News From ACFAS

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We’re dealing you and thousands of your colleagues a winning hand! Join us in Las Vegas for the 75^th Anniversary Scientific Conference (ACFAS 75), February 27–March 2, and help us celebrate the College’s 75^th anniversary.

Expect the mainstays you look forward to at every Annual Scientific Conference but on a grander scale. We’ll have:

• more clinical sessions and workshops to push your skills out of their comfort zone
• our biggest Exhibit Hall to date featuring hundreds of vendors, the ACFAS Job Fair and a wall-to-wall poster display
• a new twist on the HUB theater
• special events each night to connect you with old friends and new faces
• and much more!

Visit acfas.org/asc to book your hotel room and watch This Week @ ACFAS for details on preconference workshops and early bird registration rates. The odds are in your favor when you book your hotel room for ACFAS 75 with onPeak, our official housing partner. Choose from The Mirage ($168/night) or Treasure Island ($109/night), both in the heart of the Vegas Strip, and enjoy exclusive rates plus complimentary amenities.

Beware of Poachers…making your hotel accommodations with onPeak protects you from unauthorized third parties claiming to be the College’s housing partner and also helps ensure you receive the best price. Visit acfas.org/asc to reserve your room for our biggest conference yet! “I already paid my annual ABFAS dues in August. Why did I receive an ACFAS dues invoice?”

“I became Board Qualified with ABFAS. Don’t I automatically become an Associate Member of the College?”

“Why was my ABFAS status revoked even though I paid my ACFAS dues last year?”

ACFAS staff hears these kinds of questions all the time. To clear up the confusion between ABFAS and ACFAS, we’ve mailed all members a quick-reference card that outlines the main differences between the Board and the College.

Look for the card in your mailbox and share it with your staff so they know what each organization provides and whom to contact when they have questions. You can also download the card from the Member Resources box in ACFAS’ Member Center.

Foot and Ankle Surgery

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Researchers investigated the relationship between bone morphology and injured ligaments on imaging studies and laxity on ankle stress radiographs for patients with lateral ankle instability. Distal tibial articular surface angle, bimalleolar tilt, malleolar relative length, medial malleolar slip angle, anterior inclination of the tibia and fibular position were analyzed on ankle radiographs. Tibiotalar tilt angle and anterior translation of the talus were measured on ankle stress radiographs, and the degree of ligament injury was evaluated on ankle MRIs. Age (p=0.041), sex (p=0.014), degree of anterior talofibular ligament injury (p<0.001) and bimalleolar tilt (p=0.016) corresponded with tibiotalar tilt angle. Fibular position and degree of posterior talofibular ligament injury were significant related to anterior translation of the talus. Researchers found that differences in patient characteristics may predispose ankle stress radiograph results.


A study was conducted to define the technical aspects and rationales for magnetic resonance (MR)-guided cryoablation (CA) of Morton's neuroma (MN), while preliminary clinical experience was retrospectively reviewed as well. Procedures were conducted under local anesthesia on an outpatient basis. Twenty patients were included in the study, and 24 MN received treatment with 100 percent technical success. Lesion size and location as well as procedural and clinical results were evaluated through chart review and cross-sectional telephone survey after the 20^th case. Average procedural time was 40.9 minutes plus or minus 10.4 minutes. A single minor complication of superficial cellulitis was reported. Follow-up was available for 18 out of 24 MN. A total of 77.7 percent of patients were "completely satisfied" on a per-lesion basis, while 16.6 percent were "satisfied with minor reservations" and 5.7 percent were "satisfied with major reservations." Average pain score at last follow-up post-CA was 3.0. There were no reported "stump neuroma" cases.


A study aimed to assess whether plantar pressures are higher in patients with active diabetic foot ulcers compared with diabetic patients without a foot ulcer history and healthy controls. Researchers recruited 21 patients with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls and measured plantar pressures at ten sites on both feet. Stance phase duration also was measured. The mean peak plantar pressure and pressure-time integral of the toes and mid-foot were significantly higher in cases with diabetic foot ulcers compared to patients without foot ulcer history. Foot ulcers were also associated with significantly higher stance phase duration than the control groups.

Practice Management

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Medical groups spend more than $32,500 per physician to outfit, maintain and manage health information technology every year, according to a survey of more than 3,000 practices conducted by the Medical Group Management Association (MGMA). IT costs for each full-time doctor in physician-owned practices include $9,405 for IT staff and $23,197 for equipment, maintenance and supplies. Physician groups based in hospitals have similar costs, but those can be covered by the hospital’s IT budget. Spending has grown by 40 percent since 2009 and is expected to continue rising to keep pace with industry regulations and penalties. Christine Sinsky, vice president for the American Medical Association, believes the MGMA figures have understated the true costs of health IT. According to Sinsky, a 20 percent to 30 percent decrease in productivity is associated with the adoption of electronic health records. “And there are the one to two hours per night I consistently hear about from physicians across the country that they need to spend at home at night working on paperwork,” she says. “So $32,500 doesn’t really cover the whole picture.”


The importance of local search engine optimization (SEO) to medical practices has grown, as search engines have a better understanding of their users' location. To compete for local patients, practices should ensure their name, address and phone number are consistent in every online location. Inconsistencies can confuse prospective patients and directly affect search engine rankings. If a practice has multiple offices, each should have its own distinct page. Administrators should do their best to have their practice listed on all relevant local directories to drive more traffic to the practice website. Each page of a practice site must contain at least 300 words of useful content, and every service offered by a practice should have its own page; this increases the number of webpages indexed by search engines. Google's algorithm provides a boost to sites that are mobile-friendly, so practices should have a strong mobile strategy in place. Social media profiles are also a crucial part of maintaining a digital identity. Social media pages on Facebook, Twitter and LinkedIn should be updated regularly and provide consistent contact information.


