Balance Foot & Ankle treats diabetic feet in Howell and Bloomfield Hills — wounds, infections, Charcot, at-risk foot examinations and therapeutic footwear. This page explains what an appointment actually involves, so you know whether you need one.
Come in this week if
There is an open sore anywhere on your foot, however small and however painless. One foot is warm, red and swollen without a wound. A callus has a dark spot or a soft centre. A nail is lifting, draining or has skin splitting around it. Or you have diabetes and have never had your sensation formally tested.
Go to an emergency department today if there is fever, redness climbing the leg, pus, a bad smell, black tissue, or a foot that has gone cold, pale or dusky.
What happens at an at-risk foot visit
Sensation testing
A 10-gram monofilament at defined sites, plus vibration testing. This is what establishes whether you have lost protective sensation — the finding that changes everything else.
Circulation
Pulses, and where indicated an ankle-brachial index with toe pressures. Toe pressures matter because calcified arteries in diabetes can push an ABI into a falsely normal range.
Skin, nails and pressure
Callus over bony prominences, fissures, interdigital maceration, nail disease — and where on the sole your weight is actually landing.
Structure
Deformity, joint position, the shape of the arch, and any asymmetry in warmth between the two feet that could indicate an early Charcot process.
Footwear
We look at the shoes you arrived in. Wear pattern, depth, seams and fit tell us more about your risk than most examinations do.
A written plan
Your risk category, how often you should be seen, what to watch for, and what to do about it — on paper, not just said.
What we can and cannot do
| We do | We refer or co-manage |
|---|---|
| Diabetic wound care, debridement and offloading, including casting | Revascularisation — vascular surgery, when the blood supply is the limiting factor |
| Diagnosis and management of Charcot neuroarthropathy, including reconstruction | Glycaemic control and medical management — your primary care physician or endocrinologist |
| Foot infection management and bone infection workup | Inpatient care for systemic infection |
| Routine at-risk foot care, callus and nail management | Neuropathy symptom management beyond the foot |
| Therapeutic footwear and custom inserts, including the Medicare benefit | Certification for diabetic shoes, which by rule must be signed by an M.D. or D.O. |
The diabetic shoe rule worth knowing before you ask
Medicare’s therapeutic shoe benefit requires the certifying physician to be the M.D. or D.O. managing your diabetes — a podiatrist cannot sign that part, even though a podiatrist can prescribe and dispense. So a shoe visit needs a signed statement from your primary care doctor dated within three months before delivery. We will tell you exactly what to ask them for.
What to bring
- The shoes you wear most days — not your best pair.
- Any inserts or braces you currently use, even if you have stopped wearing them.
- A list of your medications, and your most recent A1c if you know it.
- Your insurance card, and the name of the physician who manages your diabetes.
- If you have a wound, whatever dressing you have been using.
Please do not cut, file or treat a callus or wound before the visit. We need to see it as it is.
Offices
Howell
4330 E Grand River Ave, Howell, Michigan.
Bloomfield Hills
43494 Woodward Ave, Suite 208, Bloomfield Hills, Michigan.
Book an appointment
New patients welcome at both offices. If you have an open wound, say so when you book — those are seen sooner.