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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Sole Survivors – Preventing the Ultimate Tragedy

By: Michael Zapf, DPM, MPH, FACFAS, FACFAOM

I often give a lecture to service clubs, church groups and schools entitled Sole Survivors – Helping Feet to Last a Lifetime. It is a light and breezy talk with slides where I describe bunions, ingrown nails and the other topics I cover in these articles. One topic I usually avoid, but I really should talk about in some depth, is the ultimate Sole Survival, preventing amputations. I know this is not a particularly happy topic, but if you read through to the end I will offer to give you a little gift that could prevent this tragedy from happening to you or someone you love.

Most of the time being a podiatrist is just plain fun. Healthy people with little aggravating problems come to the office. With a quick procedure or a pair of orthotics they are made happy again. But once or twice a week another kind of patient arrives at the office; one with an ulceration or infection that has the potential of serious consequences. When this patient turns up everybody, me especially, gets quite serious.

I speak about infections and ulcerations in the same sentence because they often go hand in glove with each other. An ulceration is a break in the skin that does not readily heal. Because it is a hole in the skin bacteria can enter and set up an infection.

While anybody can get an ulceration, it is commonly seen in patients with diabetes. The elevated blood sugar levels of patients with diabetes cause a variety of lower extremity problems. Diabetic patients often have decreased blood flow to the feet, a decreased immune response to infection and healing and a lack of feeling in the feet. The lack of feeling is called neuropathy and it is responsible for letting little problems such as a corn or ingrown nail grow into serious problems because their owner cannot feel them. More on this a little later.

Patients with an ulceration, or an infected ulceration, especially if they have diabetes, need quick and expert ulcer care to help them be a Sole Survivor. The mainstays of treatment are keeping the ulcer clean (this sometimes takes frequent visits to the office to surgically clean the wound) and keeping the foot elevated with no weight bearing. If the foot has bad circulation a quick visit to a vascular surgeon must be arranged. Antibiotics, and sometimes a visit to the infectious disease specialist, are used for an infection.

Most of the time your foot doctor, along with everybody else on the team, can get ulcerations and infections to heal. But it would be much easier to prevent ulcerations and infections in the first place. If podiatrists are great at getting ulcers to heal, we are even better at preventing them. But first we have to get those people who are at risk for an ulceration into our office.

I will be blunt here. If you or someone you know has either poor circulation or neuropathy of the feet, they should be making regular visits to their podiatrist. Poor circulation can be determined by feeling for pulses in the feet, observing how they look and feel and by special blood flow tests. Usually your family doctor can tell you if you have bad circulation.

Neuropathy is another story. Until recently it has been difficult to know when the feeling was "bad enough" to warrant regular visits to a podiatrist. A few years ago researchers in Louisiana developed a very simple test. If a patient cannot feel a touch with a special sized nylon filament, they are at high risk of developing foot ulcers and infections.

I have managed to acquire a small supply of extra filaments and I will make them available to Acorn readers for free on a first-come basis. Just call my office and I will mail one to you along with some simple instructions. If you can feel the end of this filament when it is placed against your foot, you are not in much danger. If you cannot feel it, you really should make an appointment with your foot doctor on a regular basis. Virtually every insurance company (even the bad ones!) will let you see a foot doctor on a regular basis if you cannot feel this filament. Call today: the sole you save may be your own.

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