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 above letter was received in January 2002. My comments are written in italics. 

Dear Doctor

 I have viewed the pictures relating to the bunion operations and wish my 82 year old mother did not have to suffer the way she is suffering now, after a bungled bunion operation that  was carried out about four years ago here in the UK.  The pin that was put in the right toe to straighten it (As I stated in my monograph pins, also called K-Wires, can be used to hold the bones in place after a bunion surgery. The hazard with these pins is twofold: they can get infected and they can break. Since they are protruding from the skin they can be a source of a foot infection during the two to six weeks they are in place. And since they are only the thickness of a thin shirt hanger wire they are subject to breaking if bent too much. This seems to be what happened to your mom. When they break off they can sometimes be retrieved, This might take a second surgery. If they are entirely embedded in the bone they can be safely left alone. If the end of the wire rubs the bone, however, arthritis is a likely result. This might have happened to your mother. I avoid using any wires that stick out of the skin at the time of bunion surgery.)  (both feet were  operated on at the same time) (Also I avoid doing both feet a the same time whenever feasible. When both feet have been operated on there is no "good foot" to stand on.) broke off during removal after the operation and  was left there for over two years, despite her complaints about pain and  there being visual swelling under the sole of her right foot and tenderness, during this time she was also given injections in the toe for what was described as a trapped nerve whilst the pin still remained. But an eventual operation proved  the pin was still left in the toe. (This should have been easily detected with an x-ray).

Since then the sole part underneath the left big toe continues to be very  tender and painful, there  is sometimes swelling of the ankle and sharp stabbing pains along the foot area and also her back  because of the imbalance in her posture. She now walks by the aid of a walking stick but tend not to use it at home only when she goes out. (Do you know if the x-ray shows that the pin in in the joint between the toe and the foot i.e. the first metatarsophalangeal joint?)

Is there any treatment to assist what she has been told is a damaged nerve in the toe, apart from undergoing another operation to perhaps have the nerve removed, although I do not feel this is advisable at her age? (Obviously this is impossible for met to say as I cannot see or examine the foot. If you ruled out the pin involvement with the bone, then the possibility of a nerve involvement is more likely).

Unfortunately, there is not much cooperation in putting this damage right and her suffering concerns me immensely.  I would be so grateful for any advice you are able to give and I appreciate without carrying out an examination personally, it is difficult to give a diagnosis, but the symptoms are as I have  described them above. (Monica, I am sorry I am not of much help. Perhaps a second opinion with a different surgeon would help you. If the pain is due to the damage caused by a retained pin in the wrong location, then it is unfortunately too late. If the pain is a trapped nerve, then perhaps a surgery would help. But first try a few cortisone injections. And there is even the possibility that a series of sclerosing injections for the nerve pain would help. See my page on sclerosing. I am sorry about your mom's pain. I wish there was something I could do.)

Yours most grateful.

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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: January 08, 2012