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.




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Ganglions2.jpg (45889 bytes)Ganglions1.jpg (53607 bytes)

The delightful bump you see on the side of this lady's foot is a ganglion cyst. If you puncture it (and I did) you would see that it is filled with a thick gel. The gel is called synovial fluid better known as joint fluid. It is the material inside every joint and the outside sheath of many tendons that helps to lubricate and nourish the joint. The fluid is held inside the joint by a covering called a capsule. If something causes the capsule to tear just a little the inside bag of fluid can pop out and form a ganglion. Early on ganglions typically get larger some days and smaller other days depending on the activity of the joint. After several months they stay pretty much the same size and start to get harder as the fluid inside gets thicker.

Ganglions can occur anywhere on the body. The ones on the wrist are sometimes called Bible Cysts because of an old fashioned treatment of whacking them with a heavy object, like a book. This thump sometimes ruptured the cyst on the inside and it would go away.

In a more civilized method of doing the same thing we sometimes "incise" them in the office. Using a local anesthetic block on the skin a needle or blade is used to puncture the cyst and the fluid can be expressed out. Replacing the gel with a small quantity of a steroid medication can sometimes get the thing to stay away. Ganglions can be subjected to this "incision and drainage" several times. If it does not go away you might want to have it surgically removed.

To see a photo of a large ganglion that was removed from a foot

just double click on this picture --->

Ganglions are not visible on plain x-rays but they are sometimes taken to see if there is any bone abnormality under the lesion. Ganglions can be seen with ultrasound examination and with MRI (magnetic resonance imaging). I sometimes ask for a pre-surgical MRI for particularly large ganglions to see if the lesion tracks down to a bone joint or to see if it is arising from a tendon.

Small ganglions can be removed in the office but larger ones, like this one, are done at the surgery center or the hospital using a bit of gentle sedation and local anesthesia (general anesthesia is not needed). The sutures left in the skin after surgical removal are removed in 2 weeks. Most foot surgeons will want you to keep the wound dry for the 2 weeks that the sutures are in the foot. During this time you will have dressings on your foot and will probably be walking in a surgical shoe.

  Mucoid cysts are similar and can be found on the toes (and fingers for that matter) by the nails. For pictures and a discussion of Mucoid Cysts                      click here-->

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Copyright © 2000 Michael A. Zapf, D.P.M., F.A.C.F.A.S., F.A.C.F.AOA.M.
Last modified: November 12, 2013