Peripheral neuropathy is nerve damage, most often from diabetes, that causes burning, tingling or numbness in the feet. Treatment aims to control the cause, ease the pain and protect feet you can no longer fully feel. At our Howell and Bloomfield Township offices the first visit includes nerve and circulation testing, and the plan can include nerve-pain medication, REMY laser therapy, custom orthotics and diabetic shoes if you qualify. Without insurance, self-pay care is $200 for your first visit and $100 for each follow-up, with no separate laser fee. Contact our Howell or Bloomfield Township office for a same-week evaluation.
Left unmanaged, peripheral neuropathy can progress to a loss of protective sensation — small cuts, blisters, and pressure sores go unnoticed until they become serious. This carries a high risk of infection, non-healing wounds, and hospitalization, and is the leading pathway to diabetic foot ulcers and amputation. Early evaluation and treatment can slow progression and protect your feet.
Numbness, tingling, or burning in your feet? Call Balance Foot & Ankle at (810) 206-1402 — same-week appointments in Howell & Bloomfield Township.
Medically Reviewed by Board-Certified Podiatrists
Balance Foot & Ankle Specialists · Dr. Tom Biernacki, DPM · Dr. Carl Jay, DPM · Dr. Daria Gutkin, DPM, AACFAS · Updated April 2026
What Is the Best Treatment for Diabetic Neuropathy in the Feet?
No single pill or device is the best treatment, because diabetic neuropathy needs three problems handled at once: the nerve damage, the pain, and the risk to feet you can no longer fully feel. The combination that works for most people:
- Slow the damage. Good blood sugar control is the foundation — it helps prevent or delay neuropathy in type 1 diabetes and slows its progression in type 2. We also look for anything adding to it, such as low vitamin B12 in people who take metformin.
- Treat the pain with a first-line nerve medication. American Diabetes Association and American Academy of Neurology guidance names four drug classes as first choices: gabapentinoids (pregabalin, gabapentin), SNRIs (duloxetine, venlafaxine), tricyclic antidepressants (amitriptyline, nortriptyline) and sodium-channel blockers. The right one depends on your kidney function, your other medications and how you tolerate side effects such as dizziness or drowsiness. Opioids, including tramadol, are not recommended as first- or second-line treatment because of their addiction and side-effect risks.
- Protect your feet. Daily self-checks, the right shoes and inserts, safe nail and callus care and scheduled foot exams are what prevent ulcers and amputations — the complications that make neuropathy dangerous.
- Add targeted options if pain persists. These include the prescription 8% capsaicin patch, REMY laser therapy in our office and, for severe pain that medication has not controlled, spinal cord stimulation. Each is covered in the treatment steps below.
Most people need a combination of these, adjusted over a few visits. That is why a podiatrist and your primary care doctor or endocrinologist work best as a team: they manage blood sugar and your overall health, and we manage your feet, including the nerve pain.
What Is Peripheral Neuropathy?
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord (the peripheral nervous system). The feet and legs are almost always affected first because the longest nerves in the body travel from the spine all the way to the toes — making them the most vulnerable to injury.
When these nerves are damaged, they misfire or stop working entirely. You may feel burning, tingling, electric shock-like pain, or — most dangerously — nothing at all. Loss of protective sensation means you can step on a nail, develop a blister, or burn your foot without ever feeling it.
Approximately 20 million Americans have some form of peripheral neuropathy, with diabetes being the single most common cause — affecting up to 50% of all diabetic patients over their lifetime.
Types of Peripheral Neuropathy Affecting the Feet
Sensory Neuropathy
Affects feeling — causes numbness, tingling, burning pain, or hypersensitivity. Most common type. Increases risk of undetected injuries and ulcers.
Motor Neuropathy
Affects muscles — causes weakness, cramping, and muscle wasting in the feet. Leads to foot deformities (hammertoes, claw toes) and gait instability.
Autonomic Neuropathy
Affects involuntary functions — causes dry, cracked skin on feet (reduced sweating), poor circulation, and impaired wound healing. Often overlooked.
