Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Total Contact Casting for Diabetic Plantar Ulcers: The Gold relates to plantar fasciitis — typically caused by tight calves and arch overload. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
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.
Treatment at Balance Foot & Ankle: EPAT Shockwave for Heel Pain →
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.
Total contact casting (TCC) is the gold standard offloading device for neuropathic plantar foot ulcers in diabetic patients — achieving ulcer healing rates of 72–100% in randomized controlled trials, significantly outperforming removable cast walkers (RCW), therapeutic footwear, and custom orthotics. The superior efficacy of TCC derives from its non-removable nature, which ensures consistent pressure redistribution 24 hours per day throughout the healing period.
Mechanism of TCC Efficacy
Plantar neuropathic ulcers in diabetic patients result from repetitive mechanical stress at areas of peak plantar pressure — most commonly beneath the first or second metatarsal head, the hallux, or the heel. Normal healing requires elimination of this cyclic mechanical disruption. TCC achieves this through: circumferential contact distributing plantar pressure across the entire plantar surface (reducing peak pressures at the ulcer by 84–92% compared to standard footwear), non-removable design ensuring compliance (the primary reason removable devices underperform), and equinus correction preventing forefoot overload. The reduction in plantar pressure allows granulation tissue formation without recurring shear disruption.
Patient Selection and Contraindications
TCC is appropriate for Wagner Grade 1–2 neuropathic plantar ulcers in patients with adequate perfusion (ABI ≥ 0.5 or toe pressure ≥ 30 mmHg). Contraindications include: active deep infection requiring daily wound inspection, severe peripheral arterial disease precluding healing, fragile skin prone to TCC-related cast sores, significant edema fluctuation, and patient non-compliance with cast care instructions. Charcot neuroarthropathy without ulceration is a distinct indication for TCC — immobilizing the acute Charcot joint to prevent progressive deformity collapse.
Application Technique
TCC application requires meticulous technique to prevent iatrogenic cast sores — the primary complication occurring in up to 10% of applications when applied by inexperienced providers. The wound is débrided and dressed before casting. Cotton stockinette and felt padding protect bony prominences (malleoli, fifth metatarsal base, Achilles). A well-molded short-leg plaster or fiberglass cast with a walking heel is applied with the ankle in slight dorsiflexion. Cast change at 5–7 day intervals allows wound inspection and addresses edema reduction. Average healing time is 5–7 weeks for Grade 1 ulcers and 8–12 weeks for Grade 2 ulcers with TCC.
Transitioning After Healing
Once the ulcer is fully epithelialized, transition to a custom accommodative orthosis in a therapeutic extra-depth shoe prevents recurrence — recurrence rates of 30–50% at one year without appropriate protective footwear. Medicare’s Therapeutic Shoe Program covers one pair of depth-inlay shoes plus three pairs of custom-molded inserts annually for qualifying diabetic patients. Addressing the underlying structural deformity (metatarsal head resection, Achilles lengthening for equinus, offloading exostosis removal) at the time of ulcer healing reduces the long-term recurrence risk.
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Diabetic Wound Care — Balance Foot & Ankle
Dr. Biernacki provides total contact casting and comprehensive diabetic foot wound care. Medicare accepted. Serving Bloomfield Hills, Howell, and all of Michigan.
📞 (810) 206-1402 | Book Online →
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
More Podiatrist-Recommended Diabetic Essentials
Diabetic-Approved Walking Shoe
Orthofeet Sprint — seamless, extra-depth, designed for neuropathic feet.
Seamless Diabetic Sock
OS1st FS4 — non-binding, moisture-wicking, protects fragile diabetic skin.
Recovery Slide for Indoor Wear
HOKA Ora 3 — protects diabetic feet from barefoot injury at home.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
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
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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Your Board-Certified Podiatrists
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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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Podiatrist-recommended products
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Clinical supplies between casting visits.
View on Amazon →Daily healing support.
View on Amazon →Post-cast offloading inserts.
View on Amazon →Peri-wound topical relief.
View on Amazon →Related resources
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Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →Pros & Cons of Conservative Care for plantar fasciitis
Advantages
- ✓ Conservative care resolves 90%+ of cases
- ✓ Multiple home treatment options
- ✓ Strong evidence base
- ✓ Imaging often not required
Considerations
- ✗ Recovery takes 6-12 weeks
- ✗ Mistakes prolong recovery
- ✗ Untreated can become chronic
- ✗ Can mimic other conditions
Dr. Tom’s Recommended Products for plantar fasciitis
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
PowerStep Pinnacle Maxx Dr. Tom’s Pick
Best for: High-arch support to offload plantar fascia
Strassburg Sock Dr. Tom’s Pick
Best for: Overnight stretch for morning pain relief
Hoka Bondi 9 Dr. Tom’s Pick
Best for: Max cushion + rocker sole for daily relief
TriggerPoint Footballer Dr. Tom’s Pick
Best for: Plantar fascia release + stretching
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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