Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: April 2026
Quick answer: Nail psoriasis and toenail fungus look remarkably similar — both cause nail pitting, thickening, discoloration, and nail separation — but require completely different treatments. The most reliable way to tell them apart is a nail culture or biopsy: fungal infection shows positive culture growth; psoriasis shows characteristic histological changes with no fungal organisms. Up to 50 percent of psoriatic nail disease is also co-infected with fungus, making laboratory testing essential before treatment.
Treatment at Balance Foot & Ankle: Laser Toenail Fungus Treatment →
This is one of the most clinically relevant diagnostic challenges in podiatry: a patient comes in with a thick, yellow, crumbling toenail. Is it fungus? Is it psoriasis? The two conditions look nearly identical, and treating the wrong one not only fails to help but can actively worsen the other.
At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, we regularly see patients who have been applying antifungal treatments for months with no improvement — because they actually have nail psoriasis. We also see psoriasis patients who have been managing their nails as psoriasis while a concurrent fungal infection silently worsens.
This guide gives you the detailed comparison: how to distinguish nail fungus from nail psoriasis clinically, why laboratory testing is essential, and how treatment differs dramatically between the two conditions.
Nail Psoriasis vs. Toenail Fungus: Understanding the Diseases
What Is Nail Psoriasis?
Psoriasis is a chronic autoimmune condition in which the immune system attacks normal skin and nail tissue, triggering abnormally rapid skin cell production. While psoriasis is most recognizable as the raised, scaly, red skin plaques that appear on elbows, knees, and scalp, nail involvement occurs in approximately 50–85 percent of all psoriasis patients at some point in their disease course.
Nail psoriasis occurs because the nail matrix (where the nail grows from) and the nail bed (the skin under the nail plate) are both active sites of psoriatic inflammation. The nail plate itself is not inflamed — but the tissue producing and supporting it is. This produces the distinctive nail changes associated with psoriasis, which overlap significantly with onychomycosis.
Psoriatic arthritis — the joint form of psoriatic disease — is associated with more severe nail psoriasis. In fact, nail psoriasis is considered a harbinger of psoriatic arthritis: patients with significant nail involvement have a two to three times higher risk of developing psoriatic arthritis. This makes accurate diagnosis of nail psoriasis particularly important — it is not just a cosmetic concern.
What Is Toenail Fungus?
Onychomycosis is a fungal infection of the nail caused primarily by dermatophyte fungi (T. rubrum, T. mentagrophytes), less commonly by non-dermatophyte molds, and occasionally by Candida species. Fungal organisms penetrate the nail plate and establish a colony in the nail bed and nail plate substance, producing the nail changes — thickening, discoloration, subungual debris — that patients recognize as toenail fungus.
Onychomycosis is the most common nail disease overall, affecting approximately 10 percent of the general population and up to 50 percent of adults over 70. It is more common in people with diabetes, peripheral arterial disease, immunosuppression, and those who frequently use public showers and pools.
Clinical Features: How to Tell the Difference
The overlap between nail psoriasis and onychomycosis is substantial — they share multiple features and are virtually impossible to distinguish with certainty on clinical appearance alone. However, certain features favor one diagnosis over the other.
Features More Characteristic of Nail Psoriasis
- Nail pitting: Multiple small depressions (pits) scattered across the nail surface. Pitting occurs in 68 percent of nail psoriasis patients. It is caused by psoriatic involvement of the nail matrix (the pit is essentially a missing clump of nail cells from the matrix). Pitting is not a feature of onychomycosis.
- Oil drop sign (salmon patch): A yellowish-amber translucent discoloration visible through the nail plate, typically in a rounded or drop-like shape. This is highly specific for nail psoriasis — it represents psoriatic onycholysis (nail separation) with trapped serum beneath the nail plate.
- Leukonychia: White spots or striations (lines) in the nail plate caused by psoriatic matrix involvement. Small white spots are common in normal nails (from minor trauma), but extensive white striations are more characteristic of psoriasis.
