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.

 


01/08/2012HomeNews+FAQShock Wave

 

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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

...nothing helped my heel pain until I had the surgery. Recovery was very quick. I was very surprised at how quick the recovery time was. Within a couple of months I could walk without pain. I had not been painless in years. That surgery was definitely the best decision I made.

R. L .Westlake Village

 

 

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.

 

Dr. Zapf’s heel surgery technique is performed in the office using just local anesthesia. It takes less than a half hour using a tiny incision on the bottom of the heel. Patients leave the office walking in their regular shoes.

Beware of advertisements for “Endoscopic Plantar Fasciotomy”. This is an expensive way to perform the same procedure Dr. Zapf does in the office at a fraction of the cost.

   

 

 

 

 

 

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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