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
Peripheral Neuropathy Treatment in Michigan
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Board-certified podiatrists specializing in diabetic neuropathy, nerve pain relief, and foot ulcer prevention at two Michigan locations.
Book Today — Same-Day Appointments AvailableOr call (810) 206-1402
Board-Certified DPMs
Same-Day Appointments
2 Michigan Locations
Insurance Accepted
Quick Answer: How Is Peripheral Neuropathy Treated?
Peripheral neuropathy treatment begins with identifying and managing the underlying cause — most commonly diabetes. Your podiatrist creates a personalized plan that may include prescription medications for nerve pain (gabapentin, pregabalin, or duloxetine), custom orthotics to protect numb feet, regular foot exams to prevent ulcers, and lifestyle modifications. Early intervention is critical: untreated neuropathy is the #1 cause of non-traumatic foot amputations in the United States.
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) — accounts for 60–70% of all peripheral neuropathy cases. Chronically elevated blood sugar damages nerve fibers over time. 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. At Balance Foot & Ankle Specialists, we use a comprehensive approach:
- 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
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 seamless 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 15x higher in patients 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
For severe or refractory cases:
- Nerve decompression surgery — releasing compressed nerves at known entrapment sites in the lower extremity (ankle, tarsal tunnel) when compression contributes to symptoms
- 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 intervention can prevent ulcers, infections, and amputations. Our board-certified podiatrists see neuropathy patients same-day.
Book Today — Same-Day Appointments AvailableOr 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 — seamless, 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 — at least every 3–6 months for comprehensive foot exams, more often if you have ulcer history.
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.
At Balance Foot & Ankle Specialists, 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-day appointments available for urgent foot concerns.
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 tight blood sugar control can stop progression and reduce pain. The key is early intervention — the longer nerves go untreated, the less reversible the damage becomes.
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. 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?
At minimum, every 3–6 months. Patients with a history of ulcers, amputations, or severe neuropathy should be seen every 1–2 months. 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.
⚠️ See a podiatrist for neuropathy symptoms if you notice:
- Numbness, tingling, or burning sensations in your feet
- Loss of balance or coordination when walking
- Foot wounds or sores that are slow to heal
- Sharp, stabbing pain that worsens at night
- Difficulty feeling temperature changes in your feet
Protect Your Feet from Neuropathy Complications
Our board-certified podiatrists specialize in diabetic neuropathy management, ulcer prevention, and coordinated vascular care. Two convenient Michigan locations. Most insurance accepted.
Book Today — Same-Day Appointments AvailableOr call (810) 206-1402 · Mon–Fri 8:00 AM – 5:00 PM
Our Michigan Locations
Howell Office
4330 E Grand River Ave
Howell, MI 48843
Phone: (810) 206-1402
Fax: 833-450-6201
Mon–Fri 8:00 AM – 5:00 PM
Bloomfield Hills Office
43494 Woodward Ave #208
Bloomfield Twp, MI 48302
Phone: (810) 206-1402
Fax: 833-450-6317
Mon–Fri 8:00 AM – 5:00 PM
Sources
- Pop-Busui R, et al. “Diabetic Neuropathy: A Position Statement by the American Diabetes Association.” Diabetes Care. 2017;40(1):136-154. doi:10.2337/dc16-2042
- Callaghan BC, et al. “Diabetic neuropathy: clinical manifestations and current treatments.” Lancet Neurol. 2012;11(6):521-534. doi:10.1016/S1474-4422(12)70065-0
- Boulton AJM, et al. “Comprehensive Foot Examination and Risk Assessment.” Diabetes Care. 2008;31(8):1679-1685. doi:10.2337/dc08-9021
- Singh N, Armstrong DG, Lipsky BA. “Preventing Foot Ulcers in Patients With Diabetes.” JAMA. 2005;293(2):217-228. doi:10.1001/jama.293.2.217
- Vinik AI, et al. “Diabetic nerve and foot problems.” Endotext [Internet]. Updated 2026. PMID: 25905370
Clinical References
- Callaghan BC, et al. “Distal symmetric polyneuropathy: a review.” JAMA. 2015;314(20):2172-2181. PubMed
- Pop-Busui R, et al. “Diabetic neuropathy: a position statement by the American Diabetes Association.” Diabetes Care. 2017;40(1):136-154. PubMed
- Bril V, et al. “Evidence-based guideline: treatment of painful diabetic neuropathy.” Neurology. 2011;76(20):1758-1765. PubMed
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 annual diabetic foot screenings for patients with neuropathy.
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 or stop progression and in some cases restore nerve function. Do not wait until numbness becomes permanent.
Advanced therapies such as MLS laser therapy may have variable coverage. Our team verifies your specific benefits before treatment. Self-pay options are available. Call (810) 206-1402 to verify coverage.
Watch: Peripheral Neuropathy Treatment by Dr. Tom Biernacki
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
4.9 ★ Rating · 1,123+ Five-Star Reviews
★★★★★
“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
What to Expect at Your Appointment
Nerve Function Testing
Non-invasive tests to measure nerve conduction and pinpoint the severity and location of nerve damage.
Vascular Assessment
We evaluate blood flow to your feet to identify any circulation issues contributing to your symptoms.
Custom Treatment Protocol
Based on your results, we’ll design a treatment plan that may include MLS laser therapy, medication management, or nerve decompression.
Progressive Relief
Most patients notice improvement within the first few sessions. We track your progress and adjust treatment as needed.
Related Treatments You May Need
Diabetic Foot Care
Neuropathy is often linked to diabetes. Comprehensive care prevents complications.
Custom 3D Orthotics
Protective orthotics help prevent injury when sensation is diminished.
MLS Laser Therapy
Laser therapy can help reduce neuropathic pain and promote nerve recovery.
EPAT Shockwave Therapy
Shockwave therapy stimulates blood flow and nerve regeneration in affected areas.
Get Neuropathy Treatment That Works
Advanced nerve therapy — same-week appointments available.
or call (810) 206-1402 · (248) 815-2221
Your Expert Podiatrists
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 Hills 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.
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Howell · (810) 206-1402 Bloomfield · (248) 335-0322🧂 DASS Medical Compression Socks — Podiatrist-Grade Graduated Compression
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“These are the compression socks I prescribe to my neuropathy and diabetic patients. Medical-grade graduated compression (15–25 mmHg) improves circulation without the fit issues of pharmacy brands.”
— Dr. Tom Biernacki, DPM
🏥 Coordinated Care Advantage
Balance Foot & Ankle partners with Vassallo Medical Group for integrated vascular and internal medicine care — a unique advantage for complex diabetic and peripheral vascular cases.
Team-based neuropathy care: our internal medicine partnership →
⚕ Related: Diabetic Foot Care Guide
Peripheral neuropathy is the most common diabetic foot complication. Our guide covers daily inspection routines, protective footwear, and when to seek urgent podiatric care.
Diabetic Foot Care: Complete Guide →Related Conditions We Treat
Learn more about these conditions or book your appointment for a personalized treatment plan.
Clinically Recommended
DASS Medical Compression Socks
Medical-grade graduated compression (20–30 mmHg) designed for neuropathy and diabetic foot care. Reduces swelling, improves circulation, and protects sensitive skin — the socks we hand out in clinic.
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