Mixed Neuropathy
Combination of sensory, motor, and autonomic damage — the most common presentation in diabetic patients. Requires comprehensive podiatric management.
Symptoms of Peripheral Neuropathy in the Feet
Neuropathy symptoms typically start gradually in both feet and progress upward — a pattern doctors call a “stocking-glove” distribution. Symptoms may include:
- Numbness or reduced sensation — inability to feel temperature changes, pain, or pressure in the feet
- Tingling or “pins and needles” — often worse at night while lying in bed
- Burning or shooting pain — sharp, electric shock-like sensations even without contact
- Sensitivity to touch — pain from bed sheets, socks, or shoes touching the feet (allodynia)
- Muscle weakness — difficulty lifting the front of the foot (foot drop), toe curling
- Balance problems — feeling unsteady, especially on uneven surfaces or in the dark
- Dry, cracked skin — feet stop sweating normally, creating cracks that become entry points for infection
- Foot ulcers — wounds that develop from undetected pressure or injury and heal very slowly
Important: The Danger of “No Symptoms”
The most dangerous symptom of neuropathy is feeling nothing at all. Complete loss of sensation means you may not notice cuts, burns, blisters, or foreign objects in your shoes. This is how small injuries progress to serious infections, gangrene, and amputations. If you have diabetes, schedule regular foot exams even if your feet “feel fine.”
Causes & Risk Factors
Peripheral neuropathy has over 100 known causes, but a handful account for the vast majority of cases we see in our Michigan podiatry practice:
Most Common Causes
- Diabetes (Type 1 and Type 2) — the single most common cause; about half of people with diabetes develop some nerve damage over time. Chronically elevated blood sugar damages nerve fibers. See our diabetic foot care page.
- Prediabetes / Metabolic syndrome — nerve damage can begin before a formal diabetes diagnosis
- Chemotherapy-induced neuropathy (CIPN) — certain cancer drugs (taxanes, platinum agents, vinca alkaloids) directly damage peripheral nerves
- Alcohol use disorder — chronic alcohol exposure is directly toxic to nerves and impairs nutrient absorption
- Vitamin B12 deficiency — common in vegetarians/vegans, patients on metformin, and older adults with reduced absorption
Other Contributing Causes
- Autoimmune disorders — lupus, rheumatoid arthritis, Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy (CIDP)
- Kidney disease — toxin buildup from impaired filtration damages nerves
- Thyroid disorders — hypothyroidism can cause fluid retention that compresses nerves
- Infections — shingles (postherpetic neuralgia), HIV, Lyme disease, hepatitis C
- Hereditary conditions — Charcot-Marie-Tooth disease and other inherited neuropathies
- Idiopathic — in approximately 30% of cases, no cause is identified despite thorough testing
Risk Factors
Your risk increases with age (especially over 55), poorly controlled blood sugar (A1C above 7%), obesity, smoking, family history of neuropathy, and certain medications (statins, some antibiotics, anticonvulsants). Peripheral arterial disease (PAD) often coexists with neuropathy and worsens outcomes — if you have both conditions, coordinated vascular and podiatric care is essential.
How We Diagnose Peripheral Neuropathy
Accurate diagnosis is the foundation of effective treatment. A neuropathy evaluation at our offices covers:
- Detailed medical history — diabetes duration, medications, alcohol use, family history, occupational exposures
- Neurological foot exam — testing sensation with monofilament (Semmes-Weinstein 5.07), vibration perception with tuning fork, sharp/dull discrimination, and proprioception
- Vascular assessment — checking pedal pulses, capillary refill time, and skin temperature (neuropathy and PAD frequently coexist)
- Musculoskeletal evaluation — assessing muscle strength, toe deformities, gait pattern, and fall risk
- Skin and wound assessment — inspecting for calluses, fissures, pre-ulcerative lesions, and fungal infections that numb patients often miss
- Laboratory coordination — A1C, fasting glucose, B12, folate, thyroid panel, complete metabolic panel, and additional tests as indicated
For complex cases, we may coordinate nerve conduction studies (NCS) and electromyography (EMG) with neurologists to determine the exact type, severity, and distribution of nerve damage.
