News From ACFAS

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Get the most out of your ACFAS 2020 experience with one of our three preconference workshops! Whether you aim to enhance your surgical skills or ramp up your coding expertise, join us in San Antonio on Tuesday, February 18 and pick from one of three workshops being offered:

Coding and Billing for the Foot and Ankle Surgeon
7:30am-5:30pm | 8 Continuing Education Contact Hours
Register Now

Diabetic Deformity: Master Techniques in Reconstruction (Cadaveric)
7am-Noon | 4 Continuing Education Contact Hours
Register Now

High Frequency Foot Surgery Techniques (Cadaveric)
Noon-5pm | 4 Continuing Education Contact Hours
Register Now

Visit acfas.org/sanantonio to see a breakdown of each workshop schedule and to register for another educational opportunity in San Antonio! Residents’ Day is back for ACFAS 2020! Join us on Tuesday, February 18 in San Antonio for another must-attend workshop designed specifically for residents.

Our seasoned professionals are eager to share their experiences and their “First and Worst” stories as they welcome residents to ACFAS and the exciting profession they’ve chosen. Walk away with helpful tips on everything from job search and interview prep, practice types and managing difficult cases. Participate in Q&A over lunch and end the day with an informal networking reception.

You won’t want to miss the chance to get first-hand advice from these seasoned surgeons and leaders of the profession. Come hear the stuff your Residency Directors can’t tell you! Visit acfas.org/sanantonio for updates and registration information. Need a little more time to pay your annual College dues? You got it–the College is extending the deadline to pay your ACFAS membership dues and avoid a late fee. A “last chance” reminder was sent out via email today to all Fellow and Associate Members with 2020 dues outstanding.

Renew your membership now at acfas.org/paymydues or via mail or fax to continue your member benefits.

If you have questions or need another statement, please contact the Membership Department at (773) 693-9300 or membership@acfas.org. The ACFAS Post Graduate Affairs Committee introduces the ACFAS Region Residency Director Mentor program, a new initiative to support and connect local residency directors with their peers. Two mentor directors have been assigned from each of the nine local ACFAS Regions throughout the country. Directors can contact their local colleague mentor with nagging questions about leading their program, to get advice about an upcoming CPME site review from someone who’s been through it, or for any other questions about the many challenges residency directors face regularly.

To contact your local mentor, visit the Contact the Mentors section on the ACFAS Region webpage at acfas.org. Your local mentors will respond to questions directly.

Foot and Ankle Surgery

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The observational cohort study aimed to determine the incidence of Achilles tendinopathy (AT) in a large group of recreational runners and to determine risk factors for developing AT. Young runners registering for running events in the Netherlands were eligible for inclusion. All participants received three follow-up questionnaires up to one month after the running event with self-reported AT as primary outcome measure. Regression analyses were performed to study the relationship between baseline variables and AT onset.

A total of 2,378 runners were included, of which 1,929 completed one follow-up questionnaire and 100 developed AT. Runners registered for a marathon (7.4 percent) had the highest incidence of AT. Risk factors for developing AT were use of a training schedule, use of sport compression socks and AT in the previous 12 months. The results indicate that one in 20 recreational runners develop AT, and AT in the preceding 12 months is the strongest risk factor for having AT symptoms.


This study aimed to determine the maintenance of correction of the first and second intermetatarsal angle (IMA), hallux valgus angle (HVA) and tibial sesamoid position after using the cross-screw intermediate cuneiform construct for first tarsometatarsal joint arthrodesis. Researchers looked at 62 patients undergoing tarsometatarssal joint arthrodesis for correction of hallux valgus with the proposed construct.

Bony union was achieved in 60 of 62 patients, while two patients required revision surgery as a result of recurrence. Final mean improvement of the IMA was 6.8 degrees, HVA was 14.8 degrees and tibial sesamoid position was 2.4 degrees. Mean loss of IMA correction was 1.5 degrees, HVA was 2.9 degrees and tibial sesamoid position was 0.8 degrees. The study indicates that the cross-screw intermediate cuneiform construct for first tarsometatarsal joint arthrodesis had a good union rate, a low complication rate and maintained radiographic correction.


The study evaluates the biomechanical strength of an innovative method of fixation for medial malleolus fractures using a fully threaded (FT) lag screw that extends to the far endosteal cortex. Medial malleolus fractures were simulated in 12 matched cadaver pairs and a single PT 4.0-mm cancellous lag screw was placed in one ankle. The contralateral ankle of the same matched pair received an FT 3.5-mm cortical lag screw that extended to the far lateral tibial cortex and achieved endosteal purchase.

