News From ACFAS

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Kris A. DiNucci, DPM, FACFAS and Christopher Hyer, DPM, FACFAS, have been elected to three-year terms on the ACFAS Board of Directors. Electronic voting for new directors on the ACFAS Board of Directors ended on January 17. DiNucci and Hyer will start their terms at the 2012 Annual Scientific Conference on March 1-4 in San Antonio, Texas.

This was the first ACFAS election conducted by electronic Internet voting. “We roughly had the same number of electronic voters as we’ve had in past years with paper ballots. Experts told us we might see a slight decline in voters, but that didn’t happen,” said ACFAS Executive Director Chris Mahaffey, CAE, FASAE. The College saved about $3,000 using electronic over paper voting.

Need more information on the controversial topic of soft tissue surgery? Watch five subject-matter experts discuss their approach to various tendon and ligament surgeries in the newest Scientific eLearning Session, Soft Tissue Techniques.

Topics include:

• Posterior Tibial Tendon Through Interosseous Ligament
• Achilles Tendon Repair with Flexor Tendon Augmentation
• Lesser Metatarsophalangeal Joint Instability – Role of Plantar Plate Repair
• FDL to Posterior Tibial Tendon
• Spring Ligament Repair

The ACFAS Fellowship Committee recently met and officially recognized one more new Foot and Ankle Surgical Fellowship Program:

Foot & Ankle Specialists of Ohio Reconstructive Surgery and Deformity Correction Fellowship
Mentor, Ohio
Fellowship Director: Stephen J. Frania, DPM, FACFAS
http://www.acfas.org/fellowshipfrania

ACFAS highly recommends the continuation of foot and ankle surgical education after residency in the form of a specialized fellowship. Programs meeting minimal requirements are officially recognized by the College, which will in turn provide support for these programs. For a complete listing of programs, support by ACFAS and minimal requirements, please visit http://www.acfas.org/fellowshipinitiative

Foot and Ankle Surgery

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Researchers performed a comparison between the primary stability of two minimally invasive Achilles tendon (AT) repair techniques, specifically a modified percutaneous repair of ruptured AT and the Achillon suture configuration. Nine matched pairs of frozen ovine ATs were tenotomized 5 cm from the calcaneal insertion, while one tendon was randomly allocated to one of the two methods. Specimens were tested executing an unidirectional tensile load to failure using a servo-hydraulic testing device controlled by an electropulse e3000 INSTRON machine, and then the tendons were loaded to failure at a rate of 10 mm/second. Successful testing was carried out for seven of the matched pairs; two were rejected because one specimen for each of the pair pulled out of the pneumatic clamp during mechanical testing. No disparities in mean strength, mean maximum load, mean failure elongation, tension, stiffness, and mode of failure were observed between the two groups.


Researchers tested supination stress of the great toe as a technique for evaluating intraoperative correction of the hallux valgus, using a sample of 30 patients, or 31 feet, with an average age of 59.8 years who underwent a proximal metatarsal osteotomy. Supination stress under traction was applied to the great toe following release of the distal soft tissues and a proximal metatarsal osteotomy, while C-arm fluoroscopy was employed to confirm hallux valgus correction and to acquire dorsoplantar non-weightbearing images under supination stress. The images were evaluated preoperatively and at the time of intraoperative supination stress, and the hallux valgus and intermetatarsal angles were quantified. The median hallux valgus angle was 34.3 degrees preoperatively and 11.9 degrees at the time of intraoperative supination stress, while the average intermetatarsal angle also underwent significant reduction between those two times, to 5.5 degrees from 16.4 degrees. The halux valgus angle was 20 degrees or less in all feet at the time of intraoperative supination stress, while the intermetatarsal angle was 10 degrees or less in all feet. All feet were classified as exhibiting lateral displacement of the sesamoids preoperatively, and of having normal sesamoid positioning at the time of intraoperative supination stress.


Researchers performed a study to ascertain whether lace-up-ankle braces have a reductive effect on the incidence and severity of lower extremity injuries suffered by high school football players. The study involved the random assignment of 2,081 players from 50 high schools to a braced or control group, with those in the first group wearing lace-up ankle braces during the 2010 football season. Brace compliance, athlete-exposures, and injuries were recorded by athletic trainers, with injury rates between groups compared by Cox proportional hazards models and injury severity tested with Wilcoxon rank sum. In the braced group, the rate of acute ankle injury per 1,000 exposures was 0.48, versus the control group's injury rate of 1.12. Acute ankle injury severity, indicated by the average number of days lost, was five days in both groups. The braced group exhibited a 0.70 rate of acute knee injury while the control group had 0.69, and no difference in the severity of knee injuries was observed between the groups. The rate of other lower extremity traumas was 0.95 in the braced group and 1.32 in the control group while both groups had similar levels of severity, with the braced group losing six days and the control group losing seven days.

Practice Management

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Side-by-side or embedded business partnerships offer physician practices an alternative to selling themselves to hospitals, as such alliances permit practices to add another doctor employed by the hospital. The perilous nature of business and legal issues innate in such relationships is the reason why so few side-by-side arrangements exist at present, although analysts say these partnerships may imbue practices with financial stability and address recruiting difficulties. Regardless of whether the hospital or the practice suggests the side-by-side arrangement, both entities should have an established link before pursuing it. "The practice and the hospital need to try to be clear with each other as to what they see as the parameters of the arrangement," says Quarles & Brady partner Alyce Katayama.


