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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.
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ACORN February 1998 Diabetes
I just returned from visiting Tom in the hospital. Tom has partially lost his battle against diabetes. More specifically, his foot lost the battle. Walking down the hospital corridor I realized once again that this disease, so commonly seen in a podiatry office, can be very cruel. I am going to tell you about Tom so that you can take some precautions if you have diabetes. Tom, 51-years old, has been a patient of mine for nearly a year. I see him every month or two to make sure his nails and calluses are kept in check and are not causing him any harm. When I saw him a month ago his foot looked fine. When he showed up last week his foot had an infection that had invaded the bones of the foot. There was no way to save it. Tom first noticed the early signs of an infection a week prior but he tried to treat the foot on his own. He persuaded himself that it was getting better. His wife knew better and forced him to come to my office. Tom discounted the serious nature of his foot because of neuropathy. His foot was totally numb. Diabetes has a way of converting some sugar, when the blood levels of sugar are high, to sorbitol. Sorbitol is a sweet sugar that our bodies cannot use. Some of the sorbitol gets trapped in the nerves and causes them to cease functioning. At first diabetic neuropathy causes burning pain. In later stages the nerves are numb. Without sensation coming from his feet Tom, had no idea that his foot was as badly infected as it was. Diabetes also decreases the ability to fight infections. An infection that would be only a minor annoyance in a non-diabetic patient can be limb threatening in a diabetic. Tom thought that a few antibiotic pills would help his foot. He did not realize that his body stopped fighting the infection and he needed early treatment with high doses of antibiotics. Diabetes causes early blockage of arteries. While Tom has enough oxygen getting to his feet to keep a non-infected foot healthy, he does not have enough to fight a badly infected foot. The triple threat of neuropathy, decreased immune status and decreased blood flow placed his foot at a very high risk of infection. For that reason virtually every non-HMO insurance plan, including Medicare, will pay for regular podiatric foot care for diabetic patients. Many podiatrists become expert at providing just this care. While many Congress people will decry from the floor of the House and Senate that podiatrists get paid "millions to just cut toe nails" this service is only covered for high-risk patients, like Tom. (The new Medicare rules, by the way, now pay all of $12 a visit for trimming the nails of high-risk patients like Tom. So much for podiatrists getting millions for cutting nails. The hospital admissions avoided by regular care for diabetic patients far outweigh the cost of the preventive services.) If you have diabetes you need to be aware of the following guidelines:
Developing a lifestyle to deal with diabetes is a life-changing event. Danger lurks for all those who deny their diabetes. Yet there is great hope. Just follow these rules and learn all you can about this disease and plan to live a long life free of complications.
Dr. Michael Zapf is a board-certified podiatrist with offices in Agoura and Thousand Oaks. For more information you can call his office at (818) 707-3668. |
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