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

When Feet Can’t Feel: The Danger of Peripheral Neuropathy

Pain is the body’s alarm system. When a stone is in your shoe, pressure on a blister, or heat from a hot surface generates pain, the normal response is to investigate and correct the problem. Peripheral neuropathy — nerve damage from diabetes, chemotherapy, alcohol use, or other causes — silences this alarm. Without protective sensation, small injuries go unnoticed and untreated. A blister becomes an ulcer. An ulcer becomes an infected wound. An infected wound can threaten a limb or a life. Understanding this progression is the foundation of neuropathic foot care.

The Scale of the Problem

Diabetic peripheral neuropathy affects approximately 50 percent of people with long-standing diabetes. Each year in the United States, roughly 73,000 lower extremity amputations are performed in people with diabetes — the majority preventable with appropriate foot care. Michigan’s high diabetes prevalence makes this a particularly important public health issue. A single preventive podiatry visit that identifies a pre-ulcerative callus or deformity can prevent a hospitalization that costs tens of thousands of dollars and months of recovery.

The Comprehensive Neuropathic Foot Exam

Annual comprehensive foot examinations for all patients with peripheral neuropathy are the foundation of prevention. The exam includes monofilament testing (10-gram Semmes-Weinstein filament) to assess protective sensation; vibration testing with a 128-Hz tuning fork; assessment of ankle reflexes; inspection of skin integrity including callus, fissures, maceration, and nail condition; vascular assessment including palpation of dorsalis pedis and posterior tibial pulses with ABI measurement when indicated; and evaluation of foot deformity including bunions, hammertoes, and Charcot changes. This exam takes 15 to 20 minutes and the information gathered drives the preventive plan.

Callus Management: The Most Important Preventive Procedure

Calluses in patients with neuropathy are not cosmetic nuisances — they are pre-ulcerative lesions. The thickened hyperkeratotic skin concentrates pressure beneath it, eventually producing hemorrhage (blood in the callus) and then ulceration. Regular professional callus debridement — removing the thickened skin with a blade under controlled conditions — dramatically reduces plantar pressure at high-risk sites. Studies show callus debridement alone reduces peak plantar pressures by 30 percent. Combined with offloading orthotics, risk reduction is substantial.

Custom Diabetic Footwear

Medicare and most insurance plans cover therapeutic diabetic shoes and custom insoles for qualifying patients with diabetes — one of the most cost-effective interventions in all of preventive medicine. Extra-depth diabetic shoes with a seamless interior and additional toe box volume accommodate deformities without creating pressure points. Custom-molded insoles distribute plantar pressure evenly, reducing peak forces at ulcer-prone sites. Patients should be evaluated for therapeutic footwear at every annual foot exam.

Wound Care When Ulcers Develop

Despite best preventive efforts, some patients develop ulcers. Rapid response is essential — the goal is healing before infection penetrates deeper tissue. Total contact casting (TCC) is the gold standard offloading device for plantar neuropathic ulcers. Advanced wound care dressings, debridement of necrotic tissue, vascular assessment, and antibiotic therapy for infected wounds all play roles in a comprehensive wound care protocol. Any wound that does not improve within 2 to 4 weeks of appropriate treatment requires vascular surgery consultation to assess and potentially improve blood flow.

Balance Foot & Ankle provides comprehensive neuropathic foot care for patients with diabetes and peripheral neuropathy throughout Livingston and Oakland counties. Prevention is always simpler and less costly than treatment. Schedule your annual foot exam today.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Neuropathy Foot Care at Balance Foot & Ankle

Peripheral neuropathy increases your risk of foot ulcers, infections, and amputation. Dr. Tom Biernacki provides comprehensive neuropathy foot care including regular screening, protective footwear, and preventive management at our Howell and Bloomfield Hills offices.

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Clinical References

1. Boulton AJ, et al. “Comprehensive foot examination and risk assessment.” Diabetes Care. 2008;31(8):1679-1685.
2. Pop-Busui R, et al. “Diabetic neuropathy: a position statement by the ADA.” Diabetes Care. 2017;40(1):136-154.
3. Singh N, et al. “Preventing foot ulcers in patients with diabetes.” JAMA. 2005;293(2):217-228.

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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.