Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Peripheral neuropathy — dysfunction of the peripheral nerves producing numbness, tingling, burning pain, or weakness in the feet and lower legs — is one of the most common conditions encountered in podiatric practice. Diabetic peripheral neuropathy alone affects 50% of patients with long-standing diabetes; but the podiatrist must recognize that neuropathy in the foot patient is not always diabetic in origin and requires systematic evaluation to identify treatable etiologies, guide risk stratification, and determine when neurological referral is appropriate.

Clinical Evaluation and Screening

The standard clinical screening tools for sensory neuropathy in the podiatric examination: Semmes-Weinstein 10g monofilament testing at 4–6 plantar foot sites (inability to detect 10g pressure = loss of protective sensation, the key threshold for diabetic foot ulcer risk); vibration perception threshold with a 128Hz tuning fork at the hallux; and proprioception testing at the hallux IP joint. Neuropathy symptom patterns that suggest non-diabetic etiology: asymmetric presentation, prominent motor weakness, rapid progression, neuropathic pain out of proportion to sensory loss, or onset before age 40 without diabetes — these warrant expanded workup including laboratory screening (CBC, CMP, TSH, B12, folate, SPEP for paraprotein, VDRL, anti-Ro/La, anti-nuclear antibodies).

Advanced Diagnostic Testing

Nerve conduction studies (NCS) and electromyography (EMG): the standard electrodiagnostic evaluation for peripheral neuropathy — identifies whether the neuropathy is axonal (amplitude loss on NCS, suggesting metabolic, toxic, or genetic causes) or demyelinating (conduction velocity slowing, suggesting inflammatory neuropathy such as CIDP that responds to treatment). Skin punch biopsy with intraepidermal nerve fiber (IENF) density analysis: a 3mm punch biopsy of the distal leg skin — stained for PGP9.5, a pan-neuronal marker — allows quantification of small unmyelinated C-fiber density. IENF density is reduced in small fiber neuropathy (SFN), which is frequently normal on standard NCS because small C-fibers are not measured by electrodiagnostics. SFN produces burning pain and autonomic dysfunction without NCS abnormalities. Dr. Biernacki at Balance Foot & Ankle performs neuropathy screening at every diabetic foot examination and coordinates neurological referral when non-diabetic neuropathy is suspected. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

Related Conditions & Resources

• All Treatments
• Plantar Fasciitis
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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Peroneal Tendon Disorders Treatment in Michigan

The peroneal tendons stabilize the ankle and foot during walking and running. Tears, tendinopathy, and subluxation of these tendons cause lateral ankle pain and instability. Our podiatrists provide targeted diagnosis and treatment from bracing to surgical repair.

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Clinical References

1. Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int. 2004;25(4):157-163.
2. Dombek MF, Lamm BM, Saltrick K, et al. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003;42(5):250-258.
3. Heckman DS, Reddy S, Pedowitz D, et al. Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am. 2008;90(2):404-418.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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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.