Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Diabetic foot ulcers are the #1 cause of non-traumatic lower extremity amputation in the United States. Dr. Biernacki provides urgent evaluation and advanced wound care for diabetic foot ulcers — debridement, offloading with total contact casting or diabetic walking boots, topical wound dressings, vascular assessment, and infection management. The goal is always limb preservation. Call immediately for any diabetic foot wound — delays are measured in hours, not days.
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
Diabetic Foot Ulcers: An Emergency Requiring Immediate Care
A diabetic foot wound is not a “watch and wait” situation. Diabetic neuropathy eliminates the pain signal that would normally prompt a non-diabetic patient to seek immediate care — by the time a diabetic patient notices a wound, it may have been present for days, already colonized with bacteria, and beginning to invade deeper tissues. Any wound on a diabetic foot requires same-day or next-day professional evaluation. Dr. Tom Biernacki prioritizes diabetic wound appointments and provides urgent access for patients with active foot wounds.
Why Diabetic Wounds Fail to Heal Normally
Diabetes compromises wound healing through multiple mechanisms: peripheral neuropathy eliminates protective sensation, allowing ongoing trauma to the wound with each step; peripheral arterial disease reduces blood flow to healing tissues; immune dysfunction impairs the body’s ability to fight bacterial invasion; and elevated blood glucose inhibits neutrophil function, collagen synthesis, and angiogenesis (new blood vessel formation). The combination creates wounds that are slow to heal, quick to infected, and at high risk of progressing to deep tissue infection, osteomyelitis (bone infection), and ultimately amputation.
Dr. Biernacki’s Diabetic Wound Care Protocol
Wound care begins with thorough sharp debridement — removal of devitalized, callused, and infected tissue from the wound bed and edges to expose healthy, healing tissue. Following debridement, appropriate wound dressings are selected based on wound characteristics: moisture-retaining dressings for dry wounds, antimicrobial dressings for colonized wounds, silver-containing dressings for infected wounds, and foam dressings for wounds with significant exudate. Offloading — removing pressure from the wound during healing — is equally critical: total contact casting, diabetic walking boots, or custom footwear are selected based on wound location and patient mobility.
When Hospitalization and Surgery Are Required
Wounds with signs of spreading infection — fever, elevated WBC, rapidly advancing cellulitis, abscess formation, or gas in the tissue on X-ray — require immediate hospitalization for IV antibiotics and surgical debridement. Dr. Biernacki recognizes these emergencies, provides urgent evaluation, and coordinates direct hospital admission with the appropriate surgical team when needed. Limb salvage surgery — arterial bypass, endovascular revascularization — is coordinated with vascular surgery when arterial insufficiency is identified as a contributing factor.
Dr. Tom's Product Recommendations
DermaRite Wound Dressing Foam Pad
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Absorbent foam wound dressing for managing exudate from chronic wounds between appointments. Used under Dr. Biernacki’s guidance as part of a prescribed home wound care regimen.
Dr. Tom says: “Dr. Biernacki’s office showed me exactly how to use this dressing for my diabetic wound between weekly debridement appointments. Very easy to apply correctly.”
Chronic diabetic wounds under podiatrist supervision, exudate management
Infected wounds or wounds without professional evaluation and guidance
Disclosure: We earn a commission at no extra cost to you.
Darco MedSurg Diabetic Walking Shoe
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Post-surgical and wound care shoe with removable insole and rocker bottom for toe and forefoot wound offloading. Dr. Biernacki prescribes this for diabetic patients with active forefoot wounds needing protected ambulation.
Dr. Tom says: “Dr. Biernacki prescribed this shoe for offloading my forefoot ulcer. It protected the wound site completely while allowing me to remain mobile during healing.”
Active diabetic foot wounds, post-surgical forefoot protection, wound offloading
Heel wounds (different offloading device required)
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Same-day urgent evaluation for any active diabetic foot wound
- Sharp debridement with skilled assessment of wound depth and tissue quality
- Total contact casting available for forefoot and midfoot ulcers
- Hospital admission coordination when infection requires inpatient management
❌ Cons / Risks
- Wounds with vascular insufficiency require vascular surgery co-management
- Osteomyelitis (bone infection) requires antibiotic therapy and often surgical debridement beyond podiatry scope alone
Dr. Tom Biernacki’s Recommendation
Diabetic foot wounds are the cases I take most seriously in my entire practice. The path from a small ulcer to amputation can be measured in weeks when things go wrong. Same-day evaluation, aggressive offloading, and expert wound management are what make the difference between saving and losing a limb.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How urgent is a diabetic foot wound?
Extremely urgent — any open wound on a diabetic foot should be evaluated within 24 hours. Diabetic patients cannot rely on pain as a warning sign, so wounds can progress rapidly without the patient realizing the severity.
What is total contact casting for diabetic wounds?
Total contact casting is the gold standard for offloading plantar diabetic ulcers — a fiberglass cast applied to the entire leg and foot that distributes weight away from the wound with every step. It dramatically accelerates healing of plantar forefoot ulcers.
How do I prevent diabetic foot ulcers?
Daily foot inspection, proper nail care, diabetic-appropriate footwear, regular podiatric preventive care visits (quarterly recommended), tight blood glucose control, and immediate evaluation of any skin breakdown are the core preventive strategies.
Do you treat osteomyelitis (bone infection)?
Yes — Dr. Biernacki evaluates for osteomyelitis with X-ray and MRI, provides surgical debridement for superficial bone infection, and coordinates with infectious disease and internal medicine for complex osteomyelitis management.
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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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