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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Laser Treatment of Fungal Nails

 Acorn July 2009

Michael Zapf, DPM

   Laser treatment of fungal nails. You have seen the ads. Now let me fill in the back story and give you some honest information.

   The story started with a wealthy father of a child with cystic fibrosis (CF). As an engineer he started researching on the ability of a laser, tuned to the correct wavelength, to penetrate tissues and kill germs without hurting the tissue. Killing bacteria in the lungs of a patient with CF is difficult. But a laser light that could kill bacteria yet safely pass through delicate lung tissue would be a godsend to CF treatment. Along the way to this Holy Grail of CF care, he tuned the laser light to a different wavelength and found that he could kill fungus in nails without harming the nails or surrounding skin. This is a big market and any profits he made here could help fund his CF research.

   Almost two yeas ago the trials started on patients in two podiatry offices in Sacramento. The results were better than they imagined. Almost 90% of the patients they treated with the laser showed improvement in the appearance of the nails as the nails grew out. These patients are the basis of the FDA approval for treating nail fungus with the laser. Some of these patients had tried to kill their nail fungus for years and many had tried the top oral medicine, Lamisil, and failed. The laser seemed like a winner and the company that produced the laser, Patholase, Inc., began marketing the PinPointe laser systems. So far about 45 podiatrists across the nation have the PinPointe laser. You may have seen it featured on a Good Morning America segment.

   Treatment with the laser is rather simple. The first step is to trim the nails down to the thickness of normal nails. The importance of this step cannot be overestimated. This mechanical treatment is nearly never done by dermatologists and is illegal to do by a pedicurist. It is, however, very familiar to podiatrists which is why the laser has mainly been marketed to us. We have a whole series of burs and sanders to thin the nail without causing pain or bleeding. The laser will not work on a thick nail that has not been seriously and properly thinned.  

   After thinning the nails and donning special laser goggles, we apply the laser light to every portion of every toe nail in a process that takes 40 minutes. There is no real pain with the lasering – just an occasional pinprick-like feeling that goes away instantaneously. After treatment, all activities can resume immediately with no post-treatment pain or disability of any kind. The Good Morning America segment indicated that the average cost of treatment is about $1200. (Our PathoLase contract does not allow us to publish our fee but you can get it with a call to our office.)

   The alternative to laser treatment is either the daily use of a topical medicine (there are dozens of kinds) that never really kills the fungus or the use of oral Lamisil pills. I think Lamisil is a very effective drug but there is always the concern of possible damage to the liver, kidney and the bone marrow. Lab test are always required to make sure Lamisil is not causing any harm. No testing of any kind is required for laser therapy and there are no real obstacles to treatment, although we avoid pregnant women and patients with cancer whenever we can.    

   After treatment with either the laser or Lamisil, precautions need to be taken so that contact with new fungus spores does not lead to a new infection. Daily, or at least twice a week, you need rub your nails, toes, the spaces between the toes and the bottom and sides of your feet with an anti-fungal cream.  Shoes should be sterilized by either spraying them with an anti-fungal spray or using an ultraviolet light shoe tree. Plastic sandals and shoes should be sprayed with Lysol as should the bath and shower area. 

   The big question is, of course, will it work for you? There is no way to know for sure but the results when the protocol has been followed carefully, and the nails thinned and trimmed to normal thickness, are very encouraging – on the order of 88% success.  We are following the protocol exactly so we are hoping for the best. It takes almost a year for a big toe nail to grow and replace the contaminated part with clean nail. A year from now I will report back on our office success rates. For more information, and success pictures, please see our web site www.LaserMyToes.com.  If you like, we, like almost all of the PinPointe laser doctors, offer a free consultation for those who want to discuss their options in person.

Dr. Michael Zapf, along with his associates Drs. Darren Payne and Steve Benson are Board Certified podiatrists with offices in Agoura Hills and Thousand Oaks. For more information you can call their office at (818) 707-3668 or visit the practice web site www.conejofeet.com.     

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