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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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).

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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: January 08, 2012