Physicians can realize major reductions in medical practice operational costs by following a few simple steps, such as reducing, reusing, and recycling office supplies and purchasing used or reconditioned office equipment. Another strategy that can save money significantly is to switch to group-purchasing deals for medical supplies. Hiring an accountant or financial consultant to help a practice budget more frugally carries benefits, and energy costs can be reduced by replacing older computers with newer, more energy-efficient models. Consultant Laurie Morgan says additional energy savings can be realized by making sure staff turn off their computers and monitors when they leave.


In 2011, more than $104,490 in incentive funds for adopting electronic health records (EHR) technology was paid out to 5,805 healthcare providers. This amount does not include Medicare-only hospitals or Medicare/Medicaid hospitals. The amount includes payments to 378 individual healthcare providers working in podiatry.

Health Policy and Reimbursement

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The Centers for Medicare & Medicaid Services (CMS) has extended its annual participation enrollment period through February 14. CMS moved the deadline for physicians to elect to continue Medicare participation or withdraw from the program because the agency anticipates congressional action in the coming weeks to address the 27.4 percent sustainable growth rate cut to physician pay this year. If Congress appears that it will allow the steep reduction in Medicare rates to take effect, that could influence physician decisions to participate in the program during the 2012 year. Medicare contractors will process participation status changes that are postmarked by February 14. The effective date for all changes will be January 1 and remain in effect for the year.


The Centers for Medicare & Medicaid Services (CMS) recently decided to perform audits prior to paying for some orthopaedic procedures in specific states. The program was scheduled to start January 1, 2012, and be enacted in Florida, California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina and Missouri — states that CMS claims display high populations of fraud- and error-prone providers, as well as high volumes of claims with short in-patient hospital stays.


The Centers for Medicare and Medicaid Services' (CMS) proposed rule to allow changes in the governance structure and medical staffing at hospitals has received little support from the more than 100 public comments that have been submitted. The proposed rule is part of a larger CMS review of the entire set of conditions for participation (CoP) that hospitals must adhere to participate in the Medicare and Medicaid programs. The proposed rule would be the first time in several years that the CMS has launched a retrospective review of the CoP.

A letter signed by more than 80 physicians groups—including the AMA, the American Academy of Family Physicians and the American College of Surgeons—takes issue with proposed changes to the existing governance and medical staff regulations. The letter notes that CMS is not statutorily authorized to reduce the regulatory burden for hospitals or to address healthcare workforce shortages.


The Joint Commission is seeking comment on a proposed National Patient Safety Goal (NPSG) for its Hospital and Critical Access Hospital Accreditation Programs. The new NPSG seeks to minimize the overuse of tests, treatments, and procedures to reduce the risk of patient harm. Physicians are encouraged to submit comments directly to the commission by January 24. Comments can be submitted here.


The New Jersey Legislature has approved a bill giving the state Department of Health oversight over all surgeries performed in the state. Previously, one-room surgical practices were overseen by the state Board of Medical Examiners. Under the new law, the one-operating-room surgical practices will be inspected by the state health department every two to three years. They have been subject to less frequent inspection by the Centers for Medicare and Medicaid Services.

Medicine, Drugs and Devices

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Nine medical specialty societies, in conjunction with the American Board of Internal Medicine (ABIM) Foundation and Consumer Reports, seek to curb waste in healthcare and improve patient outcomes through the Choosing Wisely initiative, an effort to compile lists of dubious procedures and tests that may be unnecessary, according to ABIM Foundation CEO Christine K. Cassel. Each specialty group will devise a list of five potentially redundant tests and procedures that are expensive, commonly used in their specialty, or both, and each recommendation must be backed by research and will be amended as new evidence comes forth. American College of Physicians president Virginia L. Hood cites several variables that may contribute to misuse of tests and procedures, such as a dearth of guidance for many clinical problems, doctor habits, and patient expectations. Consumer Reports Health Ratings Center director John Santa, says Consumer Reports will assist in the translation of the lists for patients, and he notes that "people are especially concerned about care that may not be effective but expose them to risks, directly or indirectly."


The Joint Commission has announced the incoming Board of Commissioners for 2012, and the Board’s decision to make the three field representatives for long term care, behavioral health care and home care full voting members. More details can be found here.


The New York University School of Medicine is using 3D technology, similar to the technology used in 3D movies, to update a medical school staple, anatomy class. At the NYU Langone Medical Center in Manhattan, medical students have dissected cadavers for years to prepare to become doctors, but medical cadavers are imperfect stand-ins for living patients as death and preservation alter the body. In an adjacent classroom, a group of students are using 3D glasses by the graphics processing company Nvidia to dissect a virtual cadaver projected on a screen. A computer grants control of a stereoscopic view, creating a tour through a virtual body with colors as bright as living tissue.

The virtual body was created by BioDigital Systems, which has created animations of the anatomy for drug manufacturers, medical device makers, and television shows. The virtual body represents an unusual collaboration between industry and academia. BioDigital plans to develop the virtual cadaver further through a new medical education website, biodigitalhuman.com, in order to create a searchable, customizable map of the human body.