Welcome to the Website of

Dr. Michael Zapf, DPM, MPH, FACFAS

Call: (818) 707-3668

 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 donít always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. I am from a generation that likes to read in depth about all sorts of things, including our ailments. This site is dedicated to all those who want more information that what can be contained in a series of bullet points. If you like this philosophy then let me know when you see me or if you ask a question.

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 and none of the articles can be used by anyone without permission from me, personally.

P.P.S. Comments about this web site or questions about your feet can be directed to me at zfootdoc (at) doctor (dot) com.

P.P.P.S.  I was going to offer a nice prize to the person who could send me a screen shot of being the 3 Millionth person to visit this web site. I am sorry I missed that opportunity. But wait until you see what I offer the 4 Millionth visitor.

 


11/12/2013HomeNews+FAQ

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Dr. Gently-Gently

and the

Painless Shots!

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O.K. I admit that neither I nor anybody can give a painless injection of anesthetic. That being said I want to assure you that I am proud of my reputation of giving as close to a painless injection as anybody can. If there were something akin to a "painless shot-off" I would certainly enter. I never realized how much I day "gently, gently" when I give an injection until I learned that there is a Calabasas family that refers to me as Dr. Gently-Gently. Not a bad rep.

"Being as nervous as I am about medical procedures, I found Dr. Zapf's shot to be virtually painless. He and his staff made it a pleasant experience. Christina B.

Why are my injections so painless? Let me answer:

1. Some people just don't like to see their foot get injected so I shield it from you with drapes to prevent you from seeing anything (unless you want to).

2. All my treatment chairs have a reclining  back. Not only does this make them more comfortable but by reclining the back, more blood gets to your brain. This, in turn, reassures patients that they will not faint. This little reassurance is often enough to get them to relax.

3. I always have a staff person with me when I do the deed. All of my staff people are naturally kind and gentle. They will place a hand on your leg which both reassures you that everything will be all right, but also takes the fear away that you might jerk your leg and maybe increasing your pain. To see these gentle people take a look at this page >

4. I NEVER, NEVER, NEVER use the "S.I.N." words in the office (especially in front of kids.) Some people react strongly against these words:                                                             

"S" = Shot      "I"=Injection      "N"=Needle              

Instead I say that I am gently, gently. gently going to put the toe to sleep.

5. You NEVER SEE THE NEEDLE. I am not David Copperfield (darn it!) but I am good at keeping that pesky needle from your line of sight. 

Image of:3.5 oz. Medium Spray6. I spray the area of the heel with a skin refrigerant to pre-numb the skin. This brings up the concept of creams, potions or lotions that will pre-numb the skin. While they may work with the skin inside your mouth or even the thin skin of the back of your hand, they do not work on the thick skin of feet. The spray I use is ethyl chloride and it will make the exact point of penetration completely frozen for a very brief second. I take advantage of that tiny little second and start the deed.

7. For toe blocks I begin with the smallest needle ever made, a 30-gague, to first inject a little plain Xylocaine. Xylocaine is the quickest acting of all the anesthetics. It works in just a few seconds. 

8. For toes I start the injection at the base, where the toe joins the foot. At this location the skin is the loosest and the anesthetic goes in with little or no resistance. Injection into tight spaces hurts. )This why no doctor should ever inject an ingrown nail from the tip of the toe by the nail. This is considered very bad form, not to mention excruciatingly painful)

8. I follow this up with a long acting Marcaine. Marcaine hurts more to start than Xylocaine which is why I start with the Xylocaine. The Marcaine, however, lasts for seven to seventeen hours to give you a loooooooong period of pain relief. 

9. I use a variation on this for injection a cortisone preparation. I use a small small needle (27 gauge). I use a preservative-free anesthetic that does not clump the cortisone in the syringe allowing me to use a smaller needle than most other doctors use or cortisone. I also use a small syringe (1 cc tuberculin – the kind used for diabetes) I find that the small pressure built up with this small syringe causes less painful tissue expansion. 

10. For heel spur injections I know the location of THE POCKET!. I call the pocket an area of loose tissue just above the insertion site of the plantar fascia. By injecting a small quantity of a powerful cortisone preparation into the pocket the pain can be minimal. Many patients have expresses some disbelief with the lack of pain saying "Have you done it yet?" after the injection is over.

I mix the cortisone with a fast-acting anesthetic Xylocaine (a Novocaine-like anesthetic). The Xylocaine I use for cortisone injection is not the typical multi-dose vial but single dose vials that are MUCH more expensive. The advantage of a single dose vial is it is made without the preservative methyl parabens. The preservative mixes with the cortisone and causes it to clump in the syringe and needle (flocculating in podiatry speak). Not only does the clumping inactivate the cortisone but other doctors have to use a larger needle to pass the now inactivated clumps through. With my non-clump formula, I can use the tiny 30 gauge needle to inject the cortisone. Ask your doctor if he or she can use a 30 gauge needle with their cortisone. I bet not.

11. Instead of pushing the medication into all the areas of the heel with the needle, I use gentle ultrasound to move the medication into all the nooks and crannies.

12 .In Agoura, you can hold a giant Teddy Bear.

13. Most important: I take my time. Rushing an injection or rushing into a procedure before the injection has had time to work is asking for pain and problems. So, if I leave the room after giving the injection I may just be staling for time for the stuff to work. It may take a bit of time and not everybody responds to the anesthetic the same.

 

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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: November 12, 2013