Average torque for the PT cancellous screws was 5.02 ± 2.34 in-lb, while average torque for the FT cortical screw was 7.63 ± 3.86 in-lb. Visual and radiographic inspections revealed no displacement of the fracture site with use of the FT endosteal lag screw. The results indicate superior biomechanical torque with far endosteal with use of an FT cortical lag screw when compared to a traditional PT cancellous lag screw in a cadaverous model.

Practice Management

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Clinical processes are at the core of the radical changes under way in the healthcare field, and hospital systems need physician leaders who can play a central role in restructuring to fit new requirements. Healthcare systems must take a hard look at the motivational, educational and organizational barriers to cultivating future physician leaders and adjust their leadership development programs accordingly.

This means equipping physicians with the ability address burnout and lead change in areas such as value-based care, clinical standardization, delivery innovation and consumer-centric engagement models. Systems should provide clearly defined leadership career paths and incentive mechanisms for aspiring leaders, as well as strong integration and mentorship opportunities with experienced administrative and clinical leaders.


A 2019 Kareo survey of nearly 800 independent practice providers highlights the challenges that physician-owned healthcare practices are facing. The survey found a high correlation between administrative time demands and physician burnout, with 70 percent of respondents saying these factors are impacting care delivery. Many of the administrative challenges began a decade ago, when the Health Information Technology for Economic and Clinical Health Act of 2009 was enacted to drive the adoption of electronic health records. While historically the mandated use of technology has been a challenge for providers, 69 percent of those surveyed agreed that more progressive, integrated technology solutions are needed to improve the efficiency and profitability of their practices.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) have extended the comment period for the proposed Transparency in Coverage Rule by 15 days. The proposed rule would require that consumers have real-time access to cost-sharing information, including out-of-pocket expenses. CMS says the extension was needed to account for robust public feedback and the consideration of the holiday season. If finalized, the rule would also require insurers to disclose their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers on their websites. The proposed rule was unveiled on November 15 and would go into effect in 2021.

Medicine, Drugs and Devices

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Companies focused on developing new antibiotics find that they are losing money and going bankrupt at a time when germs are growing more resistant to common antibiotics. Experts say the grim financial outlook for the few companies still committed to antibiotic research is driving away investors and threatening to strangle the development of new lifesaving drugs at a time when they are urgently needed. The companies that have invested billions to develop the drugs have not found a way to make money selling them, and many of these treatments are used for short periods and hospitals are unwilling to pay high prices for the new therapies. Public health experts say the crisis calls for government intervention, such as increased reimbursements for new antibiotics, federal funding to stockpile drugs effective against resistant germs and financial incentives that would offer much needed aid to startups and lure back the pharmaceutical giants.


Major drugmakers announced plans to increase prices on more than 200 drugs in the United States. Almost all the price hikes will be below 10 percent, and about half will be between 4 percent and 6 percent, with a median price increase of roughly 5 percent. Manatt Health adviser Ian Spatz suggested drugmakers could be keeping the price hikes relatively low to avoid political controversy.


Medical industry experts are concerned about artificial intelligence's (AI) highly hyped impact on healthcare falling short of reality, with patients at risk. Mildred Cho at Stanford's Center for Biomedical Ethics said digital systems developed in one hospital often fail in a different facility, while software used in healthcare has demonstrated bias against minorities. Bob Kocher at venture capital firm Venrock noted few AI products have evidence supporting their viability, and Scripps Research's Eric Topol warned no AI products sold in the United States have undergone testing in randomized clinical trials. Also fueling skepticism is the almost exclusive testing of AI models in computers rather than in medical facilities, while most AI devices do not require US Food and Drug Administration approval.


Researchers at the University of Bologna in Italy studied 142 ankle bones from 11 populations in North America, Africa and Europe. These included modern sandal-wearing farmers in southern Africa, people living in New York and preserved bones from Stone age hunter-gatherers. They found the hunter-gatherers' ankle bones were significantly shorter than those of people living in modern cities. There were other differences in the shape, which researchers say "are mostly related to footwear-related behaviors and locomotor behaviors." Researchers tie the differences in part to footwear because early hunter-gatherers would have only worn thin shoes or gone barefoot, meaning their ankles would be less restricted. Their ankles were relatively flexible. In contrast, the people who live in big cities wear constrictive footwear and walk short distances on flat surfaces like asphalt roads. Their ankles were found to be more rigid.