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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How well does sclerosing for nerves work? read this by a patient names Karen with a painful neuroma. Read Karen's story at -->

Sclerosing Corns and Nerves

By: Michael Zapf, D.P.M., M.P.H., F.A.C.F.O.

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The other day I was trying to explain to a culinary oriented patient something I had recently learned at a seminar. It was a new (to me) method of treating a variety of conditions using a concoction consisting of local anesthesia and pure alcohol. I told her we might consider sclerosing her corn and I spelled the technique, “s-c-l-e-r-o-s-i-n-g”. “Thank goodness you spelled it”, she replied. “I thought you said slow roasting.”

Sclerosing has been used for years to eliminate varicose veins without surgery. Using a variety of agents, this alcohol solution being one, a thick vein is injected with the sclerosing solution. In effect the solution scars both sides of the vein. When compression, in the form of an elastic bandage is applied, both sides of the vein scar together and the vein is closed permanently. Sclerosing has proven to be safe and effective.

In podiatry we are continually confronted by calluses, called corns, caused by prominent parts of bone rubbing against other bones or shoes. These corns are conservatively treated by trimming, padding and changing shoes. Surgery is directed at reducing the bony prominence. Surgery for corns is very common and very effective.

Sclerosing injections can often eliminate plugged sweat ducts and neuromas without surgery

A less common type of corn is the porokeratosis or, for the podiatrically challenged, a “plugged sweat duct” (PSD). They have also been given the name seed corn because they seem to have a central core that reminds people of a seed. PSDs are usually found on the bottom of the foot in weight bearing locations. PSDs are not caused by a bony prominence and there is no easy way to get rid of them forever. The only two choices were to trim them every few months or to surgically excise them with an incision going through the whole thickness of the skin. Any such surgery will leave at least a fine scar. Because scars in a weight bearing location can be as uncomfortable as the corn, surgery is not often performed. This is where slow roasting, er, sclerosing, comes in. PSD will often go away with a series of sclerosing injections performed with tiny needles and tiny syringes. Sutures and bandages are not required.

Sclerosing is also a great way to kill nerves (neurolysis). Killing nerves is not something to be undertaken lightly. But sometimes, in cases of neuromas or trapped nerves, for instance, the nerve is the problem. With sclerosing injections the nerve can be eliminated as a source of pain without surgery.

Sclerosing corns or nerves requires up to seven or eight weekly injections. Because injections have been given a “surgery code” by insurance companies, it will appear on your bill as a surgery even though you never approached an operating room.

Now you know when your hear me telling you about sclerosing corns, I am not referring to a summer barbecue.

From The Doctor’s Desk:

It is wonderful when a simple therapy can take the place of a more involved open surgery. It is even more wonderful when it can treat a problem that is otherwise untreatable. Such is the story with the annoying problem known as seed corns, plugged sweat ducts or porokeratotic lesions.

On a hard surface these little lesions hurt - sometimes a lot. Until now, none of our simple treatments, such as using a wart remover, has not worked. Getting rid of them permanently has required a full thickness skin excision. Such an incision can leave a painful scar, especially if a patient walks on it during healing.

I was very happy at a recent seminar to learn about sclerosing injections. It is an old technique used in a new method. Sclerosing can treat seed corns, neuromas and certain other conditions. I am happy to offer this to my patients as a non-surgical option in treating these vexing problems.

Dr. Michael Zapf

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I received the following letter about a seed corn April 21, 2001

Dear Dr. Zapf,
It was good to find your web site, it was the only useful information I
was able to find.  I have a seed corn under my foot which causes a lot
of pain and because I tend to walk differently on that foot now, causes
shooting pains all the way up my leg, especially when I am laying in bed
at night.  In desperation I decided to have surgery in the doctor's
office (I live in the small town of Athens, Ohio).  After the surgery I
had stitches in my foot and was on crutches for three weeks.  After that
it was great and the shooting leg pains had stopped.  Five months later
they came back, that is when I realized the seed corn had returned.  Now
I am desperate.  You mentioned SCLEROSING, what exactly would that do
for a seed corn?  Would it cure it, or just stop me from feeling it?
Thank you.

Susan R.

Dear Susan,

As you can see from what I wrote above I do use sclerosing as a first step in treating seed corns before I would ever try to surgically excise them. The surgery is cumbersome and for best results you need to be off the foot for 3 weeks afterwards. Seed corns seem to occur in little crops of three or four. The picture at the top of this page shows two seed corns in the middle of a long "linear" callus. If you successfully remove one of the little guys you might have a sibling pop next to (or in) the incision site. This new one would seem to be a recurrence of the original corn but I believe that the surgery completely eliminated the original and the "recurrence' is really a second corn. You could, of course, remove this second corn with the same surgery. As an alternative you can "sclerose' this corn just as you could have sclerosed the first one. My success of sclerosing seed corns is good but not great. In a study I did of 32 of my patients I found that they completely resolved (went away) about 1/3 of the time. In another third they did not go away but the nerve under them must have been killed because they no longer hurt. I consider this a success because if they do not hurt most people can live with the little callus under the foot. Finally in 1/3 of the cases there was no improvement and I would have to consider the treatment a failure. Keep in mind that a successful treatment takes a series of 7 or 8 (or sometimes more) weekly injections of a small quantity of the alcohol solution just under the lesion. I hope this helps

Dr. Zapf

Another note:

 From Jane B. She returned to my office for an unrelated problem but had her neuroma "sclerosed" 6 years before. She noted that she had no pain whatsoever from her neuroma since she has the treatment. She made the following note; "I will always choose an alternative method to surgery first and Dr. Zapf's special Zapping method for neuromas, sclerosing, really worked for me!"

 

   

 

 

 

 

 

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Last modified: January 08, 2012