My day began at 7:30 a.m. assisting another podiatrist on a surgical procedure. By 11:00 a.m. I was at the Los Robles Surgicenter to perform a procedure on Arlene's little toe. Arlene chose to have the procedure at the Surgicenter instead of the office because she wanted to be sedated. A new medication, Versed, is marvelous for these procedures. It relaxes you gently into a twilight sleep and is reversed so quickly that you are awake and feeling great as soon as you arrive in recovery. Her procedure went smoothly and successfully.

When I arrived at my office at 2:00 p.m. I had two patients, Robert and Margaret, were waiting. Robert is a 27 year old restaurant manager with an interesting problem. I overheard my wonderful front office manager, Marylin, talking to his wife a few days earlier when she made his appointment. The wife complained that her husband's foot was red, peeling and, most of all, well, aromatic. Over the phone I guessed he had an unusual condition called pitted keratolysis (PK). When I saw his foot I knew my phone diagnosis was correct. Two previous doctors tried athlete's foot medications that did not work. PK is not caused by fungus, but by a bacteria. The diagnosis was confirmed when I shined a hand held black light on his foot in a darkened treatment room. The peeling areas glowed coral red! Diagnosis made. Treatment with topical erythromycin will have Robert (and his wife) breathing easier in a few days.

Margaret complained that her right little toe was sore since she bumped it four weeks prior. Her daughter, a nurse, diagnosed it as a fracture and taped the toes together. She said she knew nothing more could be done for it. Obviously neither of them read last month's Acorn article on toe fractures. After an x-ray demonstrated that it was healing with too much motion, I immobilized it with a particular tape job that stopped her pain immediately.

Next was Bob, a 32 year old patient referred to me by his chiropractor. Bob started to get a pain in his right big toe after he began to hit boards with his feet. Bob, you see, practices the martial arts. While his left big toe moves 100 degrees, his right is limited to 75. His joint jams and causes him pain with extreme motion. This amount of motion is perfectly compatible for every activity except kicking boards with your shoes off. Initial treatment was a quick and almost painless cortisone injection and taping his toe straight with a flexible tape. I gave him extra tape and will see him again in a couple of weeks. I told him only to kick only soft things for awhile.

Next up was Stan. He is a pharmacist who had me remove a neuroma from his left foot the previous Monday (again, at the Surgicenter.) Neuromas are swollen and trapped nerves just behind the toes. Neuromas cause excruciating and shooting pains into the toes, especially when wearing shoes. Since two cortisone injections did not provide enough relief for Stan to stand for hours at his job. We elected to do surgery to remove the neuroma. He reported that he has had almost no pain since the surgery. I changed his dressing and saw that everything was fine.

In room two was Dorothy. She has been coming to the "Dr. Zapf Wound Care Center" on and off for several years. She has severe varicose veins that are frequently inflamed and painful and occasionally they cause little ulcers. With some space age dressings and gentle care we always heal them. This was the first visit in a long time that all her ulcers were healed and she had no new ones. Four patients to go.

Elizabeth is an 18 year old who is going to be a counselor at "outdoor Ed" next week. She called to say she had a "white thing" on the bottom of her foot. Sure enough, that is exactly what she had. It looked like a little blister with no known cause. I trimmed, padded and dressed it. I saw no evidence of a splinter or shard of glass that could be responsible. I am sure it will go away and all we will have to remember it are photographs that I took.

Sixteen year old Peter was next with a recurrent ingrown nail. The very same border of the very same toe was treated last October. At that time I removal of the nail edge under local anesthesia. I was sure it would return unless something permanent was done this time. I did a permanent nail procedure that will give him a normal looking nail with no chance of becoming ingrown again.

Following Peter was Paul He was in for his pre-operative check up for next week's bunion surgery. Paul has lived with his bunion for years until it became too painful to ignore. His insurance has chosen one of our local hospitals as the site of surgery. I must add that both Westlake and Los Robles Medical centers and the local Surgicenter are terrific places to perform foot surgery. The staffs are knowledgeable, competent and caring and they have all the right equipment.

I ended with Marguerite who has heel pain. Her last visit was four months ago and at that time I gave her a cortisone injection. Since the injection hurt very little and it gave her almost complete relief of pain, she wanted another. Her lifestyle does not lend itself to wearing orthotics, so I agreed to another injection. Again she had "very little pain." The end of a great day.