Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Foot Skin Conditions Treated by a Michigan Podiatrist
The skin of your feet faces challenges no other skin endures: constant mechanical loading, friction from footwear, occlusive warm-moist environments, and unique microbial exposure. These conditions produce a spectrum of dermatological conditions that require podiatric expertise to diagnose and treat accurately. Misdiagnosis is common — plantar warts diagnosed as calluses, fungal infections treated as eczema, or contact dermatitis misidentified as psoriasis. Dr. Tom Biernacki at Balance Foot & Ankle provides expert foot skin condition diagnosis and treatment for Southeast Michigan patients.
Athlete’s Foot (Tinea Pedis)
Tinea pedis is the most common fungal infection in humans — a dermatophyte infection of the foot skin producing scaling, itching, maceration, and blistering in characteristic patterns. The interdigital pattern causes white macerated skin between toes. The moccasin pattern produces diffuse scaling across the sole and sides of the foot. The vesicular pattern creates itchy blisters on the instep and sole. Treatment requires appropriate topical antifungal agents for adequate duration — typically 4–6 weeks — not just until symptoms resolve. Recurrence is prevented by treating the shoe environment and practicing proper foot hygiene. Untreated athlete’s foot is the most common source of toenail fungal infection.
Plantar Warts (Verrucae Plantaris)
Plantar warts are caused by human papillomavirus (HPV) infection of the plantar skin surface. They are frequently confused with calluses but have distinctive features: disruption of normal skin line pattern, pinpoint black dots (thrombosed capillaries visible under the surface), and pain with lateral squeezing rather than direct pressure. Multiple treatment options are available including salicylic acid application, liquid nitrogen cryotherapy, curettage, laser ablation, and immunotherapy. Stubborn mosaic warts (confluent multiple warts) may require combination approaches or immunological stimulation. Dr. Biernacki selects treatment based on wart size, number, location, and patient immune status.
Contact Dermatitis of the Foot
Contact dermatitis produces redness, itching, blistering, and scaling in patterns dictated by allergen exposure. Shoe dermatitis — the most common form in podiatric patients — follows the distribution of rubber components, chrome leather tanning agents, adhesives, or metal hardware in footwear. Patch testing identifies the specific allergen. Treatment includes allergen avoidance through footwear modification, topical corticosteroids for acute flares, and barrier protection. Secondary bacterial infection of excoriated skin is a common complication requiring antibiotic management.
Dry, Cracked Heels (Heel Fissures)
Hyperkeratotic heel fissures result from the combination of thick callus build-up and insufficient skin hydration — aggravated by open-backed footwear (sandals, clogs) that allow heel skin to expand laterally without containment. Superficial fissures are painful but primarily a comfort issue. Deep fissures — those penetrating the dermis — bleed, become infected, and in diabetic or immunocompromised patients can become limb-threatening. Treatment involves mechanical debridement of excess callus and urea-based moisturization protocols.
Other Foot Skin Conditions Treated
Dr. Biernacki’s foot dermatology expertise extends to: psoriasis of the foot — often producing palmoplantar pustulosis distinct from typical plaque psoriasis; pitted keratolysis — bacterial infection producing circular pits in the plantar skin with distinctive odor from overhydration and sweating; hyperhidrosis (excessive sweating) treatable with prescription antiperspirants, iontophoresis, or Botox injection; blisters from friction requiring strategic padding and footwear modification; and ingrown toenail skin infections from perionychia.
Skin Cancer of the Foot
Melanoma of the foot — including subungual (under-nail) melanoma — accounts for a significant and disproportionate number of delayed melanoma diagnoses because patients and providers rarely examine plantar skin and nails carefully. Dr. Biernacki examines all foot skin surfaces at every visit, provides dermoscopic evaluation of suspicious lesions, and refers for biopsy when malignancy cannot be excluded clinically. Any enlarging or irregular pigmented lesion on the foot or under a nail warrants expert evaluation.
Dr. Tom's Product Recommendations
Lotrimin Ultra Athlete’s Foot Cream
⭐ Highly Rated
Butenafine HCl 1% antifungal cream — the most potent OTC antifungal for athlete’s foot. Works in 1 week for interdigital cases. Approved by podiatrists for initial mild-to-moderate tinea pedis.
Dr. Tom says: “My podiatrist recommended butenafine over clotrimazole for faster results. This cream cleared my athlete’s foot in a week where other products took months.”
Mild-to-moderate interdigital and moccasin-type athlete’s foot in non-diabetic patients — most effective OTC antifungal cream available
Diabetic patients with skin breakdown, moccasin-pattern tinea extending to nails, or blistering vesicular athlete’s foot — those warrant prescription therapy and professional evaluation
Disclosure: We earn a commission at no extra cost to you.
