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 April 2003

A Shocking New Treatment in Agoura       For photographs of this session click here -->

By Michael Zapf, D.P.M.

So what do you give someone who has tried everything to solve their heel pain? How about a little sonic boom, right in the heel? The machine that delivers this boom is coming to my office in June.

Heel pain is very common in adults; about one in four will experience it sometime during their life. The pain is usually described as severe and sharp on the bottom of the heel especially the first step in the morning. With a little ice and rest some get better on their own. Others are helped when their family doctor prescribes a course of anti-inflammatory medication and, possibly exercises and heel lifts. The rest, and there are plenty left, end up in the podiatry or orthopedic office.

If I may make a generalization, most orthopedics will next add a cortisone injection or two, physical therapy and the recommendation to buy a good pair of over-the-counter arch supports. (There was a report a few years ago in the orthopedic literature stating that simple arch supports and the kind of prescription orthotics that podiatrists make are equally successful in treating heel pain. As a result of this article many orthopedists are skeptical about the orthotics prescribed by podiatrists.) The few people who are left with pain at this point are told that the pain is temporary and will go away in a few months or are given the option of heel surgery. Those that opt for waiting are usually rewarded with less painful feet but some remain with pain and can get quite frustrated.

Podiatrists also do all of the above but we find some arguments with how the orthopedic orthotic study was done and believe that a custom orthotic is often helpful. We will apply a special strapping that will mimic, at least for a few days, a prescription orthotic. If the tape helps when the ice, arch support, heel lift and anti-inflammatory medications have failed, we usually will make a pair of prescription orthotics that fit into the shoe. The orthotics seem to help about half of the people that failed the above therapies. It has the added advantage of being simple to use by just slipping them into the shoes you wear everyday. Every podiatrist has many patients who received pain relief only after receiving orthotics. We might be guilty of too much reliance on these devices but it is hard to stay away from such a successful therapy. But we also have some patients who fail all of our therapies and are also very frustrated.

While often successful, traditional heel surgery can have some significant complications. Every once in awhile the heel bone can fracture and sometimes patients trade heel pain for an equally or more painful problem on the outside of the foot. As with almost any surgery, the occasional surgery patient can be worse off after traditional surgery than they were before.

There is now a possible answer for those who failed conventional heel pain treatment and do not want traditional open surgery. The answer is harnessing shock waves, focusing them on the under side of the heel bone and "shocking" them into submission. The machine we use is made by the same companies that make shock wave machines for kidney and ureter stones. Up to now the machines for the heel were few and far between and very expensive to use. The co-payment to use the one in Van Nuys, for example, can run from $2-12,000 (!) or more. I am happy to report that a new company has come to Southern California and podiatrists have already begun treating patients. Our experience is the same as those nationally; about 60% - 70% of resistant heel pain patients have significant improvement with the procedure called ESWT (extra corporeal shock wave therapy) when all other treatments have failed.. Complications, aside from sometimes just not working, are almost non-existent. The machine is also useful for chronic Achilles’ tendonitis and the calcium bumps that form where the Achilles’ tendon inserts on the heel bone.

Until the company who owns the machine finishes negotiations with a local surgery center, they have agreed to bring the machine to my Agoura Hills office. It will be here for the first time in mid June. They will do the insurance billing and have agreed to a reasonable patient fee: either the usual co-payment and deductible or $500, whichever is lower.

As far as I know this is the first time local podiatrists have used the machine. I have several resistant heel pain and Achilles’ tendon patients who could benefit from this therapy. I am anxious to report back on the results.

Dr. Michael Zapf is a Board Certified podiatrist with , along with Dr. Darren Payne has offices in Agoura Hills and Thousand Oaks. For more information on heel pain and shock wave therapy either call his office (818) 707-3668 or visit the office web site: www.conejofeet.com.

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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