Welcome to the Website of

Dr. Michael Zapf, DPM, MPH, FACFAS

 Thank you for visiting my website. I have been placing information and articles on this site for many years and have received millions of  hits during that time (and not that many of them were mine). I have designed it for people who like to read about their foot and ankle problems. Since I started the web site, I have added two associates to my practice, Dr. Darren Payne and Dr. Stephen Benson.  Since my site is filled with just my thoughts and opinions they are not, necessarily, shared by my colleagues. To see our less controversial (and less windy) practice web site, I offer you: www.ConejoFeet.com, the practice site for The Agoura Los Robles Podiatry Centers (ALRPC). The ALRPC practice site has a lot of material about our office, many of our policies and the registration forms to be filled out before your visit. I suggest all prospective patients visit www.ConejoFeet.com.

 I made the web site to give my patients the extra depth information that I don’t always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. My younger colleagues are both under 50 and they, like many their age, do not favor in depth reading. They prefer their information presented to them in a few short, crisp bullet points. I, being of the, ahem, older generation, like to read about my ailments in greater depth. Here, I present the greater depth. If you ask a question about heel pain or bunions that I have not answered in my two monographs, I will quickly add it so that it is as complete as I can make it. If you agree with this philosophy, welcome to my page. If you correspond with me please let me know if you like the in depth reporting.

 Remember, this site is in no way intended to tell you how your own ailment or problem should be treated, only the approach I use when confronted with certain situations. Your problem may well be different from what you think it is and should always be evaluated by the appropriate professional, whether podiatrist, orthopedist or other authority. Please understand that I, nor anyone else, can offer you a proper diagnosis or treatment plan without seeing and feeling the problem at hand (foot?).  Happy reading.

 Sincerely, Michael Zapf, DPM, MPH, FACFAS, FACFAOM

 P.S. All the information in this web site is © by me and it is mine alone. No picture or any of the articles cannot be used by anyone without permission from me, personally.

01/08/2012

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ACORN February 1994

Surgery And Its Related Fears

By: Michael Zapf, DPM, MPH, and FACFAOM

            Surgery is always a little more stressful than seeing patients in the office. Outside circumstances can increase the stress. Surgery on a seven-month-old baby is one such circumstance. The entire foot fits into the palm of your hand and a one-inch incision covers almost half of the foot. Another stress increaser is doing surgery on a colleague or their relatives. I have performed surgery on physicians, chiropractors, their spouses and, last week, even a doctor’s mom. Well, two weeks ago I had the ultimate in stressful surgical patients: my mother-in-law.

     Actually, I am being overly dramatic. My mother-in-law, Lorraine, is very sweet and kind and we have a great relationship. Using the old dreaded mother-in-law line just seemed like a good way to open the article. We get to see Lorraine and her husband, Ed, a lot more often since they decided to spend the winters in Palm Desert instead of Chicago. We bribe them to visit as often as possible using their grandson, Christopher.

   For a long time Lorraine has had a painful bump on the inside of her big toe. It is caused by a bone spur (called an exostosis in medical lingo) on the toe. The spur causes a big callus to develop on the skin where the big toe rubs against the second toe. This callus is surprisingly large and painful and hurts virtually every time Lorraine wears shoes.

     Several years ago she had it “fixed” by a doctor in Chicago. He made a little incision in the skin and, with a high-speed burr, tried to shave down the bump. This sounds simple and it usually is. Something went a bit awry with Lorraine’s procedure. Inexplicably the doctor put he high-speed burr into the toe bone, instead of against her spur.  Instead of shaving down the spur, he made a large hole right in the bone. This not only did not solve her problem, but it caused some degeneration of the toe joint itself.

    We fixed this problem easily enough. In the office, under local anesthesia, I removed the spur. I also used a tiny incision, but instead of a high-speed burr, I used a little hand rasp. I have always felt that it is risky to poke a high-speed burr into a blind hole in the foot. With the high-speed burr technique, the surgeon cannot see what is happening under the skin. He or she just does the surgery by feel. With a hand held rasp you have much greater control over what you are doing. All you sacrifice is a few minutes of time for a bone spur removal. I find that most little spurs on toes bones can be removed this way.

    Some doctors use a high-speed burr to fix more complex problems, like bunions. Under the banner “minimal incision surgery” or “lunch time surgery” these practitioners advertise that they can repair most foot deformities in this manner. I hear that when it works, it is a useful procedure for the right patient. But when things go wrong with a high-speed burr, they can go very wrong. Most foot surgeons are happier doing surgery the “old fashioned way” by opening the tissues and actually seeing what they are doing.

   Lorraine’s surgery went perfectly. I needed only one stitch to close her incision and she recuperated at our house over the weekend. She only needed one Tylenol for pain. I removed the stitch when we made a house call to the desert the following weekend. She is now wearing regular shoes with much greater comfort than she has known for years.  We will know for sure how well we did when we see her Christmas letter next winter. Keep your fingers crossed.

Send mail to (zfootdoc at doctor dot com) with questions or comments about this web site.
Copyright © 2000 Michael A. Zapf, D.P.M., F.A.C.F.A.S., F.A.C.F.AOA.M.
Last modified: January 08, 2012