Same-Week Appointments at Balance Foot & Ankle
Three board-certified podiatric surgeons. 950K+ YouTube subscribers. 1,123+ five-star reviews. Howell & Bloomfield Hills, Michigan.
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: Foot surgery is typically outpatient — you go home the same day. You’ll need compression, elevation, ice, and pain medication management in the first week. Most patients need 2–6 weeks non-weight bearing or in a boot, depending on the procedure. Arrange transportation, home help, and work leave before surgery.
Before Surgery: Preparation
Pre-operative preparation begins 2–4 weeks before surgery. Medical clearance from your primary care physician is required for most procedures. This includes bloodwork, EKG (if indicated by age or history), and review of all medications.
Medications to stop before surgery (confirm with Dr. Biernacki): blood thinners (aspirin, warfarin, clopidogrel, rivaroxaban) are typically stopped 5–7 days before. Fish oil and vitamin E have anticoagulant properties — stop 2 weeks before. NSAIDs (ibuprofen, naproxen) — stop 5 days before.
Home preparation: set up a recovery area on the main floor if possible (avoid stairs with crutches), arrange a shower chair and waterproof cast cover, pre-fill prescriptions (pain medication, antibiotics), stock easy-to-prepare food, arrange for a driver and helper for the first 3–5 days.
Smoking: nicotine dramatically impairs surgical wound healing and bone union. Dr. Biernacki requires nicotine cessation for at least 4 weeks before elective foot surgery. This is non-negotiable for procedures involving bone healing (osteotomies, fusions).
Day of Surgery: What to Expect
Arrive 1–2 hours before scheduled procedure time for pre-operative preparation. NPO (nothing by mouth) instructions — typically no food or drink after midnight the night before. You may take essential medications with a small sip of water unless instructed otherwise.
Pre-operative holding area: IV placement, surgical site marking, anesthesia team consultation, and final consent review. The surgical site will be marked on the correct foot — this is a required safety protocol.
Most foot surgery is performed under regional anesthesia (ankle block or popliteal sciatic nerve block) — you are awake or lightly sedated while your foot is completely numb. General anesthesia is used for more complex procedures. The block typically lasts 12–18 hours, providing excellent pain control for the first post-operative night.
Surgery duration: simple procedures (cortisone injection, minor excision, nail procedures) take 15–30 minutes. Bunion surgery: 45–90 minutes. Complex reconstruction: 2–4 hours.
The First Week After Surgery
Day 1: when the nerve block wears off (12–18 hours after surgery), begin the prescribed pain medication regimen proactively — don’t wait for severe pain. Keep the foot elevated above heart level 80% of the day. Ice for 20 minutes every 2 hours (never directly on skin). Keep dressing completely dry.
Days 2–7: wound care per Dr. Biernacki’s specific instructions. Most dressings are changed at the first post-operative visit (5–10 days). Do not unwrap or change dressings independently unless instructed.
Weight bearing instructions vary by procedure — follow them strictly. Most simple procedures allow immediate walking in a surgical boot. Osteotomies and fusions often require crutches or a knee scooter for 4–8 weeks. Violating weight bearing restrictions is the most common cause of surgical complications.
Signs requiring urgent call to Dr. Biernacki: fever above 101.5°F, increasing (not decreasing) pain after day 3, wound drainage that is purulent (yellow/green) rather than serous, wound edges separating, significant increase in foot swelling with redness spreading from the wound.
Dr. Tom's Product Recommendations
DASS Medical Compression Socks
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Post-surgical compression for edema management after clearance from Dr. Biernacki
Dr. Tom says: “Once cleared for compression post-surgery (typically week 2–3), graduated compression dramatically reduces post-operative swelling and accelerates the transition from surgical boot to normal shoes.”
Post-surgical swelling, boot-to-shoe transition, recovery acceleration
Before surgical clearance for compression — always confirm with Dr. Biernacki
Disclosure: We earn a commission at no extra cost to you.
Doctor Hoy’s Natural Pain Relief Gel
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Topical arnica gel for peri-incisional soreness and residual post-surgical pain
Dr. Tom says: “Once wounds are fully healed (typically 3–4 weeks post-surgery), topical arnica and menthol provides safe, non-systemic pain relief for residual surgical site soreness.”
Post-wound-healing soreness, peri-incisional discomfort
Open incisions or healing wounds (wait for full wound closure)
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Most foot surgery is outpatient — home the same day
- Regional anesthesia provides 12–18 hours of post-operative pain control
- Clear weight bearing protocols allow safe mobility throughout recovery
❌ Cons / Risks
- First post-operative night (when block wears off) is typically the most uncomfortable period
- Non-weight bearing restrictions require significant lifestyle accommodation for 4–8 weeks
- Smoking is an absolute contraindication to most elective bone procedures
Dr. Tom Biernacki’s Recommendation
The best surgical outcomes happen when patients are thoroughly prepared before the operation. The patients who call me anxious at midnight on day one are almost always those who didn’t fill their pain prescription beforehand, didn’t set up their elevation station, or didn’t arrange help for the first few days. Preparation is part of your surgical care. I give every patient a detailed written pre- and post-operative instruction sheet — read it, follow it, and call us if anything concerns you.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Will I need general anesthesia for foot surgery?
Most foot surgery uses regional block anesthesia — you may receive light sedation (twilight anesthesia) but often not full general. This reduces nausea and speeds recovery.
When can I drive after foot surgery?
Right foot surgery: typically 4–6 weeks minimum. Left foot in an automatic transmission vehicle: sometimes 1–2 weeks. Confirm with Dr. Biernacki before driving.
How much time off work do I need?
Desk work: 1–2 weeks. Standing or walking work: 4–8 weeks minimum. Heavy physical work: 3–6 months for complex procedures.
What should I bring to my surgical appointment?
ID, insurance cards, comfortable loose clothing (shorts or pants that roll up), a responsible adult for discharge, and a list of all current medications.
Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Hills
📞 (810) 206-1402 Book Online →When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, CURREX, Spenco, Vionic, and Tread Labs — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- APMA-accepted with superior cushioning versus rigid alternatives
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than most premium alternatives for 90% of patients, which is why it’s the first orthotic I reach for in the clinic. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
Tread Labs Pace insole with firm orthotic arch support for flat feet and plantar fasciitis relief. The replaceable top cover design makes it one of the most durable picks in this guide — backed by a million-mile guarantee and recommended for tight-fitting athletic footwear.
✓ Pros
- Firm orthotic arch support shell (podiatrist-grade)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)