- Crumbling nail plate: Psoriatic nail destruction involving the nail matrix causes the nail plate to become friable and crumble — this also occurs in advanced onychomycosis, so it is not distinguishing alone.
- Subungual hyperkeratosis: Buildup of silvery or white scale material beneath the nail. Both conditions cause this, but the scale in psoriasis is often more silvery and adherent, resembling the scale on psoriatic skin plaques.
- Personal or family history of psoriasis: The strongest clinical clue. If a patient has psoriatic plaques on their skin, or a first-degree relative with psoriasis, nail disease is far more likely to be psoriatic.
- Symmetric nail involvement: Psoriasis tends to affect nails in a symmetric pattern (the same nail on both hands or feet). Onychomycosis is more random in which nails it affects.
- Psoriatic arthritis: Swollen, painful joints (particularly the DIP joints — the end joints of fingers and toes) alongside nail changes strongly suggest psoriasis with joint involvement.
Features More Characteristic of Toenail Fungus
- Distal lateral subungual pattern: Onychomycosis almost always starts at the free edge or sides of the nail and progresses toward the base — this is the classic DLSO pattern. Psoriasis can also cause distal changes but often affects the nail matrix (base) early.
- Dermatophytid reaction: Patients with onychomycosis sometimes develop a hypersensitivity skin reaction (dermatophytid or ‘id’ reaction) — typically a vesicular rash on the instep or sides of the feet. This indicates active dermatophyte infection.
- Concurrent athlete’s foot: Active tinea pedis (athlete’s foot) — scaling, redness, and itching between the toes or on the soles — strongly suggests the nail disease is fungal. The same organism responsible for athlete’s foot causes toenail fungus.
- No nail pitting: Absence of nail pitting in a patient without skin psoriasis or family history makes psoriasis less likely.
- Single nail involvement initially: Onychomycosis often starts in one nail and spreads. Psoriasis more commonly involves multiple nails simultaneously.
⚠️ You Cannot Diagnose Nail Fungus vs Nail Psoriasis by Appearance Alone
- Clinical appearance overlaps too significantly for reliable visual diagnosis in many cases
- Up to 50 percent of psoriatic nails are co-infected with fungus — both conditions can be present simultaneously
- Antifungal treatment of psoriatic nails provides no benefit and wastes months
- Psoriasis biologic treatment of fungal nails may worsen infection (biologics suppress immune function)
- Laboratory testing — nail culture and/or nail biopsy — is required for accurate diagnosis
Diagnostic Tests: How to Confirm Which Condition You Have
Nail Culture (KOH Preparation and Culture)
The standard first-line test for suspected onychomycosis is nail clippings submitted for potassium hydroxide (KOH) preparation and fungal culture. The specimen is taken from the most proximate (closest to the nail base) portion of the visible disease — sampling from the free edge misses the active infection zone.
KOH preparation: a portion of the nail material is dissolved in potassium hydroxide, which digests the nail keratin and leaves fungal hyphae (if present) visible under microscopy. This provides a rapid answer — a positive KOH is highly specific for fungal infection.
Fungal culture: the specimen is also grown on fungal culture media (Sabouraud dextrose agar) for 4–6 weeks. Culture confirms the specific organism (identifies the exact fungal species), which guides antifungal selection. This is particularly important because some non-dermatophyte molds require different antifungal medications than standard terbinafine.
Limitations: False negative rates for nail culture are 30–40 percent — the fungus is present but culture fails to grow it. A negative culture does not rule out onychomycosis.
Periodic Acid-Schiff (PAS) Stain on Nail Biopsy
PAS histology is the most sensitive test for onychomycosis, with sensitivity of approximately 80–90 percent compared to 53–65 percent for culture alone. A punch biopsy of the nail unit is submitted to pathology for PAS staining, which stains fungal cell walls a distinctive magenta-pink color.
PAS staining also reveals the histological features of nail psoriasis: parakeratosis (retention of cell nuclei in the nail plate), neutrophilic abscesses, papillomatosis, and dilated tortuous vessels in the dermal papillae. A skilled dermatopathologist can often distinguish psoriasis from onychomycosis on PAS-stained sections.
