Welcome to the Website of Drs.

Michael Zapf, DPM, Darren Payne, DPM

Lorie Robinson, DPM and Steve Benson, DPM

Thank you for visiting the web site of Drs. Zapf, Payne, Robinson and Benson all practicing in two offices in the Conejo Valley. Our practice name is the Agoura-Los Robles Podiatry Centers. We have combined over 60 years of experience to better serve our patients. Dr. Michael Zapf is mostly responsible for hte content of this web site.. This site is intended for the patients of The Conejo- Los Robles Podiatry Centers. If you are not a patient, you are still welcome to visit the site and learn what you can about your problem. But the doctors cannot assume any responsibility for your care and cannot offer you any medical advice. You need to see your own professional. Your problem may well be different from what you think it is, even with the help of this site. Please note that all information and photographs on this site are copyrighted by the Conejo - Los Robles Podiatry Centers and cannot be used for any private or commercial use.

04/08/2009

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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: April 08, 2009