Treatment Options for Peripheral Neuropathy
There is no single cure for peripheral neuropathy, but a multi-pronged treatment approach can slow progression, manage pain, prevent complications, and improve quality of life. We use a step-ladder approach, starting with the least invasive options:
Step 1: Address the Underlying Cause
The most important treatment is stopping further nerve damage. For diabetic neuropathy, this means tight blood sugar control (target A1C below 7%). For B12 deficiency, supplementation. For alcohol-related neuropathy, cessation. For medication-induced neuropathy, discussing alternatives with your prescribing doctor. We coordinate closely with your primary care physician and endocrinologist to optimize systemic management.
Step 2: Medications for Nerve Pain
When neuropathy causes significant pain, several classes of medications have proven effective:
- Anticonvulsants — Gabapentin (Neurontin) and pregabalin (Lyrica) are first-line treatments that calm overactive nerve signals
- SNRIs — Duloxetine (Cymbalta) is FDA-approved for diabetic neuropathy pain and may also help with associated depression
- Tricyclic antidepressants — Amitriptyline and nortriptyline at low doses block pain signal transmission
- Topical treatments — Capsaicin cream (0.075%) and lidocaine patches provide localized relief without systemic side effects
- Prescription 8% capsaicin patch (Qutenza) — applied in a medical office for 30 minutes; FDA-approved in 2020 for diabetic nerve pain in the feet, and repeated no more often than every three months
Step 3: Protective Foot Care & Custom Orthotics
Preventing complications is just as important as managing pain. Our podiatric approach includes:
- Custom orthotics — redistributes pressure away from high-risk areas to prevent calluses and ulcers. See our custom orthotics page.
- Therapeutic footwear — extra-depth, extra-width shoes with smooth interiors to reduce friction on numb feet (often covered by Medicare for diabetic patients)
- Regular diabetic foot exams — at least annually, or more frequently for high-risk patients. We check sensation, circulation, skin integrity, and nail health at every visit.
- Callus and nail care — safe debridement of calluses and proper nail trimming to prevent ulceration. See our medical pedicure service.
- Wound care — immediate treatment of any breaks in skin integrity to prevent infection and progression
Step 4: Physical Therapy & Rehabilitation
Balance training, strength exercises, and gait retraining reduce fall risk, which is several times higher in people with peripheral neuropathy. Physical therapy can also include TENS (transcutaneous electrical nerve stimulation) for pain relief, desensitization techniques, and exercises to maintain muscle mass in weakening feet. We refer to specialized physical therapists experienced in neuropathy rehabilitation.
Step 5: Advanced Interventions
When pain or complications need more than the steps above:
- Nerve decompression surgery — releasing compressed nerves at known entrapment sites in the lower extremity (ankle, tarsal tunnel) when compression contributes to symptoms
- REMY Class IV laser therapy — an in-office option we add when burning or aching nerve pain persists despite medication. Research on laser treatment for neuropathic pain is still limited, so we use it alongside the steps above, not instead of them, and it does not reverse nerve damage. Self-pay patients pay no separate laser fee.
- Spinal cord stimulation — for severe diabetic nerve pain that medication has not controlled, high-frequency (10 kHz) spinal cord stimulation has been FDA-approved since 2021. We refer appropriate patients to a pain specialist; see are spinal cord stimulators worth it for neuropathy?
- Charcot foot management — when neuropathy leads to progressive bone and joint destruction, we provide offloading, immobilization (total contact casting), and surgical reconstruction when necessary
- Amputation prevention — aggressive wound care, infection management, and vascular coordination to save limbs. We partner directly with vascular surgeons and wound care specialists.
Don’t Wait Until Numbness Becomes an Emergency
Early neuropathy care can prevent ulcers, infections, and amputations. Same-week appointments at both offices, and same-day visits for a new wound.
Book Online — Howell Book Online — Bloomfield TownshipOr call (810) 206-1402
Daily Foot Care for Neuropathy Patients
If you have peripheral neuropathy, these daily habits can prevent serious complications:
- Inspect your feet every day — check the tops, bottoms, between toes, and heels for cuts, blisters, redness, swelling, or color changes. Use a mirror or ask a family member to help.