PCR Testing for Onychomycosis
Polymerase chain reaction (PCR) nail testing is now available and provides the highest sensitivity of any test — detecting fungal DNA even when culture fails. PCR tests can also identify the species rapidly (in days versus 4–6 weeks for culture). PCR is particularly valuable when clinical suspicion is high but culture is negative, and when species identification matters for treatment selection.
Dermoscopy
Dermoscopy — a handheld illuminated skin magnifier used by dermatologists — allows visualization of nail plate surface features at 10x magnification. Some dermoscopic patterns are more suggestive of psoriasis (regular pitting, oil drop sign) versus onychomycosis (longitudinal striations from subungual debris, irregular distal discoloration). Dermoscopy is a useful screening adjunct but does not replace culture.
Treatment: Where the Two Conditions Diverge Completely
Once a diagnosis is established — or if both conditions are confirmed — treatment approaches are fundamentally different.
Treating Onychomycosis (Fungal Nail)
First-line: Oral terbinafine (Lamisil) — 250 mg daily for 12 weeks achieves mycological cure in 76–86 percent of patients. Requires baseline liver function tests and monitoring. Rarely causes hepatotoxicity (approximately 1 in 50,000 patients). Most effective antifungal for dermatophyte onychomycosis.
Alternative: Oral itraconazole (Sporanox) — pulse dosing (one week per month for 3 months) achieves 63–80 percent mycological cure. More drug interactions than terbinafine. Used when terbinafine is contraindicated or fails.
Topical options: Efinaconazole (Jublia), tavaborole (Kerydin), and ciclopirox lacquer — cure rates 15–55 percent for mild to moderate disease. Applied daily for 12–18 months.
Laser therapy: 3–4 sessions of Nd:YAG 1064nm — 60–80 percent mycological cure. Non-invasive, no systemic side effects.
Treating Nail Psoriasis
Topical treatments for mild nail psoriasis:
- High-potency topical corticosteroids (clobetasol propionate) applied to the nail fold and periungual skin — reduce inflammation, improve pitting and onycholysis
- Calcipotriol/betamethasone combination — effective for subungual hyperkeratosis
- Tazarotene (topical retinoid) — improves nail pitting and onycholysis
- Intralesional corticosteroid injection into the nail matrix — highly effective for pitting but painful procedure
Systemic and biologic treatments for moderate to severe nail psoriasis:
- Methotrexate — effective for nail psoriasis as part of overall psoriasis control
- Cyclosporine — rapid improvement in nail psoriasis but long-term toxicity limits sustained use
- TNF-alpha inhibitors (adalimumab, etanercept, infliximab) — significant nail psoriasis improvement in clinical trials (50–80 percent NAPSI score reduction)
- IL-17 inhibitors (secukinumab, ixekizumab) — among the most effective treatments specifically for nail psoriasis, achieving NAPSI score reduction of 50–80 percent at 6 months
- IL-23 inhibitors (guselkumab, risankizumab) — newer agents with strong nail psoriasis efficacy data
Key takeaway: If laboratory testing confirms BOTH nail psoriasis and concurrent fungal infection, both conditions must be treated simultaneously. The standard approach is to treat the fungal infection first with antifungals (since untreated fungus will worsen with biologic immunosuppression), then address the psoriatic nail disease with appropriate dermatologic management.
When Co-Infection Is Present
Co-infection of psoriatic nails with dermatophytes occurs in up to 50 percent of nail psoriasis patients. In these patients:
- Antifungal treatment is initiated first and completed before initiating immunosuppressive biologic therapy
- After fungal clearance is confirmed, psoriatic management begins
- Ongoing monitoring for fungal re-infection is important in patients on biologics (which suppress the immune defenses that normally prevent fungal infection)
Living With Nail Psoriasis: Management Tips
Unlike onychomycosis, nail psoriasis is a chronic condition that cannot be permanently cured — only managed. Here are approaches to reduce the impact on daily life:
- Keep nails short: Shorter nails experience less trauma — and psoriatic nails are particularly vulnerable to the Koebner phenomenon, where trauma to psoriatic skin triggers new psoriatic plaques. Trauma to psoriatic nails can worsen onycholysis and subungual hyperkeratosis.
