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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Is Heel Pain Keeping You From Springing Forward? 

By; Michael Zapf, DPM, FACFAS                              Acorn March 2008

 It is spring and it is time to bring you all up to date on one of the most common foot complaints: plantar fasciitis, more commonly known as heel pain. The percentage of people who get the condition is not known but I would not be surprised if 20% of you did not get it at some time during your lifetime, dampening the spring in your step.

   The condition presents as a searing pain at the back of the arch by the heel that is usually worse with the first step in the morning or after resting. Patients start to dread the morning alarm clock.  It can occur after a specific trauma or change in activities like getting that new treadmill. More often it creeps up with no remembrance of any inciting event but results from the accumulation of microtraumas.

   Self treatment is often effective and includes stretching exercises, ice therapy such as rolling the heel on a bottle of frozen water, massage, aspirin or ibuprofen (Motrin) and over the counter arch supports or just plain better shoes. The last point needs to be stressed as flip-flops, bare feet and sandals usually make the condition worse which may be why it is seen more often in women. Extra weight also makes the condition worse.

   In the office we will sometimes take an x-ray to look for spurs, stress fractures or other bone issues. In our office we will also measure the thickness of the plantar fascia with an ultrasound machine. A normal plantar fascia is only as thick as a leather belt but an inflamed one can be two to four times this thick. The ultrasound is a clever way of making the diagnosis and to assess the effectiveness of treatment.

   Treatment by your foot doctor will be mechanical, medical or a combination of both. Mechanical therapy can include the application of a tape strapping that will often stop your pain immediately and a stretching program. If the tape helps more than over-the-counter arch supports, we will often make a prescription orthotic that will hold your foot in just the right position to alleviate your heel pain. The prescription orthotic device is best worn in a reasonably stable shoe, so it may not be used if you are a dedicated sandal wearer. Medical therapy might include a prescription for a strong anti-inflamatory medication and possibly one to three cortisone injections. Contrary to popular opinion cortisone injections do not have to hurt. I have found a technique that is virtually painless more than half the times I inject a heel and only rarely do patients complain of significant pain.

   Surgery to release the plantar fascia from its attachment on the heel bone is done very infrequently, at least in our office. More commonly we employ high energy sound waves at the site of the heel pain in a process called shockwave therapy (ESWT). It is done in the office using a little local anesthesia. I have done shockwave therapy on more than 100 patients and can honestly report that it is 75-80% effective in providing significant long term pain relief without the need for surgery. My personal opinion is that the safety profile of shockwave therapy makes it a better bet than even micro surgery for plantar fasciitis. In our office we are even evaluating a mini-shockwave device that can be done without even local anesthesia.      

   If you have heel pain, consider getting help from your foot doctor. We cannot do anything about the challenge of getting up early, but we can make that first step a bit more comfortable.

Dr. Michael Zapf is a podiatrist with the Agoura-Los Robles Podiatry Centers with offices in Agoura Hills and Thousand Oaks. For more information please call his office at 818-707-2592 or see his expanded article on the web site www.conejofeet.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