Peripheral neuropathy has 50+ possible causes — diabetes, B12 deficiency, autoimmune, hereditary, chemotherapy, alcohol. Identifying the cause guides targeted treatment beyond symptom management.
You’re in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what peripheral neuropathy causes means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Peripheral Neuropathy and the Foot: Causes, Evaluation, and relates to foot neuropathy — typically caused by nerve compression or systemic. Most patients improve in varies by cause 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
Diabetic peripheral neuropathy is nerve damage from prolonged hyperglycaemia, causing burning, tingling, numbness, or loss of protective sensation in the feet. It will not reverse without addressing glucose control. Daily foot checks, proper footwear, and annual monofilament testing prevent ulceration.
Watch: Dr. Tom Biernacki, DPM
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Peripheral neuropathy — dysfunction of the peripheral sensory, motor, and/or autonomic nerves — is present in approximately 50% of diabetic patients with 10+ years of disease duration, and causes the sensory loss, weakness, and autonomic dysfunction that drives the cycle of pressure damage, ulceration, infection, and amputation that kills 22% of people who develop a diabetic foot ulcer. Understanding the types of peripheral neuropathy, recognizing its clinical features, and implementing protective foot care protocols are among the most impactful interventions available in podiatric medicine.
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Types of Peripheral Neuropathy
Distal symmetric polyneuropathy (DSPN) — the most common form in diabetes: a length-dependent process where the longest nerves (to the feet and hands) are affected first; loss of protective sensation (LOPS) — inability to feel pain, temperature, pressure, or injury — is the key clinical feature that converts normal minor trauma into a catastrophic ulcer; the Semmes-Weinstein monofilament test (10-gram monofilament applied to 10 standardized plantar sites) screens for LOPS — inability to feel the 10g monofilament at any site indicates LOPS. Motor neuropathy: intrinsic foot muscle atrophy producing ‘intrinsic minus’ foot posture — toe clawing, plantar fat pad migration, metatarsal head prominence — all increasing plantar pressure. Autonomic neuropathy: loss of sudomotor function producing anhydrosis (dry, cracked, fissured skin that is the most common portal of entry for foot infection); loss of vasomotor tone producing an arteriovenous shunting that explains the paradoxically warm foot with bounding pulses of the Charcot foot. Other causes of peripheral neuropathy: alcohol (length-dependent sensory loss); B12 deficiency (often silent — screen all patients on metformin which impairs B12 absorption); chemotherapy-induced peripheral neuropathy (CIPN); hereditary neuropathies (Charcot-Marie-Tooth disease); hypothyroidism; vasculitis; idiopathic.
Protective Foot Care Protocol
Daily foot inspection: examine all surfaces of both feet daily with a mirror for the plantar surface — looking for redness, blistering, cuts, calluses, and wounds; any skin break in a neuropathic foot requires same-day podiatric evaluation. Footwear prescription: diabetic/therapeutic shoes (extra-depth, wider toe box, seamless lining) with custom accommodative orthotics — reduces plantar pressure at callus/ulcer locations; Medicare Part B covers one pair of therapeutic shoes and three pairs of inserts per year for qualifying diabetic beneficiaries (the Therapeutic Shoe Bill — a critically underused benefit). Moisturization: apply urea cream or lanolin-based moisturizer to plantar surfaces daily (not between toes — moisture promotes maceration and fungal infection); prevents the fissures that serve as infection portals. Dr. Biernacki at Balance Foot & Ankle provides comprehensive diabetic foot examinations including monofilament testing, vascular assessment, and therapeutic shoe prescription for patients with peripheral neuropathy and diabetes. Call (810) 206-1402 at our Bloomfield Hills or Howell office for annual diabetic foot care.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your neuropathy symptoms, 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 Diabetic Essentials
Diabetic-Approved Walking Shoe
Orthofeet Sprint — seamless, extra-depth, designed for neuropathic feet.
Seamless Diabetic Sock
Watch: Peripheral Neuropathy Home Remedies [Leg & Foot Nerve Pain Treatment] — MichiganFootDoctors YouTube
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
Frequently Asked Questions
What is the best treatment for peripheral neuropathy in the feet?
Treatment depends on the cause. For diabetic neuropathy, blood sugar control is most important. Other options include B12 supplementation, MLS laser therapy, topical creams (capsaicin, lidocaine), and prescription medications like gabapentin or duloxetine. Our podiatrists tailor treatment to each patient’s specific type and severity.
Can neuropathy be reversed?
In some cases — particularly when caused by vitamin deficiencies or early-stage diabetes with good glucose control. However, long-standing nerve damage is often permanent. Treatment focuses on slowing progression, managing symptoms, and preventing dangerous foot complications like ulcers.
How often should I see a podiatrist if I have neuropathy?
Patients with peripheral neuropathy should have comprehensive foot exams every 3–6 months, or more frequently if they have diabetes, poor circulation, or a history of foot ulcers.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Differential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Diabetic Neuropathy and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Tarsal tunnel syndrome. Burning radiating into the arch with positive Tinel’s at the medial ankle.
- Peripheral artery disease. Pain with walking that resolves with rest, weak pulses, hair loss on toes.
- Lumbar radiculopathy. Symptoms following a dermatome, often with back pain — MRI of spine, not foot.
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
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.
Most Common Mistake We See
The most common mistake we see is: Stopping B-vitamin supplementation as soon as symptoms improve. Fix: maintain supplementation for 6-18 months alongside strict glucose control.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Sudden loss of sensation on one side
- Wound on the foot not felt by the patient
- One-sided symptoms (rule out compression)
- Back pain plus leg symptoms (possible radiculopathy)
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Pros & Cons of Conservative Care for diabetic foot care
Advantages
- ✓ Daily inspection prevents amputation
- ✓ Most insurance covers DME
- ✓ Custom orthotics help
Considerations
- ✗ Daily commitment required
- ✗ Slow wound healing
- ✗ Charcot risk if neuropathy
Dr. Tom’s Recommended Products for diabetic foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Drew Moonwalker Diabetic Shoe Dr. Tom’s Pick
Best for: Medicare-covered diabetic footwear
Diabetic Compression Socks Dr. Tom’s Pick
Best for: Daily protection + circulation
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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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
Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
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Natural topical pain relief I use in our clinic. Arnica + camphor formula — apply directly to the area 3–4x daily. ($20–25)
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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