New Surgery for Heel Pain
By: Michael Zapf, D.P.M., M.P.H., F.A.C.F.A.S., F.A.C.F.O.
An actual letter:
Dear Dr. Zapf,
I cannot believe how my right foot feels now. After my
fall I started to feel a terrible pain in my right heel area. This fall was in 1996 and I
have had to live with this everyday until Dr. Zapf operated on it [with the in-office
plantar fasciotomy October 2000]. I now can walk without pain in my right foot. This
operation consisted of a small incision to the right heel area and I was able to walk
within days.
I would recommend Dr. Zapf to anyone who needs this kind
of foot surgery.
I cannot believe it! It's so great now.
Diane S. Camarillo, CA
Another letter:
I don't know why you
wouldn't tell everybody to just have the surgery instead of "dinking"
around with all those shots and orthotics. I had the surgery 2 years ago and I
have not had any pain since. It was like you went in and took out the pain
away. I wanted to smack you ;-) for not doing the other one. You said to
wait the other one out and the pain did go away. It was just a little hole in
the foot - almost no hole at all. The worst part was hearing the ligament being
cut. If anyone ever questions me about it I would tell them not to put it
off for any reason. I was able to go back to work (as a supermarket checker) in just
2 weeks. I could have gone back sooner but Dr. Zapf suggested 2 weeks.
Deanna, Thousand Oaks,
Q. What are they talking about?
A. The in-office plantar
fasciotomy surgery. It takes just a few minutes and is done with just a local injection of
anesthetic. Below is a copy of my office brochure on the procedure:
From The Doctor's Desk
It is a rare person who has heel pain that I
cannot control without surgery: less than 3 in a hundred would be my guess.
Almost half of the patients I see for heel pain are better with orthotic therapy alone.
The rest need a combination of injections of cortisone, oral anti-inflammatory
medications, physical therapy and some times a night splint.
Only when these methods fail is heel surgery warranted.
The new method that I introduced into the Conejo Valley is every bit as effective as
traditional methods. Its advantage over the new Endoscopic Plantar Fasciotomy techniques
is the ease of performance, quicker recovery for the patient and it saves money because it
is done right in the office.
Dr. Michael Zapf
One Patient’s Words
Mickey came back. Actually his name was not Mickey,
but he always wore a shirt emblazoned with a picture of the world’s most famous
rodent. He seemed to have an endless supply of such shirts. For the purposes of this
column it seems like an appropriate name. Mickey said he wanted the same micro surgery for
his left heel that worked so well for his right one a year before.
I first saw Mickey in the office two years ago. He complained of pain in his right heel
especially during the first few steps in the morning or after periods of non-weight
bearing. As a podiatrist I see many such patients. Fortunately almost everyone responds to
conservative treatment. Not Mickey. I tried strapping his foot with tape; I made orthotics
for his shoes; I injected the heels with cortisone on a number of occasions; and I even
tried a cast and a night splint but his pain persisted. After six months of trying
everything I could think of, Mickey became a surgical candidate. This happens in fewer
than 5% of heel pain patients.
Heel pain is caused by a tight pull of a ligament that extends from the toes, across
the bottom of the foot to the heel. When the foot lands on the ground, it elongates. The
elongation results in a tight pull of the ligament on the heel bone. The ligament is
called the plantar fascia and its inflammation is known as plantar fasciitis.
Surgery for heel pain used to be inconvenient and expensive. Heel surgery was usually
done in the hospital or surgery center and usually involved anesthesia. A three inch
incision was made on the side of the heel. Through this incision the plantar fascia was
cut or removed. If a heel spur was present, it was removed at the same time. Recovery was
best done in a non-weight bearing cast for a few weeks. It was not unusual for the total
cost to exceed $5,000 not including lost income or schooling. That is no longer the case.
I performed Mickey’s heel surgery in the office using just local anesthesia. It
took less than a half hour. I made a tiny incision on the bottom of the heel. Through this
incision I used a tiny scalpel blade to nick the plantar fascia. It required just one
stitch and Mickey left the office wearing the same pair of tennis shoes he walked in with.
No cast, no crutches, no anesthesia and little discomfort. He required only four pain
pills and was back to work within a week. And the total cost was under $1000. His heel
pain was gone immediately and has not returned.
I call my procedure non-endoscopic plantar fasciotomy (NEPF). This is opposed to
one you will begin to see advertised called endoscopic plantar fasciotomy (EPF). A group
in Texas has found a way to use instruments normally used by hand surgeons to look inside
the foot with a camera. Under video control they use a knife and cut the plantar fascia.
Use of this high tech instrumentation is being marketed as the newest answer to heel pain.
Doctors that take the very expensive training course seem to be performing many, many EPF
procedures. Be aware that just because your doctor has a new tool, doesn’t mean there
are that many more people who need the treatment. And high tech instrumentation does not
come cheap. The average costs for EPF are expected to be well above $5000. This is
progress? Mickey had the exact same surgical result for less than one fifth of the cost.
Mickey had his second surgery two weeks ago and is experiencing the same excellent
progress. He said he went grocery shopping three days after the procedure. You might have
seen him. He was that happy guy over by the cheese counter.
