Welcome to the Website of
Dr. Michael Zapf, DPM, MPH, FACFAS
Call: (818) 707-3668
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 donít always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. I am from a generation that likes to read in depth about all sorts of things, including our ailments. This site is dedicated to all those who want more information that what can be contained in a series of bullet points. If you like this philosophy then let me know when you see me or if you ask a question.
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 and none of the articles can be used by anyone without permission from me, personally.
P.P.S. Comments about this web site or questions about your feet can be directed to me at zfootdoc (at) doctor (dot) com.
P.P.P.S. I was going to offer a nice prize to the person who could send me a screen shot of being the 3 Millionth person to visit this web site. I am sorry I missed that opportunity. But wait until you see what I offer the 4 Millionth visitor.
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<--- This is a picture
of the bottom of the right foot of a patient with two little seed corns that are also called porokeratotic lesions or plugged sweat ducts. Note that the seed corns seem to occur in the middle of a more typical and regular callus. They seem to be a specialized callus. Whatever they are called they are They grow into a second little callus that feels like you are walking on a little grain of sand or rice. When you pick at them you often get a little piece of skin from the center that people sometime mistake for a "seed", hence the name. When the seed comes out you are under the wonderful delusion that you have gotten the center of the lesion and you are done with the thing. Wrong-O! the thing is still there and continues to grow and cause complications.
The left picture is a photograph of another patient with a little seed corn (porokeratotic lesion) on the bottom of the right foot. The second picture (2) shows it in close-up. It is called a seed corn because picking at it with a fingernail often results in the removal of a little piece of keratin that tends to make people think in unfounded optimism "I've gotten it our at last." Sorry, but you haven't. We will see you in the office.
Why they even develop is still a mystery. The best guess is they are a special type of callus. In fact they seem to develop in calluses. In the case pictured it is developing in a linear callus running between the first and second metatarsal heads of the foot. Look closely and you will see two separate seed corns in the long callus.
They are called plugged sweat ducts because of the mistaken notion that an underlying sweat duct must be plugged. Rumor has it that some researcher found a sweat gland under a lesion when looking at it with a special electron microscope (and you thought your job was boring). Later research has never verified this finding and the name is probably an anomaly.
Treating The Aggravating Little Monster (ALM)
Treatments for a porokeratotic lesion are as follows:
1. Ignore it! This is a benign lesion that can be safely ignored if it does not cause any harm and doesn't hurt. It does not "need" treatment just because it is there.
2. Wear comfortable shoes and socks. If wearing padded shoes and socks keeps the ALM from hurting, then go for it. Ask at the office for our list of shoe recommendations.
3. Trimming the lesion. In the office I can make these guys stop hurting for weeks (sometimes many weeks or months) by just trimming the lesion with a sharp scalpel blade.
4. Padding the lesion. Putting a pad around the lesion will protect the ALM and frequently keep it from hurting. Putting a pad on the lesion is a natural thought when something hurts but avoid that; put the pad around the lesion. In the office I use an "aperture" pad made of felt with a circle cut into it. Putting the pad around the lesion makes it feel much better.
5. Removing it surgically. Sometimes an attempt will be made to remove the ALM under local anesthesia using a scalpel blade and a tool that I call a "melon baller for ants" (technically a curette) that scoops the lesion out of the skin. While it works great for warts, for a known sweat duct this is not a highly productive maneuver. It permanently removes the ALM only 10-20% of the time. This is a great technique for a "suspected" porokeratosis. With this technique you can remove foreign bodies like glass or pet hair (really! - pet hair from short haired dogs and cats can actually work its way into the skin). If this is really a wart masquerading as a seed corn, it will also remove it.
6. Sclerosing: I an one of the few people who use a technique to kill off seed corns with a series of injections. I have lectured to this technique to other podiatrists a number of times. Just under the skin I place 4% alcohol solution in anesthetic solution. This is more fully described under the section called sclerosing. Click the green word sclerosing to go to the sclerosing page -
7. Surgical removal using two completely through the skin incisions is 100% effective but has a risk of permanent scarring. To reduce the scarring you should stay off of your feet for 2-3 weeks (crutches!). Needless to say this is the least common method of treating a seed corn. 7. Surgical removal using two completely through the skin incisions is 100% effective but has a risk of permanent scarring. To reduce the scarring you should stay off of your feet for 2-3 weeks (crutches!). Needless to say this is the least common method of treating a seed corn.
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dot com) with questions or comments about this web site.