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

By: Michael Zapf, D.P.M.

January 2003

Hat trick, Triple Crown, and triple-double are three examples of names given to accomplishment in threes. On the last Thursday in December I accomplished a triple accomplishment of sorts: the triple no pain. My surgery day is Thursday and I usually perform two or three foot surgeries. On that special Thursday I did three relatively routine bunionectomies. What made them special was what they told me the following week when they returned. None of the three needed to take even one pain pill. I am not telling you this to brag but to dispel one of the myths of foot surgery – that it is always painful.

I did my foot surgery residency in the mid 1980s. Patients at that time routinely spent 3 days in the hospital for a bunion surgery. The first day after surgery was spent just "dangling" their feet but without walking. Physical therapists would help them walk on the second day and they would be ready to go home on the third. During their stay in the hospital they started with intravenous Demerol for pain and we would wean them to oral medications by the time of discharge.

Insurance companies were the first to see the needless coddling these patients were receiving. While the doctors complained, the "heartless" insurance companies stopped paying for overnight stays for bunion surgeries. And to tell the truth, they were right. By 1987 nearly all bunion surgeries were performed on an out-patient basis and they rarely needed more than a prescription of pain pills, and sometimes less.

Since that time we foot surgeons have refined our techniques to what they are today: highly predictable and usually nearly painless. Most bunion surgeries are done at a surgery center or the outpatient department of a hospital. Patients return home only a few hours after the procedure and usually walk the same day in a post-operative surgical shoe.

Among the techniques that make this procedure, and most foot surgery for that matter, less painful is the delicate handling of the tissues of the foot during surgery. When an instrument is used that might create heat, a cool irrigation is used. When a bone is cut it is done in such a way as to minimize any movement of the pieces. If that can’t be done, screws are used to eliminate movement that would otherwise result in pain. During the procedure a long acting Novocain-like anesthetic is used so that there is no pain on waking up. I like to have my patients take an anti-inflammatory medication starting two days before surgery. This is called preemptive analgesia. After surgery the use of ice packs reduces painful inflammation even more.

Maybe there are reasons not to have a bunion repaired, perhaps other medical conditions or the timing is inconvenient, but pain should not be one of them. So if the fear of pain is keeping you from calling your foot doctor, I have three reasons that might change your mind.

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Dr. Michael Zapf is a podiatrist in private practice in Agoura Hills and Thousand Oaks. For more information on bunions and foot care see the web site: www.conejofeet.com or call his office at (818) 707-3668

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