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 Things happen fast in medicine so whatever you read could well be outdated, especially if it was written many years ago.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


07/24/2010HomeNews+FAQShock Wave

 

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

 

 

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: July 24, 2010