Welcome to the personal website of

Dr. Michael A. Zapf, DPM, MPH, FACFAS, FACFAOM

Thank you for visiting the web site of Dr. Michael Zapf. He is a member of the Agoura-Los Robles Podiatry Centers

The "real" practice web site, the one that contains registration forms, doctor information for all the office and directions to the office is located at:

www.conejofeet.com   ç Click here

I am Dr. Michael Zapf. I have been offering a full range of podiatric medical services, from ingrown nails to heel pain and foot surgery, to my friends and neighbors in the Las Virgenes, Conejo and Simi Valleys since 1985. This is my personal web site. It has been up since 1990 and has received more than 2 million visits. The entire site is my responsibility only and nearly everything on the site was written by me. You are welcome to peruse this site and learn what you can about me, your feet and the problems your feet can develop. Things happen fast in medicine so whatever you read could well be outdated, especially if it was written many years ago. On this site you will read historic articles that I wrote for a lay audience as long as 25 years ago, so please do not take anything on this site as definitive or as applying directly to your condition. You may wonder why I have my own site even though there is also an official practice site. Well, my partners are of a younger generation raised on tweets, e-mails and iPhones. They want a professional site that they believe better represents the professional nature of our practice. They also believe that people no longer take the time to read anything of length. I, on the other foot, think there is still a world out there full of people who still read lengthy descriptions of problems and solutions. if you are one of those old fashioned readers, then this site if for you. Let me know what you think. Let me know you are out there.

Please note that all information and photographs on this site are copyrighted by me, Michael Zapf, DPM, and cannot be used for any private or commercial purposes. I work with two other podiatrists in my practice who may or may not share any of my ideas and philosophy. Do not expect them to practice the way I do or even believe in any of the speculation I present here. If you appreciate what I have written and want me to be your treating doctor, you will have to ask for me specifically. Even if my office says at first, " He is booked until next month",  I still want to see you as long as you are a little flexible with your schedule. If your visit is an emergency, I know that  you will be happy with either of my associates, Dr. Darren Payne or Dr. Steve Benson. They are exceedingly well trained and capable in any foot emergency.

Michael Zapf, DPM, MPH, FACFAS, FACFAOM     (If you want to know what all those initials mean, click here   è  

Our office phone number is (818) 707-3668 and my e-mail address is zfootdoc [at] doctor [dot] com

Agoura Hills Office: 28240 Agoura Road, Suite 101, Agoura Hills, CA 91301

Thousand Oaks Office: 555 Marin Street, Suite 290, Thousand Oaks, CA 91360

For the address, hours and registration forms please see the practice web site: www.conejofeet.com

07/24/2010

To Order Foot Supplies è ç click

For Information about Laser Treatment for Fungal Nails Click hereè
 

For information about Shockwave Therapy for heel pain          click here è

Exciting news!!! New Thousand Oaks Location  è

The Matricectomy - A Photographic Journey

Many thanks to the brave gentleman who took all these pictures so I could show them so clearly on the web site. He showed uncharacteristic bravery for a guy.

The first photo (1) shows the evil ingrown nail before we started. He has chronic and recurrent ingrown nails on the left side of the toe (fibular border). This toe killed him in shoes. He wanted desperately to get this toe better. Others tried and others failed. Now it was my turn. The photo on the right shows the first step. I am injecting the base of the toe with plain Xylocaine after first spraying the injection site with enough Ethyl Chloride (the bottle behind the foot) to pre-freeze the skin. As I describe under gentle injections, I used the smallest syringe and the smallest needle made for this injection. I find these little needles and syringes produce the least amount of pain.  I follow the Xylocaine injection with a second injection of long acting Marcaine. I do not start with the Marcaine because it stings so much going into the tissues that I want the toe first made numb with the gentle Xylocaine. Also note that I inject at  the base of the toe where the skin is loose and movable. Injecting it at the tip of the toe where it is ingrown (a favorite trick of some urgent care centers) is cruel and unusual punishment.  For more of my injection technique please see --> 

12

After securing anesthesia of the toe it is scrubbed with a brown anti-bacterial solution called Betadine. Next I place a blue "toe-niquet" over the toe to keep any 'red stuff" out of the wound site. Not only do I not like the sight of the red stuff but it interferes with the effectiveness of the acid I use to kill the nail root. Next I use a tiny tool called a curette to loosen the skin away from the edge of the edge of the toe nail.

45

After freeing the edge of the nail plate I use an fancy nail cutter called an English Nail Splitter to cut the edge of the nail parallel to the side of the toe (6).

6

After cutting the side of the nail plate I use a little tweezer like instrument called a mosquito hemostat to reach in and grab the piece of nail that was inside the toe. Done correctly you do not have to remove any nail that you can see - just the nail that is inside the toe itself. 

7

Double click on picture number (8) to see in a large version just how much nail can be removed without changing the shape of the toe nail itself.

8

After the edge of the nail plate is removed it is time to kill the edge of the nail root that causes the edge to grow (9). I use an applicator stick (medical speak for a Q-Tip) that was dipped in an acid called phenol. To kill the nail root requires two or three applications of phenol placed directly on the nail root tissue.  

    910

Finally the toe-niquet is removed and the toe is dressed with an antibiotic cream, sterile gauze and covered with a compressive bandage called Coban (here it is blue).

11

After the surgery patients are given the following instructions.

Matricectomy Post-Operative Instructions:

1. It is best to return home and elevate the foot/feet until the feeling returns (which can take from 2 to 6 hours). At that time remove the stretchy (usually brown) Coban covering the gauze. Delay taking a shower or bath for 12 hours from the time of surgery.

2. Clean the nail border(s) using any one of the three interchangeable methods (not all 3 at the same time):

      A) Using a shower of clean tap water - holding the toe(s) under the shower using it like a shower-pic.    

      B) Clean the edge of the nail plate with a Q-Tip and hydrogen peroxide

      C) Soaking in an (Epsom or kitchen) salt solution and cleaning the wound edge with a Q-Tip

3. Tomorrow morning do the first cleaning of the toe(s). Remove the white dressing and clean the wound(s) using one of the three methods that are interchangeable. After cleaning the nail border(s) please dress the wound with the prescription antibacterial and cover the toe with a Band-Aid. Wear regular shoes that are not too tight on the toes.

4. Keep the wound clean including avoiding getting dirt or sand into he wound and showering only with a Band-Aid or other covering on the toe(s) until healing is complete. Wounds do not heal faster if they are allowed to "dry-out" or "air-out"

 5. Call the office if the toe becomes more swollen, painful or red than you think is normal.

 6. Please schedule a follow-up visit for 3 to 5 days after the procedure.

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: July 24, 2010