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.
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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Skin grafting — transplantation of autologous skin or bioengineered skin constructs to resurface a wound that has a healthy, well-vascularized wound bed — is the definitive closure method for large diabetic foot wounds that are too wide or deep for primary closure or healing by secondary intention within a reasonable timeframe. Appropriate patient selection (adequate vascularity, controlled infection, healthy granulating wound bed), graft technique, and post-operative immobilization are the critical determinants of graft take rate and ultimately wound closure success.
Split-Thickness Skin Graft (STSG)
STSG anatomy: harvested with a dermatome at 0.012–0.015 inch thickness (split — includes epidermis and superficial dermis); donor site (usually the thigh) re-epithelializes from residual dermal appendages in 10–14 days. Prerequisites for graft take: wound bed TcPO2 >30 mmHg (adequate tissue perfusion); wound bacterial count <10^5 organisms per gram tissue (semi-quantitative biopsy); clean, granulating wound bed without eschar or necrosis. STSG technique: wound debridement to viable bleeding tissue; meshed graft (1.5:1 or 3:1 meshing expands graft area and allows drainage); fixation with staples or sutures; NPWT (wound VAC) over the graft for 3–5 days post-application improves take rate from 50% to 85% by maintaining graft-wound bed contact and removing fluid. Graft take rate: 70–85% with NPWT in appropriately selected diabetic foot wounds. Limitations: STSG donor site morbidity (painful, slow-healing); graft lacks dermal elements (less durable to shear stress than full-thickness graft); plantar weight-bearing surface grafts prone to breakdown.
Bioengineered Skin Substitutes
Dermal substitutes (Integra, Alloderm): acellular dermal matrix providing a scaffold for fibroblast ingrowth — used in a two-stage approach (Stage 1: dermal substitute application; Stage 2: thin STSG at 3–4 weeks after neovascularization); reduces donor site requirements; superior durability for plantar wounds. Bilayered cell therapy (Apligraf): living bilayered construct with neonatal fibroblasts and keratinocytes — delivers growth factors and cytokines; FDA-approved for diabetic foot ulcers; produces 40% wound closure vs. 8% with standard therapy in pivotal RCT; expensive; requires refrigerated storage. Dehydrated human amnion/chorion membrane (dHACM — EpiFix, Grafix): placental-derived growth factor-rich membranes — weekly application produces significantly faster wound closure than standard care in RCTs; becoming a standard of care for stalled chronic diabetic foot wounds. Dr. Biernacki at Balance Foot & Ankle provides advanced wound grafting and bioengineered skin substitute therapy for complex diabetic foot wounds. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
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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 diabetic foot concern, 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.
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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
How often should diabetics have their feet checked by a podiatrist?
People with diabetes should have a comprehensive foot examination by a podiatrist at least once per year, and more frequently (every 1–3 months) if they have neuropathy, poor circulation, history of foot ulcers, or active foot problems.
What is the biggest foot danger for diabetics?
Loss of protective sensation (neuropathy) combined with poor circulation creates a dangerous combination — minor injuries can go unnoticed and become infected. Foot ulcers affect 15–25% of diabetics over their lifetime and are the leading cause of non-traumatic amputations.
Does Medicare cover diabetic foot care?
Yes. Medicare covers annual diabetic foot exams for patients with peripheral neuropathy, as well as therapeutic shoes and inserts under the Diabetic Shoe Bill. Balance Foot & Ankle accepts Medicare.
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
Skin Grafting for Diabetic Wounds in Michigan
Balance Foot & Ankle performs split-thickness skin grafting and applies bioengineered skin substitutes for complex diabetic foot wounds. Our wound care specialists optimize healing for limb preservation.
Learn About Our Advanced Wound Care → | Book Your Appointment | Call (810) 206-1402
Clinical References
- Veves A, et al. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers. Diabetes Care. 2001;24(2):290-295.
- Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care. 2015;4(9):560-582.
- Lavery LA, et al. The efficacy and safety of Grafix for the treatment of chronic diabetic foot ulcers. Int Wound J. 2014;11(5):554-560.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentDifferential 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.
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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.
Frequently Asked Questions
Can a podiatrist help with neuropathy?
What does neuropathy in feet feel like?
Is foot neuropathy reversible?
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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