A growing number of physicians are using professional blogs as a platform for health communication, but much uncertainty remains regarding the responsibilities and boundaries of physicians providing medical content within social media. Seventeen physician bloggers were surveyed for a study published in BMC Medical Informatics and Decision Making. Participants identified multiple benefits of distributing health information through blogging, including advancing their careers, keeping up with medical literature and increasing exposure for their practice. Physician bloggers also identified barriers to social media use, such as time, permission from their institutions and fear of misspeaking. Participants said they had set their own rules for social media health communications and expressed uncertainty about boundaries regarding what and how to post on social media. Some physician bloggers felt they could fit posting into their daily schedule, but others felt it was an impediment to patient care. The study indicates a need for formalized policies and best practices to address the uncertainty and provide physicians with social media training.

Health Policy and Reimbursement

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Providers are asking the U.S. Centers for Medicare and Medicaid Services (CMS) to slow its introduction of new payment models as hospitals struggle to keep up with rapid changes. Since the beginning of 2016, nine payment models have been introduced or expanded, and another three were announced for selected markets. The changes are part of a goal to tie 50 percent of fee-for-service Medicare payments to value-based care through alternative payment models by the end of 2018. Comments on a proposed cardiac bundled payment model urge CMS to evaluate the data from existing models before pushing a new arrangement. According to the Federation of American Hospitals, the multiple changes to the delivery system and payment structure have placed undue burden on hospitals. The group says CMS should first process the outcomes of the Comprehensive Care for Joint Replacement Model (CJR) and the Bundled Payments for Care Improvement initiative. The American Hospital Association also pushed back against an additional CMS proposal to expand the CJR model to include surgical hip and femur fracture treatment.


Americans are deeply concerned about increases in out-of-pocket expenses for healthcare and have little confidence in making financial decisions regarding their plan options. A survey from Alegeus of more than 4,000 U.S. healthcare consumers reveals that 49 percent of consumers do not understand the cost implications of different plan choices, and 69 percent say deciphering healthcare jargon is a significant obstacle to making financial decisions. Planning for out-of-pocket costs is the most challenging aspect of managing healthcare, according to 66 percent of consumers. After years of disengagement from healthcare decisions due to relatively small deductibles, many consumers are not ready to take a more active role in their accounts. Forty-one percent of respondents experience difficulty in understanding and managing their benefit accounts, and 36 percent struggle to determine their eligibility for certain expenses. The report also indicates a consumer preference toward human interaction until they become more familiar with their health plan. Once consumers build confidence, their interest in digital tools and support grows.


A survey conducted by the Kaiser Family Foundation finds that eight out of 10 Americans support the federal government negotiating with drug companies to lower the price of medicines for people on Medicare. Further, 78 percent support limiting the amount that drug companies are allowed to charge for high-cost drugs for severe illnesses. Sixty-six percent say they support the creation of an independent group that oversees the pricing of drugs. Respondents also expressed support for a requirement that drugmakers release information on how prices are set and permission for Americans to buy drugs from Canada. The survey also notes that a majority of Democrats, Republicans and Independents support these changes.

Medicine, Drugs and Devices

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A study aimed to determine whether a urine dipstick test could be used as a substitute for quantitative cotinine assays to assess smoking status in patients undergoing orthopaedic surgery, as smokers often underreport how much they smoke. Researchers analyzed urine samples with cotinine assays and dipstick tests for 127 patients undergoing a foot and ankle arthrodesis or osteotomy. Twenty patients self-identified as current smokers. The dipstick had a sensitivity of 88.9 percent and a specificity of 97.3 percent compared with the quantitative assay. Patients claiming to have stopped smoking prior to the surgery had the highest rate of disagreement between reported smoking status and urine test results.


Drugmakers are facing heavy criticism for the rising cost of prescription drugs in the United States, but industry executives are placing blame on a system in which pharmacy-benefit managers (PBMs), pharmacies and wholesalers take their own cut of each prescription. PBMs oversee drug-benefit plans for employers and insurers, choosing which drugs to cover and driving down prices from drugmakers through rebates. Despite their purchasing power, PBMs have struggled to hold down drug costs, as prescription drug spending rose 8 percent to $321.9 billion last year. Rebates are based on a percentage of the drug’s price, so PBMs have benefited from the skyrocketing costs. Critics of the system say drug companies must increase list prices to offset the percentage it rebates, but PBMs argue that drug costs would be even higher without rebates. In addition to rebates, PBMs collect rebate administration fees of 2 percent to 5 percent of product sales and fees for distributing expensive drugs through mail-order pharmacies.


A recent study examined the effects of minimalist footwear on leg and foot muscle volume and its possible application in rehabilitation programs. Twenty habitual runners underwent a six-month training program and were outfitted with minimalist running shoes, consisting of an open-topped upper, separate toe compartments, zero heel-to-toe drop, no midsole cushioning or arch support and a 3mm outer sole. An additional 18 runners received the same training program using their own traditional running shoes with a heel-to-toe drop over 5mm, additional cushioning and artificial arch support. Runners in the experimental group exhibited significantly larger leg and foot muscles after six months. The mean volume of extrinsic foot muscles increased by 7.05 percent, and the intrinsic foot muscles increased by 8.8 percent. Foot muscle growth was contributed primarily by the forefoot, rather than the rearfoot. The volume of the forefoot and rearfoot increased by 11.9 percent and 6.6 percent respectively. The volume of leg and foot muscles in the control group remained unchanged.