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 Things happen fast in medicine so whatever you read could well be outdated, especially if it was written many years ago.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

FOR FUNGUS NAILS

Fungal nails could possibly be the most common foot problem in the world. It is also one of the least talked about. People who have no problem talking about their bunions or heel pain sometimes cringe to even think about their thick, brownish-yellow nails. What these people need is a perfect drug: a medicine taken for a very short time, with nearly no side effects, interacts with few medications, causes no damage to their bodies and works for a very long time. To the relief of those suffering with fungal nails, such medication may finally exist.

TOPICAL TREATMENT

In the past, treating fungus nails with anything less than an oral medication was less than successful. All that has changed with PENLAC, the new prescription topical medication. PENLAC is applied once a day using a fingernail polish-type brush. It builds up a slightly yellow tinge to the nail. Used on nails partially infected with a superficial fungus the medicine provides success between 10% and 35% of the time. Thoroughly infected nails are less successful. A little (3.3 ml.) bottle provides 400 applications and costs about $60. PENLAC probably increases the effectiveness of the oral medications.

GRISEOFULVIN AND KETOCONAZOLE

In the recent past the only two oral medications available for fungus nails were Griseofulvin (also called Fulvicin or Gris-peg) and Ketoconazole (Nizoral.) The former worked only 20% of the time. Ketoconazole had a 60-80% effectiveness but had an unacceptable risk of kidney and liver damage. Both had to be taken daily for 12-18 months and both required frequent liver function tests. Unfortunately, the moment the medication was stopped the fungus often returned.

SPORANOX

Sporanox was the first of the new medications to hit the market. The European pulsed method involves taking 4 tablets a day for a single week (28 tablets) repeated for two more consecutive months at a cost of about $600 for 84 tablets. This method cures about 70% to 80% of fungus nail infections. A temporary nail removal or aggressive trimming the nail will increase the effectiveness of the treatment.

Aside from the cost, the only drawback to Sporanox is its interaction to a variety of other medications such as blood thinners and oral anti-diabetes medications.

LAMISIL

Lamisil is taken one tablet a day for three months (cost: about $550 for 90 tablets.) Cure rates are reported in excess of 70%. Again, temporary nail removal or trimming can increase the cure rate. Lamisil does not interact with other drugs. Its only drawback is a report that it does not kill certain uncommon types of fungus.

DIFLUCAN

Diflucan has not been approved for oral treatment of fungal nails but it is sometimes used anyway. The dosage is one tablet a week until the nail looks better, usually six or seven months. The cost is $20-30 a pill!

LAMISIL OR SPORANOX

Both medications effectively treat most cases of fungus nails. Certainly Lamisil is the cheaper of the two with no real drug interactions. If the infection is one of the common fungi (and most are) Lamisil is your drug. If a culture of your fungus shows it to be an unusual “saprophyte” and you are not taking one of the interacting drugs, then Sporanox is suggested. If you are on a medication that interacts with Sporanox but have a saprophyte fungus, you should probably take Lamisil and hope for the best.

AM I CURED?

If you take either of the oral medications you stand a 70%+ chance of clearing your nails of the fungus. I do not believe this will be a permanent correction, however. There must be some underlying condition that caused the nails to be invaded by the fungus organisms. This condition is probably not changed by taking the medication so I expect that the nail fungus will recur. 

    CONSIDER YOURSELF LUCKY IF YOUR NAILS STAY CLEAR AND FREE

    OF FUNGUS FOR THREE YEARS!   

LABORATORY CULTURES FOR FUNGUS

Before taking an oral medication you probably should have a fungus culture that proves your problem is due to a fungus. Certain conditions (like psoriasis) can make your nails look like they have a fungus when, in reality, they do not.

BLOOD TESTS

Lamisil and Sporanox have been used for many years and appear to be very safe. Still, most authorities recommend that blood test be made to assess liver function prior to starting treatment and after the first third of the treatment is completed.

INSURANCE APPROVAL

Many insurance companies will cover the two approved oral medications for fungus without a hitch. Some, like the Blues in California, want to call this a cosmetic condition and refuse to cover the medication costs. I beg to differ, however. A fungus nail infection is an infectious disease and deserves treatment. A cosmetic procedure is designed to take something that is normal and try to improve on it. Bringing an abnormal part back to normal is a RESTORATIVE procedure and deserves to be reimbursed by those insurance companies that reimburse for medications. I use the example of a breast augmentation as a cosmetic procedure but a post-surgical reconstruction after mastectomy as a restorative procedure. Now I do not mean to equate the severity of fungus nails with breast cancer, but it does point out the differences between restorative and cosmetic.

TEMPORARY NAIL REMOVAL

There is no question that the effectiveness of any fungus treatment is increased if the contaminated part of the nail is removed. Usually this is done with an office visit. Occasionally it may require local anesthesia. Alternatively, a urea cream applied to the nails for two days can easily and painlessly remove most of the bad nail.

PERMANENT NAIL REMOVAL

Believe it or not sometimes people choose to have a thick toe nail permanently removed. These people are sick of dealing with thick, discolored and painful nails. The procedure is done under local anesthesia in the office and takes just a few minutes. The nail is removed and the nail root is treated with a chemical to kill the nail root. The result is not all that bad. I do not advocate this for everybody, but for those who do not mind the look of such a nail, it is a very acceptable alternative.

George is a retired photographer who was sick and tired of his fungal nails, especially on his big toes. He asked to have both of them removed permanently. I talked him into doing just he left one first. It took longer than expected to heal fully, about 4 months. Now he is happy. This photo is of his nails about 5 months after the procedure. Note that you can make an argument that the thick right big toe nail is actually less attractive then the left (on the right, of course) one with the nail removed permanently.

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