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Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Vitamin B12 & Diabetes — Why Metformin Users Need relates to diabetic foot care — typically caused by reduced circulation + neuropathy. Most patients improve in ongoing daily inspection with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
Vitamin B12 & Diabetes — Why Metformin Users Need Supplementation
If You Take Metformin, You Likely Need B12
Metformin is the most prescribed diabetes medication in the world — and one of its well-documented side effects is vitamin B12 depletion. Studies show that 10-30% of long-term Metformin users develop B12 deficiency. B12 deficiency causes peripheral neuropathy — making it impossible to distinguish medication-worsened neuropathy from diabetic neuropathy. At Balance Foot & Ankle, B12 assessment is standard in our diabetic neuropathy workup. Call (810) 206-1402. Our Bloomfield Hills office shares a building with the Grunberger Diabetes Institute for coordinated diabetic care.
How Metformin Depletes B12
Metformin interferes with calcium-dependent absorption of vitamin B12 in the terminal ileum. The effect is dose-dependent and cumulative — patients on high-dose Metformin for years have the highest depletion risk. Serum B12 levels below 300 pg/mL are associated with neuropathy symptoms, even in the “normal” reference range.
Our Recommendation for Metformin Users
All long-term Metformin users should: have serum B12 levels checked annually, supplement with Nutricost Vitamin B12 (Methylcobalamin form — more bioavailable than cyanocobalamin) and Nutricost B-Complex, and discuss B12 monitoring with their prescribing physician. If you’re already experiencing neuropathy symptoms, B12 correction is one of the first interventions that may produce meaningful improvement — it’s inexpensive, safe, and commonly missed.
Call (810) 206-1402 to schedule a neuropathy assessment that includes B12 evaluation.
Professional Podiatric Care in Michigan: Balance Foot & Ankle’s Comprehensive Services
At Balance Foot & Ankle, Michigan patients receive comprehensive podiatric care across the full spectrum of foot and ankle conditions. Our fellowship-trained podiatrists provide conservative and surgical treatment for all foot and ankle pathology — from plantar fasciitis, bunions, and nail disorders to complex reconstructive surgery, diabetic foot care, and sports injuries. Our clinical approach prioritizes accurate diagnosis, evidence-based treatment selection, and honest communication with patients about realistic outcomes.
We serve patients in Livingston and Oakland counties from two convenient Michigan locations: our Howell office at 4330 E Grand River (serving Brighton, Hartland, Pinckney, Howell, and all of Livingston County) and our Bloomfield Hills office at 43494 Woodward Ave #208 (serving Troy, Birmingham, West Bloomfield, Farmington Hills, and all of Oakland County). Both offices offer in-office X-ray, same-week new patient appointments, and a full range of diagnostic and treatment services. We accept Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna, Medicare, and most Michigan insurance plans. Call Balance Foot & Ankle at (810) 206-1402 to schedule your appointment.
Michigan patients from throughout the region — Livingston County communities including Howell, Brighton, Hartland, Pinckney, and Fowlerville, and Oakland County communities including Bloomfield Hills, Troy, Birmingham, West Bloomfield, Farmington Hills, Pontiac, and Rochester — can access expert podiatric care at Balance Foot & Ankle. Our clinical team is committed to providing the highest standard of foot and ankle care available in Southeast Michigan, from routine preventive care to complex surgical intervention. Call (810) 206-1402 to schedule — we look forward to serving you at our Howell or Bloomfield Hills location.
Scheduling with Balance Foot & Ankle is straightforward — call (810) 206-1402 during business hours and our front desk team will find an appointment time that works for your schedule, verify your insurance coverage before the visit, and answer any preliminary questions you have about what to expect. Our Howell office at 4330 E Grand River has convenient parking and is easily accessible from I-96, M-59, and Grand River Avenue. Our Bloomfield Hills office at 43494 Woodward Ave #208 is located on Woodward Avenue with parking adjacent to the building. Both locations are accessible by patients throughout Southeast Michigan, and our team looks forward to providing you with the professional, evidence-based podiatric care that you and your feet deserve.
Related Treatment Guides
- Diabetic Foot Care & Neuropathy
- Plantar Fasciitis & Heel Pain Treatment
- Custom 3D Orthotics
- Sports Foot & Ankle Injury Treatment
Michigan patients are welcome to call Balance Foot & Ankle at (810) 206-1402 to learn more about the specific services available at our practice, confirm insurance coverage, or schedule a new patient appointment. Our Howell office serves Livingston County patients with convenient access from the Howell, Brighton, Hartland, and Pinckney communities. Our Bloomfield Hills office serves Oakland County patients with convenient access from the Birmingham, Troy, West Bloomfield, and Farmington Hills communities. Both offices welcome new patients and provide the same high standard of podiatric care that Livingston and Oakland county residents have come to expect from Balance Foot & Ankle.
Medical References & Sources
- American Podiatric Medical Association — Patient Education
- American Orthopaedic Foot & Ankle Society — Foot Conditions
Dr. Tom’s Recommended Products for Diabetic Foot Care
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
These are products I personally use and recommend to my patients at Balance Foot & Ankle.
- Dr. Comfort Men’s Paradise Diabetic Shoe — Medicare-covered diabetic shoe with seamless interior — eliminates pressure points that cause diabetic ulcers
- Foundation Wellness DASS Diabetic Socks — 30% commission (Levanta) — non-binding, seamless toe, moisture-wicking diabetic socks protecting neuropathic feet
- Derma Sciences Bordered Gauze Dressings — Non-adherent wound dressing ideal for diabetic foot wound management between podiatry visits
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Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
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Subscribe on YouTube →On Metformin? Your Feet May Need B12
Metformin depletes vitamin B12 over time, potentially causing or worsening peripheral neuropathy. Our podiatrists screen for B12-related nerve damage.
Clinical References
- Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(4):1754-1761.
- de Jager J, Kooy A, Lehert P, et al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ. 2010;340:c2181.
- Ahmed MA, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. BMC Pharmacol Toxicol. 2016;17(1):44.
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
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentMore Podiatrist-Recommended Diabetic Essentials
Diabetic-Approved Walking Shoe
- Tie-Less Lacing System eliminates the need to tie laces. Heel strap enables to adjust the grip around the heel. Cushioning sole with a mild Rocker adds spring to your step. Soft, padded fabric interior with no overlays eliminates irritation.
Orthofeet Sprint — seamless, extra-depth, designed for neuropathic feet.
Seamless Diabetic Sock
- Provides continuous support of the Plantar Fascia by gently stretching the fascia tissue.
- Compression zones promote circulation, reduce impact vibration, boost recovery and strengthen feet.
- Lightweight, seamless design with extra cushioning provides support while still being comfortable.
- Supports the heel/arch and overall foot structure while stabilizing the tendon for better performance
- Made from high quality materials, the socks are moisture wicking and breathable.
OS1st FS4 — non-binding, moisture-wicking, protects fragile diabetic skin.
Recovery Slide for Indoor Wear
- Model ID: 1135061-BTRT
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
Pros & Cons of Conservative Care for diabetic foot care
Advantages
- ✓ Daily inspection prevents amputation
- ✓ Most insurance covers DME
- ✓ Custom orthotics help
Considerations
- ✗ Daily commitment required
- ✗ Slow wound healing
- ✗ Charcot risk if neuropathy
Dr. Tom’s Recommended Products for diabetic foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Drew Moonwalker Diabetic Shoe Dr. Tom’s Pick
Best for: Medicare-covered diabetic footwear
Diabetic Compression Socks Dr. Tom’s Pick
Best for: Daily protection + circulation
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’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
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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.
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