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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ACORN January 1994

Something New for Fungus Nails

By: Michael Zapf, DPM, MPH, FACFO

                While fungus infecting a nail makes the nail yellow, brown or white, it makes people who have it see red. The fungus causing the problem is a little microscopic plant that normally lives in the soil. Under the right conditions it gets into the nails and sets up housekeeping. It is extremely hard to evict. Fortunately more and more doctors are reporting success using an old treatment in a new way. The result is more people experiencing the pleasure of normal looking nails.

                Why a fungus infects a nail has been a mystery for hundreds of years. In some cases it occurs after a traumatic episode to the toe. This may be as great as dropping a heavy object on the toe or it could be as little as years of wearing tight or ill-fitting shoes. In other cases some type of sickness or disease predisposes the body to fungal involvement. In still more cases the cause will never be known. An otherwise healthy person suddenly notices a discoloration creeping up the nail. Sometimes only one nail is affected and other times all ten are involved. It rarely occurs on the hands and even more rarely on the hands or feet of children.

                Up to now the most successful treatment for fungal nails is one of a variety of oral medications. These drugs will work about 60-80% of the time if they are taken religiously for 10 to 20 months. The drawback is the potential for rare but significant and severe problems with the liver or kidneys. While the chance for problems is quite rare it would be foolish to take any oral anti-fungal medication without periodic blood checks to assess the liver and kidneys. Should the tests show any abnormalities the drug is immediately withdrawn and the abnormal laboratory values almost always revert to normal. These medications are widely prescribed but the potential side effects make many doctors a bit wary of using them.

                The easiest form of treatment is also the least effective: topical medicines. Using even the most sophisticated topical medication on the fungus nail is usually not very effective. Mycocide, a new topical medication, has recently been introduced and early reports indicate that it might be much more effective than other topical medications. Still, I would consider it a success if half of the fungus nail patients had their nails clear up using Mycocide twice a day.  The problem is that many of the fungus spores (or  “seeds” of fungus) are located deep under the thick nail. Without doing something to get rid of the thick and infected nail, the fungus spores just sit underneath waiting to sprout. For this reason many doctors recommended trimming or removing some of the nail plate to allow the medicine to get where it can do some good.

                Removing the nail plate and treating the nail bed with topical medications until the new nail grows back seems to be as effective as the oral medication without the side effects. Certainly the drawback is the pain of the procedure and the discomfort of the newly nail-less toe for a week or two. A final insult is not having a nail on the toe for the time it takes for a new nail to grow.

                In an ideal world there would be a medicine you could put on the nail that would melt away the infected part of the nail and let the normal nail alone. Such a medicine would not harm normal skin or nail, would not hurt to use and would not cause any disability. Fortunately such a medicine exists and it is called 40% urea paste.

                Applying this benign cream to a fungus nail will soften and remove only the infected nail so that topical medicine, like Mycocide, can work effectively. In some cases one or two treatments with the urea paste will remove all the infected nail. In other cases it will take a series of applications to fully clean the nail. The good news is that there is no pain, blood, disability or time away from work or school. The medicine is removed 3 to 7 days after it is applied. Most insurance carriers will cover the cost of this procedure, especially if the nails are thick enough to be painful.

                If you have fungal nails and choose to take oral medication, the chances of any problems are very small. Should you wish to avoid the risk altogether, now you have an alternative that is easy, safe and probably equally effective.

Dr. Michael Zapf is a board certified podiatrist in practice in Agoura Hills and Thousand Oaks. For more information please call his office at (181) 707-3668

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