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, the one that contains registration forms, doctor information for all the office and directions to the office is located at:

www.conejofeet.com   ç Click here

I am Dr. Michael Zapf. I have been offering a full range of podiatric medical services, from ingrown nails to heel pain and foot surgery, to my friends and neighbors in the Las Virgenes, Conejo and Simi Valleys since 1985. This is my personal web site. It has been up since 1990 and has received more than 2 million visits. The entire site is my responsibility only and nearly 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 Things happen fast in medicine so whatever you read could well be outdated, especially if it was written many years ago. On this site you will read 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. You may wonder why I have my own site even though there is also an official practice site. Well, my partners are of a younger generation raised on tweets, e-mails and iPhones. They want a professional site that they believe better represents the professional nature of our practice. They also believe that people no longer take the time to read anything of length. I, on the other foot, think there is still a world out there full of people who still read lengthy descriptions of problems and solutions. if you are one of those old fashioned readers, then this site if for you. Let me know what you think. Let me know you are out there.

Please note that all information and photographs on this site are copyrighted by me, 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 philosophy. Do not expect them to practice the way I do or even believe in any of the speculation I present here. 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 first, " He is booked until next month",  I still want to see you as long as you are a little flexible with your schedule. If your visit is an emergency, I know that  you will be happy with either of my associates, Dr. Darren Payne or Dr. Steve Benson. They are exceedingly well trained and capable in any foot emergency.

Michael Zapf, DPM, MPH, FACFAS, FACFAOM     (If you want to know what all those initials mean, click here   è  

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

Agoura Hills Office: 28240 Agoura Road, Suite 101, Agoura Hills, CA 91301

Thousand Oaks Office: 555 Marin Street, Suite 290, Thousand Oaks, CA 91360

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

07/24/2010

To Order Foot Supplies è ç click

For Information about Laser Treatment for Fungal Nails Click hereè
 

For information about Shockwave Therapy for heel pain          click here è

Exciting news!!! New Thousand Oaks Location  è

This could be the most important page on my web site. Diabetes leads to foot problems. Foot problems lead to infections and ulcerations. Ulcerations lead to amputations. Most amputations are preventable!

I repeat:

75% of all AMPUTATIONS ARE...

 PREVENTABLE!!!

More hospital days are spent on diabetic foot ulcers than on any other complications of diabetes.

Diabetics should have a complete foot exam once a year and a foot inspection each visit with his or her family doctor.

What is diabetes?

Diabetes is, simply, too much sugar (glucose) in the blood. The way the system works is that you either take in sugar or food that is converted to sugar and the hormone insulin moves it into your cells where it is used for energy. You can develop too much sugar in the blood by not making enough insulin or by not responding to your insulin. Either way your blood sugar levels rise to levels that are too high. In general, blood sugar levels above 130 are bad and indicate diabetes. [ 130 really means 130 micrograms per deciliter written as 130 mg/dl - OK now ignore this part and just think about the big numbers]

If you have diabetes you know that sometimes your sugar levels are high and sometimes they are low. There is a way to determine how they have been during the last month. This test is called the HbA1c [hemoglobin A-1-C] When you come to my office, or your doctor's office, we will measure the HbA1c levels, [also called glycosylated hemoglobin]. In general levels of the test are as follows:

            HbA1C level        corresponds to an average blood glucose level

                5                                        90

                6                                        120

                7                                        150

                8                                        180

                9                                        210

Blood sugar levels can be treated by the following:

1. DIET AND EXERCISE - good for reducing blood sugar HbA1c levels up to a per cent or more.

2. ORAL MEDICATION (pills) - either 1, 2 or 3 in combination. each one seems to reduce the HbA1c level by almost 1%.

3. INSULIN which is injected and can lower the blood sugar to any level you want.

How does diabetes affect the feet?

Diabetes affects the feet in the following ways: 

1) Clogs the circulation - the more your diabetes is out of control the more the disease will cause a blockage of the arteries. Sometimes the blockage can be so great that feet and legs are in jeopardy. You cannot heal an infection or close a wound if there is not enough blood.

