Welcome to the personal website of

Dr. Michael A. Zapf, DPM, MPH, FACFAS, FACFAOM

Thank you for visiting the web site of Dr. Michael Zapf. He is a member of the Agoura-Los Robles Podiatry Centers

The "real" practice web site, the one that contains registration forms, doctor information for all the office and directions to the office is located at:

www.conejofeet.com   ç Click here

I am Dr. Michael Zapf. I have been offering a full range of podiatric medical services, from ingrown nails to heel pain and foot surgery, to my friends and neighbors in the Las Virgenes, Conejo and Simi Valleys since 1985. This is my personal web site. It has been up since 1990 and has received more than 2 million visits. The entire site is my responsibility only and nearly everything on the site was written by me. You are welcome to peruse this site and learn what you can about me, your feet and the problems your feet can develop. Things happen fast in medicine so whatever you read could well be outdated, especially if it was written many years ago. On this site you will read historic articles that I wrote for a lay audience as long as 25 years ago, so please do not take anything on this site as definitive or as applying directly to your condition. You may wonder why I have my own site even though there is also an official practice site. Well, my partners are of a younger generation raised on tweets, e-mails and iPhones. They want a professional site that they believe better represents the professional nature of our practice. They also believe that people no longer take the time to read anything of length. I, on the other foot, think there is still a world out there full of people who still read lengthy descriptions of problems and solutions. if you are one of those old fashioned readers, then this site if for you. Let me know what you think. Let me know you are out there.

Please note that all information and photographs on this site are copyrighted by me, Michael Zapf, DPM, and cannot be used for any private or commercial purposes. I work with two other podiatrists in my practice who may or may not share any of my ideas and philosophy. Do not expect them to practice the way I do or even believe in any of the speculation I present here. If you appreciate what I have written and want me to be your treating doctor, you will have to ask for me specifically. Even if my office says at first, " He is booked until next month",  I still want to see you as long as you are a little flexible with your schedule. If your visit is an emergency, I know that  you will be happy with either of my associates, Dr. Darren Payne or Dr. Steve Benson. They are exceedingly well trained and capable in any foot emergency.

Michael Zapf, DPM, MPH, FACFAS, FACFAOM     (If you want to know what all those initials mean, click here   è  

Our office phone number is (818) 707-3668 and my e-mail address is zfootdoc [at] doctor [dot] com

Agoura Hills Office: 28240 Agoura Road, Suite 101, Agoura Hills, CA 91301

Thousand Oaks Office: 555 Marin Street, Suite 290, Thousand Oaks, CA 91360

For the address, hours and registration forms please see the practice web site: www.conejofeet.com

07/24/2010

To Order Foot Supplies è ç click

For Information about Laser Treatment for Fungal Nails Click hereè
 

For information about Shockwave Therapy for heel pain          click here è

Exciting news!!! New Thousand Oaks Location  è

Dear Dr. Zapf,

I had two surgeries for Morton's neuroma. top and bottom 15 years ago and the pain is back more severe than ever and I. cannot walk. Do you do it a third time?

Stephanie

Dear Stephanie:

First things first, do you and did you have a neuroma in the first place. A neuroma is a swollen nerve that is commonly found in the foot between the 3rd and 4th metatarsal heads. IT is painful to squeeze the metatarsal heads (the area of the foot just behind the toes) together and a doctor can actually feel a click when he or she pops the nerve up and down between the metatarsal heads with our fingers. The diagnosis is usually made this way - 95% just by fee. X-rays are taken to rule out other pathology like bone cysts and spurs. I, and many other doctors, use a diagnostic\, picture taking ultrasound to visualize and size the neuroma. Neuromas have very characteristic pictures with ultrasound and we can measure their diameter. Neuromas less than 5mm usually respond to a cortisone injection or two. Between 5 and 10mm may respond to injections plus a series of alcohol injections, called sclerosing or, more properly, alcohol neurolysis. Neuromas over 10mm usually fail to respond to non-surgical solutions and need surgery. If there is any question about a lesion being a neuroma we can order an MRI to get a better picture of the lesion. Now, I am going to assume that you already have done all of this, it was diagnosed correctly, was surgically corrected properly with a pathology report indicating a neuroma.

To see a picture of a neuroma removed at surgery click on -->  Neuroma

For more information on Neuromas click on -->  Neuromas

(Note: sometimes a pain in the interspace is not a neuroma and is, instead, damage to the toe-foot joint (the metatarsophalangeal joint) that is irritated when your doctor feels for thee nerve. Sometimes you can have both. Your doctor needs to be good with his or her fingers)

Here is a little secret: neuromas can recur. The nerves can grow back. We know nerves grow back every time there is a successful hand re-attachment. If the nerves did not repair themselves, there would not be any movement in the fingers of the reattached hand. Nerves grow a millimeter or so a month after severing. If an examination shows you likely have a neuroma and  it is visualized on an ultrasound or an MRI, a third excision is a reasonable approach.

First, however, I would consider a non-surgical approach to treating the neuromas. The first of the two approaches I can recommend is the aforementioned alcohol neurolysis. Your doctor will inject about 1/2 CC of 4% alcohol in anesthetic solution just proximal to the neuroma on a weekly basis for 8 weeks. One third of the time the neuroma will response wonderfully and hurt no longer. One third of the time the nerve will improve some and surgery can be avoided. One third of a time there is no positive response. The good news is that this method never has any side effects and can be done again, in a few years, if necessary. I personally love procedures that have no negative side effects.

For more information on alcohol neurolysis click on --> Neurolysis

A final method is very new and only a few of us can do it called Radiofrequency Ablation or RFA. With RFA an electrode is placed against the nerve and turned on for 30 seconds to "ablate" or kill the nerve. This is a common approach used by orthopedists, cardiologists, neurosurgeons and cancer surgeons, but it is very new in podiatry. I doubt that you will find an RFA trained podiatrist in your area as the technique is so new but it should become more common in a year or two. Maybe you can use the alcohol method for now.

Good luck and let me know what method is chosen and how you do.

Michael Zapf, DPM

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: July 24, 2010