- Wash and dry carefully — use lukewarm water (test with your elbow, not your foot). Dry thoroughly between toes to prevent fungal infections.
- Moisturize — but not between toes — apply cream or lotion to prevent cracking. Excess moisture between toes promotes infection.
- Never walk barefoot — always wear shoes or slippers, even indoors. One undetected puncture wound can lead to serious infection.
- Check shoes before wearing — shake out shoes and run your hand inside to check for pebbles, torn linings, or foreign objects before putting them on.
- Wear proper socks — smooth, moisture-wicking diabetic socks without tight elastic bands. Change daily.
- Trim nails carefully — cut straight across, not too short. If you cannot see well or reach your feet, see your podiatrist for nail care.
- Control blood sugar — this is the single most effective way to slow neuropathy progression in diabetic patients.
- Don’t use heating pads or hot water bottles — numb feet cannot feel excessive heat, leading to burns.
- Schedule regular podiatry visits — every 6–12 months with neuropathy alone, and more often if you also have poor circulation, a foot deformity, or a past ulcer.
Coordinated Vascular & Neuropathy Care
Peripheral neuropathy and peripheral arterial disease (PAD) frequently occur together, especially in diabetic patients. Poor circulation compounds the problems caused by nerve damage — wounds heal more slowly, infections spread faster, and amputation risk increases dramatically.
We don’t manage neuropathy in isolation. For complex diabetic and vascular cases in Howell, we partner directly with internal medicine and vascular specialists to ensure your feet receive truly comprehensive care. Learn about our coordinated care with Vassallo Medical Group →
This team approach means your blood sugar management, vascular health, nerve function, and foot integrity are all being monitored and treated in coordination — not in separate silos.
When to See a Podiatrist for Neuropathy
Schedule an appointment at Balance Foot & Ankle Specialists if you experience any of the following:
- Persistent tingling, numbness, or burning in your feet lasting more than 2 weeks
- Any open wound, sore, or blister on your feet that is slow to heal
- Color changes in your feet or toes (red, purple, black, or white patches)
- Sudden onset of foot drop (inability to lift the front part of your foot)
- Loss of balance or unexplained falls
- New diagnosis of diabetes or prediabetes (baseline foot exam recommended)
- You have diabetes and haven’t had a foot exam in over 12 months
Seek Urgent Care If:
You notice a foot wound with red streaking, increasing warmth, foul odor, or drainage — these are signs of spreading infection. Diabetic foot infections can become limb-threatening within hours. Call us at (810) 206-1402 immediately or visit the nearest emergency room.
Why Choose Balance Foot & Ankle for Neuropathy Care
Board-Certified Specialists
Three experienced podiatrists trained in diabetic foot management, wound care, and neuropathy assessment.
Diabetic Foot Program
Comprehensive diabetic foot exams, risk stratification, custom orthotics, therapeutic shoes, and ulcer prevention protocols.
Coordinated Care Network
Direct partnerships with vascular surgeons, endocrinologists, and internal medicine physicians for complex neuropathy cases.
Same-Day Urgent Access
Neuropathic wounds and infections don’t wait — neither do we. Same-week appointments available for urgent foot concerns.
Neuropathy Treatment Near Me: Getting Seen in Michigan
If you are looking for neuropathy treatment near you, Balance Foot & Ankle treats peripheral neuropathy at two Michigan offices and most new patients are seen within the same week. You do not need a referral from your primary care doctor to be evaluated, though we are glad to coordinate with them, and with your endocrinologist or neurologist, once we know what we are dealing with.
Howell office, Livingston County
4330 E Grand River Ave, Howell, MI 48843. Free parking at the door and ground-floor access, which matters when balance is already affected. Convenient from Brighton, Fowlerville, Hartland and Pinckney. Book online or call (810) 206-1402.
Bloomfield Township office, Oakland County
43494 Woodward Ave #208, Bloomfield Township, MI 48302, an easy drive from Birmingham, Troy, Pontiac and West Bloomfield. One phone line reaches both offices: (810) 206-1402.
