Welcome to the Website of

Dr. Michael Zapf, DPM, MPH, FACFAS

 Thank you for visiting my website. I have been placing information and articles on this site for many years and have received millions of  hits during that time (and not that many of them were mine). I have designed it for people who like to read about their foot and ankle problems. Since I started the web site, I have added two associates to my practice, Dr. Darren Payne and Dr. Stephen Benson.  Since my site is filled with just my thoughts and opinions they are not, necessarily, shared by my colleagues. To see our less controversial (and less windy) practice web site, I offer you: www.ConejoFeet.com, the practice site for The Agoura Los Robles Podiatry Centers (ALRPC). The ALRPC practice site has a lot of material about our office, many of our policies and the registration forms to be filled out before your visit. I suggest all prospective patients visit www.ConejoFeet.com.

 I made the web site to give my patients the extra depth information that I don’t always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. My younger colleagues are both under 50 and they, like many their age, do not favor in depth reading. They prefer their information presented to them in a few short, crisp bullet points. I, being of the, ahem, older generation, like to read about my ailments in greater depth. Here, I present the greater depth. If you ask a question about heel pain or bunions that I have not answered in my two monographs, I will quickly add it so that it is as complete as I can make it. If you agree with this philosophy, welcome to my page. If you correspond with me please let me know if you like the in depth reporting.

 Remember, this site is in no way intended to tell you how your own ailment or problem should be treated, only the approach I use when confronted with certain situations. Your problem may well be different from what you think it is and should always be evaluated by the appropriate professional, whether podiatrist, orthopedist or other authority. Please understand that I, nor anyone else, can offer you a proper diagnosis or treatment plan without seeing and feeling the problem at hand (foot?).  Happy reading.

 Sincerely, Michael Zapf, DPM, MPH, FACFAS, FACFAOM

 P.S. All the information in this web site is © by me and it is mine alone. No picture or any of the articles cannot be used by anyone without permission from me, personally.

01/08/2012

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Acorn Article

 January 2001

 PTD or Adult Flatfoot

             Almost every week an adult patient comes into the office with a complaint that their feet have flattened. Sometimes called fallen arches, adult flatfoot is surprisingly common. An adult flat foot hurts to walk with pain in the arch and inside of the ankle without recollection of any damage or trauma.

            The cause is usually traced to the posterior tibial (PT) tendon that has “given out.” I would say it runs in families, but with this problem there is very little running possible. The tendon starts as a strong muscle attached to the tibia, the big bone in the lower leg. The tendon of this muscle travels down behind the inside ankle bone and inserts into no fewer than five bones on the bottom of the foot. When this tendon fails it becomes very difficult to rise up onto your tiptoes. Often there is visible swelling on the inside of the ankle and running your finger long the course of this tendon causes considerable pain.

            If this tendon is ruptured in an accident suffered by an otherwise healthy adult, the tendon is easily and successfully repaired with surgery. When it dies a slow death a simple tendon surgery is not very successful. Surgery for PT dysfunction (PTD) is long and complicated and involves the fusion of several of the foot joints with screws. It requires several weeks of wearing a cast and being non-weight bearing with crutches or a wheel chair. Because surgery for adult PTD is so difficult many people opt to try a course of conservative therapy first.

            Conservative care involves bracing or supporting the foot to keep it from flattening, or at least flattening too much. Conservative care has spared many people from surgery.

            The first level of conservative care is wearing good, strong and supportive shoes. Avoid sandals, thongs, bare feet, wearing socks-only and slippers around the house. The closer to a hiking boot you wear the more support you get. Interestingly, a high-heeled shoe adds support to an adult flat foot and many people find relief with high-heeled pumps and cowboy boots.

            Many people try to add an over-the-counter arch support to their shoes. If this helps, you are lucky. Most people, however, find PTD too strong a force for flimsy nd inexpensive support.

            In the office I will try to make any of three levels of arch supports. The first is the standard orthotic made from a cast taken of the foot. This device fits into many of the commonly worn shoes. The next is a stronger nd bigger device but one that still fits in some shoes and is not visible to others. This one is often called by the initials UCBL (University of California Biomechanics Laboratory).

            The final level of support is a device that attaches to the leg but passes under the foot. This device, called an ankle-foot orthosis (AFO) provides considerable support but at the expense of being visible to others.

            If you have or develop PTD you will unfortunately get to know foot pain. Early treatment with the proper support, however, can give you tremendous relief and stave off surgery.

Dr. Michael Zapf is a podiatrist in private practice in Agoura and Thousand Oaks. For more information call his office at (818) 707-3668 or visit his web site: www.zfootdoc.com.

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: January 08, 2012