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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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

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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