2) Kills nerves - high glucose levels in the blood cause a small portion to be converted to Sorbitol - a funny sugar that will gum up the nerves of the feet and legs. It is not all that unusual for long term diabetic patients to have virtually no feeling in their feet. This is very risky because if such a patient stepped on a thumb tack they would not feel it. If a corn ulcerated of a nail became ingrown they might not appreciate that an infection was developing.

3) Lowers immunity - this is the third of the unholy triad. Long term diabetic patients are not able to mount as effective a response to an infection as their non-diabetic counterparts. 

What do people with diabetes need to do for themselves?

QUESTION: I received this internet question from Rebecca In The Middle Of Nowhere: My question is I love to go barefooted and I haven't been able to find any cream or lotions for my dry skin and especially my feet. I have type 2 diabetes and my feet are really dry to the point of cracking and I have corns as well as warts what do I do?

ANSWER: Dear Rebecca, Thank you for your question. Every podiatrist has seen many diabetic patients that have suffered devastating complications from the disease. Even when you do everything right it can be devastating, but if you do not respect the disease it can take you toes, feet or life. The disease ends up causing neuropathy, where you cannot feel or appreciate trauma, bad circulation where you cannot get blood to the site of a trauma and decrease in immune function where you have trouble healing a wound or dealing with an infection. With long standing diabetes an ingrown nail can lead to disaster. Please obey the following rules:

1. NEVER GO BAREFOOT: Bare feet always loose when it comes to a challenge like an chair in the dark or a needle in the rug. A break in the skin can lead to an underappreciated infection.

2. KEEP THEM MOIST: Rub a good skin cream or moisturizing lotion on them once or twice a day

3. KILL THE FUNGUS: If you have athlete's feet be sure to use an easily obtained anti-fungus cream on your feet every day. That fine scale that you see on your skin that you think is just "dry skin" is probably fungus.

4. INSPECT YOUR FEET EVERY DAY: Since you cannot feel trauma you must look for it. If your eyesight is poor have someone else look at them every day. This includes the bottom. If your weight or arthritis makes it so you cannot personally inspect the bottom of your feet prop up a little mirror across from the toilet and hold you feet up next to the mirror to see them more closely.

5. KEEP YOUR BLOOD SUGAR UNDER CONTROL: Every day your blood sugar goes over 130 mg/dl you are damaging your feet. Do whatever it takes to keep the sugar under control. Increasing exercise and maintaining the proper body weight aver very important.

6. SHOW EVERY FOOT PROBLEM TO YOUR DOCTOR: Your doctor or podiatrist should know about every corn, callus and infected nail. Please do not try to take care of these yourself.

7. MAKE REGULAR VISITS TO YOUR FOOT DOCTOR: If your "nowhere" has an ISP (internet service provider) it cannot be that far from somewhere. Most "somewhere" have a foot doctor. Please visit him or her twice a year just to check things out.

8. GET FREE SHOES: If you are old enough for Medicare and have diabetes you may well be eligible for a free pair of shoes every year. Your foot doctor will carefully size and fit your foot to a New Balance, Florsheim or other fine shoe that will exactly fit your feet. Ask for details from your foot doctor.

When do people with diabetes need to see the podiatrist?

Answer; Twice a year if you are not having problems and immediately if you are.

What will the podiatrist do?

COUGH SYRUP FOR NEUROPATHY?

The is an interesting report that oral dextromethorphan, widely available as an over-the-counter cough suppressant (the DM in Robitussin DM or Benylin DM) may alleviate some types of neuropathic pain. In one study patients who took 3 tsp. every 6 hours had some reduction in pain symptoms. The side effects are drowsiness, headache and nausea. This was not a great study and contained more anecdotal info than real data but it seems harmless enough. A better method has been, and always will be, keeping the blood glucose levels close to normal.

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: July 24, 2010