Welcome to the Website of
Dr. Michael Zapf, DPM, MPH, FACFAS
Call: (818) 707-3668
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 donít always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. I am from a generation that likes to read in depth about all sorts of things, including our ailments. This site is dedicated to all those who want more information that what can be contained in a series of bullet points. If you like this philosophy then let me know when you see me or if you ask a question.
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 and none of the articles can be used by anyone without permission from me, personally.
P.P.S. Comments about this web site or questions about your feet can be directed to me at zfootdoc (at) doctor (dot) com.
P.P.P.S. I was going to offer a nice prize to the person who could send me a screen shot of being the 3 Millionth person to visit this web site. I am sorry I missed that opportunity. But wait until you see what I offer the 4 Millionth visitor.
To order foot supplies --> <-- click
I am writing from the UK after visiting your web-page. My girlfriend has what appears to be a excess amount of bone on the top of each foot ( I think this may be the metatarsal?. They appear as 'humps' - just as you would get on a camel! The hospital here has suggested surgery but I am concerned and want to know all I can about this before any form of surgery takes place. It may be that we travel to the US to have the operation.
I have searched endless websites but not been able to find anything about this. Can you help? Thanks.
I should have addressed this before. Your girlfriend has a bony bump on the top of her foot where the first metatarsal bone meets the bone behind it, the cuneiform bone. It is technically a "First Metatarsocuneiform Exostosis" commonly called a dorsal bump. It is normally a benign and harmless little bump. But it does have a superficial nerve that runs right over the top of it. When the nerve is compressed between the shoe or ski boot and the underlying bone, pain results.
Treatment for this can be conservative or surgical. If you know what shoe or shoes are he main culprits and you can avoid them, do so (this is the Henny Youngman* School of Medicine). Sometimes merely lacing athletic shoes or hiking boots so that a lace misses the bump will do. Other times an pad can be affixed to the foot or the shoe that displaces weight and pressure away from the bump.
When conservative methods fail the bump can be easily and successfully removed. Here in the States the bump is removed under local anesthesia, possibly with sedation, but full anesthesia is not needed. A 2-3 cm incision is made directly over the bump and dissection is carried down to the bone. The bone bump is removed with either a little power saw or a hammer and chisel (osteotome and mallet in medical speak). Overnight stays in the hospital are not needed. We have patients walk the same day in a post-operative surgical shoe and they can wear regular shoes in 10-14 days after surgery when the sutures are removed. I ask my patients to keep the wound dry for the 10 days before suture removal.
Just superficial to the bump is a cutaneous (skin) nerve and just to the side is the very important dorsalis pedis artery, so you want a reasonable experienced surgeon to perform this procedure.
Olaf, I do not think you have much to worry about. This is a relatively common problem and most foot surgeons get to do several a year. My advice -- go for it.
(* Henny Youngman was an American comic famous for one liners like: I went to the doctor and told him "it hurt when I did this". He said, "don't do that")
October 8, 2003
Dr. Michael Zapf and Dr. Darren Payne,
I have a hard bony lump on my left First Metatarsocuneiform joint which makes wearing shoes very uncomfortable. I have had this lump for several years now, but as of this year it is now causing me more pain. Once I take the culprit shoe off, the pain lasts for several hours. My GP after seeing the x-ray had me see a specialist. My GP believed the bump to be an osteochondroma, which as I understand is a common benign bone tumor, but she just wanted to make sure it was not an osteosarcoma. I saw a specialist, and during the exam I seemed to come away with him telling me that I had a form of bursitis which surgery could help. But from what I knew about bursitis, that diagnosis did not make sense to me. I requested the report from the specialist which stated small exostosis over the cuneiform. I am not sure if bursitis and metatarsocuneiform exostoses have anything in common. Even though this is supposed to be a very common problem, I have not found much information about it online or on medline. I was wondering how soon a patient can go back to normal activity after the surgical removal of the exostosis and what types of surgical complications are possible? Knowing that there is a nerve that runs on top of that joint I was concerned about going through with surgical removal. I figured since the pain wasnít unbearable, I would try to just live with it and find shoes that were better suited for my feet. If the procedure is actually an easy common one, I might be more interested. Thanks for your help.
Osteosarcoma? I should hope not but only your foot specialist (podiatrist or orthopedist) can help you there. Usually these are just bony bumps arising from a "jamming" of the first metatarsal on the first cuneiform bone. This is frequent in high arched feet. If this bump is not a bother it can stay. If it gets in the way (particularly problematic in ski boots) it can go with a 30 minute surgery. I do mine at the Surgery Center under local anestehsia with sedation (general anesthesia is not necessary). A surgical shoe is worn for 2 weeks and a sit down job can be resumed as soon as 4 days after surgery. The complications mostly involve entrapment of a nerve that runs across the bump (a few %) and not taking enough bone to make patients happy (~5%).
Send mail to (zfootdoc at doctor
dot com) with questions or comments about this web site.