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 Article

August 2000

When Is A Bunion Not A Bunion

By: Michael Zapf, DPM, MPH, FACFAS

I finally had a real Deli Pastrami. As I write this I can still taste the pastrami from Katz Deli in New York’s Lower East Side. My family and I stopped there for lunch just before winging our way back to the Conejo from the Big Apple. (Look for our vacation photo in an upcoming Acorn). For fifteen years I have been listening to the lament of my New York patients that you "just can’t get good deli out here" so I went and tried it for myself. Katz is one of New York’s finest and oldest delis. They have been hand-slicing their pastrami and corned beef since 1888. The sandwich was wonderful, piled high with the thickest and leanest pastrami I have ever had and served by a waiter who worked there for 35 years. I even got "yelled at" for loosing my punch ticket they use to keep track of the food. Going to Katz was a wonderful experience, but I have a secret for all you who are not from New York: some our local Delis are good too. Don’t tell the New Yorkers, though. Now to the bunions.

A bunion is the enlarged bone just behind the big toe. With a bunion the big toe usually leans over and crowds the lesser toes. For many people bunions hurt so much that bigger shoes and decreasing activities are not an option and surgery is the only choice. Because of the active and young population of our community I do a lot of bunion surgeries.

With that said, I didn’t do three bunions this week. Now that may not seem like such an odd statement but these were three patients who actually had a bunion but or one reason or another we decided not to do anything about it. Let me tell you about them.

Marvin was easy. He is an 88-year-old retired teacher with huge bunions. He has lived with them for at least 50 years and is in no hurry to have them operated on. But the right one is now hurting. Fortunately for Marvin his pain was made worse by an attack of gout. I say fortunately because with a short course of an anti-inflammatory medication he can quiet down his gout and live, again, long and happy with his bunions. Marvin, by the way, is from New York and loves Katz.

Ariel is 13 and has a bunion that hurts when she plays basketball. It is not surprising to see a teenager with bunions. Sometimes they start as early as 5 or 6 when there are strong forces that lead to their formation. She is a candidate for bunion surgery and will get one eventually but not right now. I suggested that she wait until her foot matures and the growth plates in her feet close. Then we can get a better assessment of the amount of correction she needs for a perfect correction. In the meantime I will make her a pair of custom orthotics that can counter at lest some of the forces causing her bunions.

Finally there was Kathy, a 32-year-old real estate professional. She has bunions and wanted advice on getting them fixed. Both of her sisters were happy with their recent bunion surgeries. I told her my three criteria for not fixing a bunion: First, if they do not hurt wearing the shoes you need to wear when doing the things you need to do. A realtor needs to wear much different shoes than a fitness trainer. Kathy’s bunion did not hurt even in the highest of heels. The next two criteria need an x-ray. Second, if the x-rays indicate that the size of the bunion gets close to the point of no return I suggest a bunion surgery. When a bunion goes from medium to large it suddenly gets hard to fix and has a reduced likelihood of long-term success. Kathy’s was safely in the small to medium size. Third, I suggest a surgery if there is visible damage to the bunion joint or neighboring joints due to the position of the bunion. Kathy’s x-rays did not show any of the tell tale signs of the damage a bunion can cause. Her cartilage was undamaged and there were no changes to the neighboring toe joints. I cautioned Kathy to return in a year or so for follow-up examination but just because she noted a bunion was no reason to have a bunion surgery.

So this is a strange thing to say, but if you don’t want your bunions fixed, go see your local podiatrist. You might be surprised at what we don’t do. And if you want a good pastrami, stay local. But remember, don’t tell the New Yorkers I said that.

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