News From ACFAS

As a member of the Alliance of Wound Care Stakeholders, ACFAS participated in the successful effort to get the Medicare Part B carrier for WI, IL, MI, and MN to rescind a non-coverage policy for negative pressure wound therapy.

ACFAS recently met with top Blue Cross Blue Shield Association (BCBSA) clinical staff as part of its involvement in the Specialty Society Insurance Coalition. This was the first ever meeting between the Coalition, which was co-founded by ACFAS, and BCBSA senior staff. Coalition members and BCBSA staff are forming follow-up work groups on a number of important issues.

ACFAS is gearing up to support its members in states with legislative scope of practice battles in 2010. ACFAS expects DPMs in MA, SC, and NY, among others, to continue their ongoing battle to expand scope to the ankle next year.


Let the diverse faculty of experts be your guide as you reconstruct an adult flatfoot, selecting from a variety of procedures, at the October 10-11 Flatfoot Surgical Skills Course to be held at the Scientific Education and Research Institute near Denver, CO.

You owe it to yourself, and your patients, to incorporate these fresh approaches and thought processes into your surgical tool box. Register online, using the web link below.


Have you recently changed your work or home address, phone or fax number, or e-mail address? Does your practice have a web site? Do you want to change your “preferred address” for receiving the Journal of Foot & Ankle Surgery and other ACFAS mailings?

Your contact information also appears in the online membership directory, allowing other members to find you, and in the “physician search” feature on the consumer web site, FootPhysicians.com.

To help ACFAS stay in contact with you, and to keep yourself available to your peers and to potential patients, use the web link below to access your online member profile and make any necessary changes. You’ll need to use your member login: your user ID is your ACFAS member number, and your password is your last name. If you’ve lost your member number, contact the ACFAS office at 773-693-9300.

ACFAS Fellows who meet criteria for election to the Board of Directors are encouraged to submit a nomination application by October 1. Two 3-year director terms are open for nomination this year. The Nominating Committee will announce recommended candidates to the membership no later than October 27. Candidate information and ballots will be mailed to all voting members no later than December 11. Ballots must be returned to the ACFAS office by January 10, 2010. New officers and directors will take office during the ACFAS 2010 Annual Scientific Conference on February 24, 2010 in Las Vegas.

Read complete details on the recommended criteria for candidates and download the nomination application, using the web link below, or contact Executive Director Chris Mahaffey at 773-693-9300, Ext. 1305, mahaffey@acfas.org. Questions regarding eligibility criteria should be directed to Nominating Committee Chairman John M. Giurini, DPM at jgiurini@bidmc.harvard.edu or 617-632-7071.

Foot and Ankle Surgery

Hardware Removal Halts the Majority of Postoperative Foot and Ankle Pain

Hardware removal following foot and ankle reconstructive or trauma surgery can reduce postoperative pain, according to new research. In a study of 28 patients in a study to evaluate hardware removal outcomes in terms of how greatly and quickly pain levels improved, researchers found that 94 percent of patients had a decrease in pain postoperatively.



New Experiences in Treating Postburn Talipes Equinovarus Associated With Bone and Joint Pathologic Changes

Researchers here outline their attempt to solve the problem of postburn talipes equinovarus associated with bone and joint pathologic changes by simplified and modified techniques. In addition to lengthening the shortened Achilles tendon and the contracted scar above it, the surgeons performed triple arthrodesis directly on densely scarred, deformed foot of each patient without replacing the scar tissue with normal tissue tube or flap. Only the proximal scar-periosteum wound edge of the curved incision, two centimeter distal to the conventional one, was elevated to expose the bones to be excised. The two excised wedge-shaped bone blocks, one on the dorsum and the other on the lateral side of the deformed foot, were composed of a larger part of the talus and lesser parts of the navicular, cuboid, and calcaneus bones. The researchers conclude that the scar tissue can be elevated without risk of necrosis if it is still attached firmly to the underlying periosteum, and arthrodesis can be done under it.



Subperiosteal Resection of Aneurysmal Bone Cysts of the Distal Fibula

Researchers describe the treatment by subperiosteal resection of an aneurysmal bone cyst in the distal fibula in eight patients and highlight the role of the periosteum in the regeneration of bone defects. The mean age of the patients was 13.5 years (12 to 17). Seven patients had an open growth plate. None received instillation of bone marrow, autogenous bone graft, allograft, or any synthetic bone substitutes. All had complete regeneration of the bone defect within three to nine months, with no joint instability or recurrence. The researchers concluded that the periosteum played a major role in the complete filling of the bone defects and avoided the morbidity of other techniques.



Former Preemies May Have Weak Bones

Premature infants with very low birth weight have less dense bones later in life than their peers born at term with normal weight, according to Dr. Petteri Hovi of the National Institute for Health and Welfare in Helsinki, Finland, and colleagues. This may boost their risk of osteoporosis in adulthood. Former preemies were found to have a twofold increased risk of having bone mineral density in the range that doubles their risk of bone fractures.

