor Hoy’s Natural Pain Relief Gel — Topical pain relief for heel & arch pain.
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Same-day appointments in Howell & Bloomfield Hills, MI.
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Or call: (810) 206-1402
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.