Do not wait for your next routine appointment if any of these apply
Numbness is the reason neuropathy becomes dangerous: it removes the pain signal that would normally tell you something is wrong. Call the same day, or seek emergency care if you cannot reach us, if you notice a sore, blister, crack or ulcer that you did not feel form; drainage or an odor from a wound; new redness, warmth or swelling in one foot; a wound that has not improved in a week; or a sudden change in foot shape. These are not things to monitor at home, particularly if you have diabetes or peripheral artery disease.
What to bring to the first visit
Bring the shoes you actually wear most days, a list of your current medications, and any recent bloodwork such as A1c, B12 or thyroid results if you have them. Much of the useful information in a neuropathy workup comes from identifying a treatable cause, and medication and lab history is often where that answer lives.
Frequently Asked Questions About Neuropathy
Can peripheral neuropathy be reversed?
It depends on the cause and how early treatment begins. Neuropathy caused by vitamin deficiencies or medication side effects can often improve significantly once the underlying issue is corrected. Diabetic neuropathy damage is generally permanent, but good blood sugar control can slow its progression, and the pain itself can usually be reduced with treatment. The key is early intervention — the longer nerves go untreated, the less reversible the damage becomes.
What causes peripheral neuropathy in the feet?
Diabetes is the most common cause. Others include chemotherapy, heavy alcohol use, vitamin B12 deficiency (common with long-term metformin use), kidney disease, an underactive thyroid, autoimmune conditions, some infections and inherited neuropathies. In about 30% of people no cause is found even after testing, which doctors call idiopathic neuropathy. Blood tests help rule treatable causes in or out.
Is gabapentin bad for neuropathy?
No. Gabapentin is one of the standard first-line medications for nerve pain, but it does not suit everyone. Common side effects are dizziness, drowsiness, leg swelling and unsteadiness, which matters because neuropathy already raises fall risk, and the dose has to be adjusted for kidney function and increased gradually. Gabapentin is FDA-approved for nerve pain after shingles, while pregabalin, duloxetine and the 8% capsaicin patch carry FDA approval specifically for diabetic nerve pain. If gabapentin leaves you foggy or unsteady, talk to the prescriber rather than stopping it suddenly; it should be tapered, and there are several alternatives.
Why should I see a podiatrist for neuropathy instead of just my primary care doctor?
Your primary care doctor manages the systemic disease (diabetes, B12 levels, etc.), while your podiatrist specializes in protecting your feet from neuropathy’s consequences. We perform detailed neurological foot exams, prescribe custom orthotics, manage calluses and nails safely, treat wounds before they escalate, and coordinate with your care team. This partnership between your PCP and podiatrist is the gold standard for neuropathy management.
Does insurance cover neuropathy treatment and diabetic shoes?
Yes, most insurance plans cover neuropathy evaluation and treatment. Medicare specifically covers therapeutic shoes and custom inserts for qualifying diabetic patients through the Therapeutic Shoe Bill. We verify your coverage and file all claims on your behalf. Without insurance, visits are $200 for the first and $100 for each follow-up, with the care done at that visit included; diabetic shoes are priced separately. Call our office at (810) 206-1402 to check your specific benefits before your appointment.
How often should I have my feet checked if I have neuropathy?
It depends on your risk. International diabetic foot guidelines (IWGDF) recommend a foot exam every 6–12 months with neuropathy alone, every 3–6 months if you also have poor circulation or a foot deformity, and every 1–3 months after a previous ulcer or amputation. Between visits, perform daily self-inspections at home and contact us immediately if you notice any new wounds, color changes, or swelling.
What is Charcot foot and how is it related to neuropathy?
Charcot foot (Charcot neuroarthropathy) is a serious complication of peripheral neuropathy where the bones in the foot weaken, fracture, and the foot progressively deforms — often without the patient feeling significant pain. Early signs include sudden swelling, redness, and warmth in one foot. If caught early, immobilization (total contact casting) can prevent permanent deformity. Untreated Charcot foot leads to a “rocker bottom” deformity that creates pressure ulcers and dramatically increases amputation risk.
Can neuropathy cause falls?