Practice Management

Disparities: Study Finds Risk in Off-label Prescribing

Off-label prescribing allows physicians to use drugs in ways that are not specifically approved by the Food and Drug Administration. However, a new survey of physicians appearing in the journal Pharmacoepidemiology and Drug Safety has found that many might not even know when they are prescribing off-label. The average physician in the survey identified the FDA approval status correctly for only about half the drugs on a list provided by the researchers.

Off-label prescribing is one of the issues that landed Pfizer in trouble with the U.S. government. Pfizer has reached a $2.3 billion settlement with the government, including $1.3 billion in criminal fines, related to its promotion of the arthritis pain drug Bextra for uses and in doses not approved by the FDA. At issue is also Pfizer's marketing of the drug, which included paying physicians up to $1,500 to attend "consultant meetings" in exotic locations in hopes of boosting sales.



Friendly With Doctor, but Facebook Friends?

The proliferation of social networking sites has implications for physicians. Medical schools now advise students to think twice about what they post on social networking sites. In a recent article in the New England Journal of Medicine, Dr. Sachin H. Jain recounted his experience when a woman whose baby he helped deliver as a medical student asked to become his Facebook friend during his second week of internship. Jain said he was wary of letting his former patient see his list of friends, view his photos, or read his personal blog, but did not want to appear rude. He decided to accept the invitation, partly because he was curious to see how her baby was doing. It turned out the patient was thinking about applying to med school herself and wanted some advice. Among the lessons learned from the experience: Be careful about how you manage your online identity.



How to Reduce Your Practice's Credit Card Fees

It is important for medical practices to curb charges related to credit and debit cards. One way is to contact credit card processing companies in an effort to negotiate lower rates. Smaller practices might save more by using a processor affiliated with a local chamber of commerce or a professional association. Practices should ask about processing fees, such as per-transaction flat fees, monthly or yearly fees, or fees for failing to meet minimum volume requirements. Promises to lock-in low rates for longer than six months should be avoided because processors adjust fees according to interchange rates that change twice a year. Having a credit card swiped in the presence of a patient also is likely to carry lower fees than if credit card information is called or keyed in later.

Health Policy and Reimbursement

Drive-Thru Medical: Retail Health Clinics' Good Marks

A pair of studies appearing in the September issue of Annals of Internal Medicine show that clinics in drug stores provide care for minor ailments on par with, or better than, other medical facilities at significantly lower costs. For the studies, researchers analyzed data on 2,100 patients treated for middle ear infections, sore throats and urinary tract infections at retail clinics in Minnesota, where retail clinics are well-established. The average cost for treatment at clinics was $110, including the evaluation, pharmacy, laboratory, and other costs, while the average cost was $156 at an urgent care facility, $166 at a doctor's office, and $570 at an emergency department.



Health Bill Would Cut Drug Spending for Many on Medicare, Budget Office Says

Medicare beneficiaries would have to pay higher premiums for prescription drug coverage under the health reform legislation now being considered by lawmakers, but many would see their total drug spending decline, according to a new report by the Congressional Budget Office (CBO). Premiums for drug coverage would rise an average of 5 percent in 2011 and 20 percent in 2019, according to CBO, but spending on prescription drugs apart from those premiums would fall, on average, as would overall prescription drug spending. Furthermore, the report estimates that the drug-related provisions of the House measure would save the federal government $30 billion between 2010 and 2019.



U.S. Health Reform Estimates Need Long View: Study

The Congressional Budget Office (CBO) may be missing potential savings from various health reform proposals by not looking at efforts to manage or prevent expensive, chronic conditions such as diabetes and heart disease, researchers said in a study published in Health Affairs. CBO uses a 10-year forecast that cannot look at the cost of programs aimed at diseases that can last for decades, say the researchers. CBO should instead use methods that would weigh savings from earlier treatment and other intervention that could help reduce costly complications from conditions that arise when left untreated or improperly treated.

Technology and Device Trends

New Hope for Deadly Childhood Bone Cancer

Researchers at the University of Utah's Huntsman Cancer Institute have found hat patients who experience poor outcomes for the treatment of Ewing’s sarcoma, the second most common bone cancer in children and adolescents, have tumors with high levels of a protein known as GSTM4, which may suppress the effects of chemotherapy. Their findings could lead the way to drugs that can suppress GSTM4 in certain patients as well as a screening test that could reveal which therapies will be most effective for patients. The research was published in the online edition of Oncogene.



Protein Involved in Causing Osteoporosis, Arthritis Identified

Researchers have identified that a gene called interferon regulator factor-8 (IRF-8) is involved in the development of diseases such as rheumatoid arthritis and osteoporosis, discovering that downregulation of IRF-8 increases the production of cells called osteoclasts that are responsible for breaking down bone. The research could lead to new treatments for the diseases. The study is published online at the journal Nature Medicine.



The Future of Cartilage Repair?

Tissue scaffolds that stimulate bone and cartilage growth when implanted in joints could offer more effective, less expensive, and less painful treatment options for sports injuries and arthritis. Research by scientists at MIT and Cambridge University has demonstrated that the scaffolds stimulate mesenchymal stem cells in the bone marrow, which gradually produces new bone and cartilage.



Abstract News © Copyright 2009 INFORMATION, INC.

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