Footnote to podiatrist's Honduras visit
By Michael Zapf, DPM

I am back from my annual January trek to Honduras with a team that performs clubfoot surgery on local children. We performed 30 surgeries during the visit.

The venture is sponsored by the Rotary Clubs of Westlake Village Sunrise and of Agoura Hills/Oak Park and is paid for with the proceeds from a car raffle. This year our prize is a threeyear, 45,000mile, maintenanceincluded lease on a beautiful Mercedes E350.

During some of the downtime in Honduras, I had a long discussion on a very common and very difficult problem of pain on the ball of the foot behind the second toe. Pain here is one of the most common reasons people come to my office. You can often see some swelling of the tissues on the ball of the foot and frequently there is a second toe hammertoe.

This is a progressive disorder and can lead to a disfigured foot where the second toe crosses over the big toe, especially if there is a bunion. This is one case where early treatment is better than waiting for unfixable deformity. If you have a lump under and behind the second toe, get thee to a foot doctor, and orthotics are probably in your future.

Here is a podiatric secret: we hate this deformity. When orthotics and softer shoes do not provide enough relief we are left with a choice of a cortisone injection or surgery. Injections can possibly make things worse in the long run, so we shy away from them if we can. But if a patient has a wedding or vacation trip planned, we sometimes relent even though we know we shouldn't.

Up to now, surgery has its own problems, and at least half the time the foot after surgery is different but not really better- up to now. Putting together ideas from my colleagues in Honduras and another from San Diego, I am, for the first time, truly happy to have a new approach to this vexing problem. It involves a transfer of a tendon in the toe to a new location and not the cutting of the metatarsal bone.

So, if you don't win the car, and are forced to walk, I can now make that a less painful experience. I look forward to explaining it in greater detail.

Dr. Michael Zapf is a podiatrist in private practice in the community for 20 years. He and his associate, Dr. Darren Payne, have offices in Agoura Hills and Thousand Oaks. For more information, call (818) 707-3668 or visit www.conejofeet.com.