Yes — peripheral neuropathy is a major risk factor for falls in older adults. When you cannot feel the ground beneath your feet, your brain loses critical feedback about your body’s position in space (proprioception). Combined with muscle weakness from motor neuropathy, fall risk increases dramatically. Balance training, proper footwear, and home safety modifications are important parts of our neuropathy management plan.
What happens if neuropathy in the feet goes untreated?
Untreated neuropathy leads to progressive loss of protective sensation, a higher risk of falls, injuries you do not notice, and wounds that will not heal. In people with diabetes it is the main pathway to foot ulcers and amputation, which is why regular podiatry exams matter even when your feet feel fine.
Our Michigan Locations
Howell Office
4330 E Grand River Ave
Howell, MI 48843
Phone: (810) 206-1402
Fax: 833-450-6201
Mon–Fri 9:00 AM – 4:30 PM
Bloomfield Township Office
43494 Woodward Ave #208
Bloomfield Township, MI 48302
Phone: (810) 206-1402
Fax: 833-450-6201
Mon–Fri 9:00 AM – 4:30 PM
Neuropathy Treatment Cost and Insurance Coverage
Peripheral neuropathy treatment is covered by most insurance plans, including Medicare, Blue Cross Blue Shield, United Healthcare, and Aetna. Covered services include diagnostic nerve testing, office visits, medication management, and diabetic foot exams. Medicare covers a foot exam every six months for people with diabetic nerve damage that has caused loss of protective sensation.
Key takeaway: Peripheral neuropathy is progressive — the nerve damage gets worse over time if the underlying cause is not addressed. Early diagnosis and treatment can slow progression and, when the cause is treatable (such as low vitamin B12), sometimes restore nerve function. Do not wait until numbness becomes permanent.
Advanced therapies such as REMY laser therapy may have variable coverage. Our team verifies your specific benefits before treatment. Without insurance, self-pay care is $200 for your first visit and $100 for each follow-up, with no separate laser fee. Book online or call (810) 206-1402 to verify coverage.
Related Reading
- Diabetic Foot Care Daily Routine
- When to See a Podiatrist: 10 Signs
- Diabetic Neuropathy: 8 Warning Signs in Your Feet
WHAT OUR PATIENTS SAY
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★★★★★
“The numbness and tingling in my feet had gotten unbearable. The neuropathy treatment program here has given me real relief for the first time in years.”
— William P., Howell
★★★★★
“Dr. Tom actually listened to my neuropathy symptoms and created a treatment plan that works. Other doctors just told me to live with it.”
— Barbara J., West Bloomfield
Serving Patients Across Southeast Michigan
Balance Foot & Ankle provides expert podiatric care from two convenient locations. Our Howell office serves patients from Brighton, Hartland, Fowlerville, Pinckney, Fenton, Hamburg, Whitmore Lake, South Lyon, and throughout Livingston County. Our Bloomfield Township office serves Birmingham, Troy, West Bloomfield, Pontiac, Farmington Hills, Southfield, Royal Oak, Clarkston, Lake Orion, Rochester Hills, Waterford, Commerce Township, Novi, and Walled Lake across Oakland County.
Board-certified care at both Michigan locations
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Most insurance accepted · On-site X-ray · Board-certified podiatrists
Howell · (810) 206-1402 Bloomfield · (810) 206-1402Related Treatments at Balance Foot & Ankle
Common conditions we treat in our Howell and Bloomfield Township offices.
Related: Numbness can mask a foot wound — see our diabetic wound care for same-week treatment in Howell.
Neuropathy treatment across Metro Detroit & Livingston County: we care for patients from Howell, Brighton, Novi, Bloomfield Township, Birmingham, Troy, Rochester Hills, and Auburn Hills.
In Michigan? Our podiatrists provide in-office neuropathy treatment in Bloomfield Township and at our Howell office — nerve testing, diagnosis, and a treatment plan, usually within the week.
Difficulty getting to the clinic? Advanced neuropathy can make travel and foot self-care hard, especially for older or diabetic patients. If leaving home is a challenge, we also offer in-home podiatry visits across Michigan so routine nerve and foot checks are not skipped.