Gold Bond Rough & Bumpy Skin Cream
⭐ Highly Rated
Urea-based heel cream for cracked, dry, and thickened foot skin. 10% urea softens and exfoliates hyperkeratotic skin on heels and soles — podiatrist-approved for daily use on dry heel fissures.
Dr. Tom says: “My podiatrist recommended urea cream for my cracked heels. This Gold Bond formula cleared my heel fissures in 2 weeks of daily use after debridement.”
Dry cracked heels, hyperkeratotic skin, and plantar callus maintenance between professional debridement visits
Deep heel fissures penetrating to the dermis or bleeding cracks — those require professional wound care first, not home moisturizers
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Accurate podiatric diagnosis prevents months of ineffective self-treatment for misidentified conditions
- In-office wart and skin lesion treatment provides faster resolution than home therapy
- Professional callus debridement immediately relieves painful pressure lesions
- Expert skin cancer screening of the foot catches melanoma that patients and providers miss
❌ Cons / Risks
- Wart treatment often requires multiple sessions — HPV-related lesions are notoriously persistent
- Contact dermatitis requires identifying and eliminating the causative allergen — footwear replacement may be necessary
- Recurrent athlete’s foot requires ongoing prevention strategies, not just treatment of each episode
- Deep heel fissures in diabetic patients require wound care-level management, not simple moisturization
Dr. Tom Biernacki’s Recommendation
Foot skin conditions are enormously underserved in medicine. Most patients spend months or years trying over-the-counter products that don’t work because they’ve been given the wrong diagnosis. I see plantar warts that have been treated as calluses for a year, contact dermatitis that’s been treated as fungal infection, and skin cancer that was dismissed as a bruise. Accurate diagnosis is the entire game in foot dermatology.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How can I tell if I have a plantar wart or a callus?
The key distinction: calluses have smooth skin with normal skin line pattern running through them; they are painful with direct pressure. Warts disrupt the normal skin lines — look closely and you’ll see the fingerprint-like lines stop at the wart border. Warts also show tiny black or red dots (thrombosed capillaries) visible under the surface, and are more painful with lateral squeezing than direct pressure. If uncertain, Dr. Biernacki can distinguish them definitively with clinical examination.
Does athlete’s foot go away on its own?
Rarely. Tinea pedis is a chronic infection that persists without antifungal treatment. Even when symptoms improve temporarily — especially in cold weather or when feet are less occluded — the fungus remains and returns. Treatment requires adequate-duration topical antifungal therapy (4–6 weeks minimum, not just until symptoms resolve) and ongoing prevention including treating the shoe environment with antifungal powder.
What causes pitted keratolysis?
Pitted keratolysis is caused by bacterial infection — Corynebacterium and Kytococcus species — that produce enzymes destroying keratin in the plantar skin, creating the characteristic pits. The bacteria thrive in the warm, moist, sweat-soaked environment of occluded footwear. Treatment includes prescription topical antibiotics, antiperspirants to reduce sweating, and improved foot hygiene and moisture management.
Is melanoma under the toenail serious?
Yes — subungual melanoma is the most common melanoma in non-white populations and carries a poor prognosis due to delayed diagnosis. Any darkening of the nail plate — especially if increasing in size, irregular at the edges (Hutchinson’s sign extending to the nail fold), or changing in color — requires biopsy to rule out melanoma. Do not assume nail darkening is just a bruise without professional evaluation, particularly if you don’t recall a specific injury.
Can I treat a plantar wart at home?
OTC salicylic acid products (Dr. Scholl’s Freeze Away, wart pads) can treat small solitary warts in healthy patients with normal immune function. However, they require consistent daily application for weeks to months and are less effective than in-office treatment. Large warts, mosaic wart clusters, warts on pressure-bearing areas, and warts in immunocompromised or diabetic patients require professional treatment. Any lesion that is growing, bleeding, or changing despite home treatment needs evaluation.
Michigan Foot Pain? See Dr. Biernacki In Person
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What causes this condition?
Causes include mechanical stress, biomechanical imbalance, age-related changes, and sometimes systemic disease. Our clinical exam plus imaging identifies the specific driver.
Can it go away on its own?
Mild cases sometimes resolve with rest and supportive footwear. Persistent symptoms past 4-6 weeks rarely resolve without active treatment.
Is surgery required?
Most patients resolve with non-surgical care. Surgery is reserved for refractory cases or structural deformity.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot issues, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.