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

February 2001

Shocking New Therapy For Heel Pain

Lakers’ center Shaquille O’Neil missed several basketball games in early February due to heel pain. He should have been with me last Saturday. I attended a seminar on the newest treatment for heel pain: shock wave surgery. In this procedure high power shock waves, produced by a 20,000-volt spark plug and focused on the heel can result in significant pain relief when all other treatments have failed. The treatment, called extra corporeal shockwave therapy (ESWT) has been available for 10 years in Europe but was only recently approved in the United States. The only FDA approved ESWT machine in California is located at a local surgical center.

Heel pain is quite common. The pain can range from the mild annoyance of a “stone bruise” to a cause of missing work, even if you are a million dollar athlete like Shaq. Classically the pain is felt on the bottom of the heel with the first in the morning or after other periods of being off of the foot. In the first few months of heel pain the discomfort eases off after a few steps. In advanced cases the pain can persist throughout the day. Sometimes a heel spur can be seen on an x-ray. Heel pain with an actual spur on the x-ray is often more resistant to treatment.

Most of the time the pain can be successfully treated by over the counter anti-inflammatory medications, heel lifts, stretching and shoes with some arch support. More resistant cases can be helped with prescription strength in-shoe arch supports called an orthotic. Sometimes a prescription anti-inflammatory medications or an injection of a cortisone medication are prescribed. Fortunately more than 90% of all heel pain patients are improved with these non-surgical therapies.

Unfortunately, non-surgical methods fail about 10 times out of a hundred. One or two of these people will choose to just live with their pain rather than face surgery. In the past the others had to choose from a variety of traditional surgeries. The surgery for heel pain involved cutting of the ligament involved, called the plantar fascia, removal of the heel spur or both. Finally, there is an alternative to traditional surgery, shock wave therapy.

Extra Corporeal Shock Wave is patterned after the shock wave therapy machines that have been used for 15 years to break up kidney stones. In the foot, ESWT is usually performed under light sedation and local anesthesia. During the 30 minute treatment the device is aimed at the heel and 2000 shocks are directed at the painful area. Afterwards the heel is sore for a few days and sometimes the heel is “black and blue” for a few days more. Shaq should note that some athletes have been able to return to sports the next day. In one double blind study with patients at seven different sites, the most common side effect from the procedure was temporary pain and numbness occurring in 15 of 273 patients. Success was reported by 62% of the patients after one treatment. When the “failures” were subjected to a second treatment the success rate was an astounding 90.5%. The success of this study led to the FDA approval of this particular machine for heel pain.

ESWT is great news for anyone who has heel pain despite six months of conservative, non-surgical, care and for anyone who has heel pain despite having surgery. With this technique you may be able to finally “Wave” good-bye to resistant heel pain.

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Dr. Michael Zapf is a board certified podiatrist in private practice with offices in Agoura Hills and Thousand Oaks. Dr. Zapf is one of only a few doctors certified to perform shock wave therapy and is able to offer it to patients for relief of heel pain.  For more information please call his office at (818) 707-3668 or see the “Shock Wave” link onto his web site: 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