- Moisturize the nail folds: Apply urea-containing cream or petroleum jelly to the periungual skin and subungual area daily. Hydration reduces the discomfort and cracking associated with subungual hyperkeratosis.
- Avoid nail cosmetics during flares: Nail polish removal requires acetone-based solvents that dry and irritate already-compromised nail skin. Artificial nails create occlusive environments that can worsen psoriatic onycholysis.
- Protect during manual work: Wear protective gloves for dishwashing, cleaning, and manual labor — moisture and chemical exposure worsen psoriatic nail changes.
- Joint monitoring: Given the association between nail psoriasis and psoriatic arthritis, patients with nail psoriasis should have regular screening for joint symptoms — morning stiffness, swollen joints, back pain. Early detection and treatment of psoriatic arthritis prevents joint damage.
Frequently Asked Questions
Can nail psoriasis be mistaken for a fungal infection?
Yes, very commonly. The two conditions share multiple overlapping features including nail thickening, discoloration, separation from the nail bed, and accumulation of material under the nail. Studies find that onychomycosis is misdiagnosed as nail psoriasis (and vice versa) in 30 to 50 percent of cases based on clinical appearance alone. Laboratory confirmation — nail culture and/or PAS histology — is the only reliable way to make the distinction.
Is nail psoriasis contagious?
No. Nail psoriasis is an autoimmune condition, not an infectious disease. It cannot be transmitted from person to person through contact. Toenail fungus, by contrast, is contagious — it spreads through contact with contaminated surfaces, shared footwear, and person-to-person contact. If someone in your household has toenail fungus, preventive measures are warranted for other family members.
Can nail psoriasis go away on its own?
Nail psoriasis is a chronic relapsing-remitting condition. Some patients experience spontaneous improvement or periods of remission, particularly with overall psoriasis control through systemic treatments. However, nail psoriasis rarely fully resolves without treatment, and untreated psoriatic nail changes tend to worsen over time, sometimes leading to complete nail destruction (nail dystrophy).
How long does nail psoriasis treatment take to work?
Nail psoriasis treatment is slow because nails grow slowly — approximately 1 to 2 millimeters per month for toenails. Even highly effective systemic treatments like IL-17 inhibitors show the most dramatic nail improvement at 6 to 12 months of treatment, as treated nail matrix grows out clear nail plate. Patients should be counseled to expect gradual improvement over this timeframe rather than rapid cosmetic change.
Should I see a podiatrist or dermatologist for nail psoriasis?
Both specialists play a role. Dermatologists typically manage the systemic aspects of psoriasis, including biologic prescribing. Podiatrists manage the foot-specific aspects including nail debridement, management of co-existing onychomycosis, footwear assessment, and ruling out mechanical or trauma-related nail changes. For patients whose nail psoriasis is part of widespread psoriatic disease, a dermatologist should lead the care team. For isolated nail disease with foot-specific concerns, a podiatrist may serve as the primary manager.
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Sources
- Gupta AK, et al. Nail psoriasis: a review of treatment options. Am J Clin Dermatol. 2021;22(2):215-226.
- Tosti A, et al. Diagnosis and treatment of nail disorders. Dermatol Clin. 2021;39(2):183-196.
- Dand N, et al. Nail psoriasis: what have we learned from biomarker and genetic studies? J Eur Acad Dermatol Venereol. 2022;36(2):175-183.
- Schons KRR, et al. Nail psoriasis: a review of the literature. An Bras Dermatol. 2014;89(2):312-317.
- Gupta AK, et al. Onychomycosis in psoriasis: prevalence and management challenges. Mycoses. 2022;65(1):22-30.
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
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.
- 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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