Welcome to the personal website of

Dr. Michael A. Zapf, DPM, MPH, FACFAS, FACFAOM

Thank you for visiting the web site of Dr. Michael Zapf. He is a member of the Agoura-Los Robles Podiatry Centers

The "real" practice web site, that contains registration forms, doctor information and directions to the office is located at:

www.conejofeet.com

Dr. Michael Zapf has been offering a full range of podiatric medical services, from ingrown nails to heel pain and foot surgery, in the Conejo Valley since 1985. This site is my responsibility only and everything on the site was written by me. You are welcome to peruse this site and learn what you can about me, your feet and the problems your feet can develop. Things happen fast in medicine so whatever you read could well be outdated. In addition I have historic articles that I wrote for a lay audience as long as 25 years ago, so please do not take anything on this site as definitive or as applying directly to your condition. Please note that all information and photographs on this site are copyrighted by Michael Zapf, DPM and cannot be used for any private or commercial purposes. I work with two other podiatrists in my practice who may or may not share any of my ideas and practices. Do not expect them to practice the way I do or even believe in any of the speculation I present on this site. If you appreciate what I have written and want me to be your treating doctor, you will have to ask for me specifically. Even if my office says at fisrst that "I am booked" I still want to see you and ask your to be flexible in your scheduling time. If there is any emergent nature to your visit, I know that  you will be happy with either of my associates, Dr. Darren Payne and Dr. Steve Benson. They are exceedingly well trained and capable in any foot emergency.  

Our office phone number is (818) 707-3668 and my e-mail address is zfootdoc [at] doctor [dot] com

For the address, hours and registration forms please see the practice web site: www.conejofeet.com

01/02/2010

To Order Foot Supplies --> <-- click

For Information about Laser Treatment for Fungal Nails Click here-->
 

For information about Shockwave Therapy for heel pain click here -->

This page contains some great pictures of the surgical removal of a wart. It takes a few seconds to load, but it is worth it.  Before you get to engrossed (or maybe just grossed) in this page you should go to the general page on warts first at -->

This wart belongs to Kristi, a young mother. She has had the wart for at least 10 years! She has seen family practitioners, internists and a dermatologist for the wart. She has had it injected with something she couldn't remember the name of, had it treated with topical anti-wart medication and went through the ultimate torture of weekly freezing with liquid nitrogen for more than a year - all with no relief. She still has this rock-like thing on the bottom of her foot. She likes to be outdoors (this is California after all) and feels quite embarrassed about her "little friend".

This is a fairly good size wart but I have removed them the same way up to three times the size.

Here is a delightful close up of the nasty thing. An interesting thing to note is how the skin lines seem to diverge around the wart. It reminds me of a cartoon I once saw of a side of a snow covered mountain with a single tree growing out of the snow. Also seen are a single pair of ski tracks that are seen going to the tree, splitting apart and coming together as they continued down the mountain (O.K. so you had to see it for yourself). Anyway, the wart grows up between the skin lines and pushes them aside. If you look real close you can see a little satellite wart at about 7:00 o'clock.

The first step is to gently, gently, gently put the wart to sleep. I use several techniques to make this as painless as humanly possible. Sure it still hurts a bit but only for a few seconds.

For more information on why my injections hurt as little as possible see >

The next step is to shave the lesion with a scalpel blade so that it is very flat. Then with a tiny rounded blade a little circumferential cut is made around the margin of the wart. Think of it as a little moat around the wart. If this picture comes out right you will see a circle around the wart representing the "moat".

This little cut is VERY IMPORTANT. Too deep and it will cut through the deep layer of skin causing a long lasting scar. Too narrow and you bisect the wart potentially leaving pieces to regrow. Too wide and you take needless amounts of skin. Too shallow is not really a problem as you can always go deeper. You want someone doing this who has done it many times. I have done it hundreds of times and have developed quite a feel for the exact amount of tissue to take.

This is a good photograph to show he technique. I am using an instrument called a curette (known to my kid patients as a "melon baller for mice") to start scooping the wart out as a single ball. This technique is also very important. You do not want to penetrate the deep layer of the skin (the dermis) by going through the basement membrane which can leave a permanent scar.

Do it right and it peels out like a plug. It is a wives' tale (spouse's tale?) that there are roots to a wart. There are no roots. If you see roots when you remove a wart it probably means that you didn't get it all the first time and need to go back for more of the wart. Early in my career I did the same thing until I learned the tricks of the wart trade. There are no "roots."

Now we are almost done with 90% of the wart cleanly and clearly peeled back from the foot. Notice how compact and solid the wart is. It was removed without any traces of the wart remaining in the hole.

This is the goal of every wart surgery: to remove just the wart completely and entirely with a minimum of fuss and bother.

This is the finished product. A clean hole. The little ripple in the center of the hole is not wart. It is a thin part of the basement  membrane caused by the pressure of the wart  for the last 10 years.

This wart is probably gone. Even with such a clean removal there is still a chance it will come back. When it comes to warts there is no such thing as perfection. Just good surgery.

You may notice in this picture that the area around the wart is blanched and yellow. It is really normal colored skin but the iodine used to scrub the foot discolors the skin yellow. It will wash off easily. The blanching is due to an ingredient in the injection used to temporary stop the flow of blood as well as a tension I placed on the foot to slow any escape of that famous red fluid. I am sorry that some of these pictures are not in perfect focus, I took the pictures with my right hand while holding the foot with my left.

To return to the general wart page just click here -->

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 02, 2010