News From ACFAS

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Honor your colleagues and hear from ACFAS leadership at the virtual ACFAS Membership Meeting on March 4, 2021, 8pm CT/9pm ET. In addition to the installation of the 2021 ACFAS Board of Directors and remarks from incoming ACFAS President, Thanh Dinh, DPM, FACFAS, Eric Walter, DPM, FACFAS will be honored as the 2021 Distinguished Service Award recipient, Naohiro Shibuya, DPM, MS, FACFAS, Annual Scientific Conference Committee Chair will give an update on the 2021 Annual Scientific Conference and the new ACFAS Fellows will be recognized. To register for the ACFAS Update & Member Recognition Program, visit acfas.org. More A to Zs in foot and ankle research is coming up—register now for the next ACFAS Virtual Journal Club set for tomorrow, January 21, at 7pm CT. The program is hosted by the University of Maryland Limb Preservation and Deformity Correction Fellowship and presented by Jacob Wynes, DPM, MS, FACFAS, Korey Dubois, DPM and Robert Brandao, DPM, AACFAS.

Secure your spot today at acfas.org/JournalClub, where you can also find archived ACFAS Journal Club programs to watch at your convenience. Need a tool to help deal with the stresses of the ongoing pandemic and the past year? Join ACFAS for a complimentary webinar on Mindfulness and Medicine set for Thursday, February 4 at 8pm CT. The program features psychotherapist Dave Potter, who will talk about mindfulness-based stress reduction and how attendees can tune their minds, track thought patterns, and become more conscious of associated physical sensations to reduce stress and anxiety as well as manage expectations.

To register for the program, visit acfas.org.

Foot and Ankle Surgery

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This scoping review aimed to identify self-management actions and risk avoidance strategies for diabetes-related foot complications. Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified and screened independently by reviewers, who identified 19 eligible papers. In total 25 different foot self-management actions and risk behaviors were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Most of the interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behavior. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes.


The study looked at the therapeutic outcomes of intra-articular opening osteotomy combined with lateral ligament reconstruction for Takakura 3B ankle arthritis with medial distal tibial platform erosion. From September 2009 to May 2016, 17 patients with Takakura 3B ankle arthritis were reviewed, including three male and 14 female patients. All underwent the operation of intra-articular opening osteotomy combined with lateral ligament reconstruction. All patients were followed for a mean follow-up of 87.2 months. The Visual Analogue Scale improved from 5.5 to 2.3, while the mean American Orthopaedic Foot and Ankle Society score improved from 47.7 to 75.8. The SF-36 scale improved from 41.6 to 67.7, and the Ankle Osteoarthritis Scale improved from 60.9 to 28.2. The TT angle improved from 14.3 to 5.3, and the TAS and TLS changed from 83.4 degrees and 77.5 degrees to 90.7 degrees and 78.6 degrees, respectively.


This prospective cohort study investigated whether the Modified Broström-Gould technique utilising a Gracilis autograft would significantly improve stability while maintaining normal ankle biomechanics in young, high-demand patients. The study involved 19 patients (20 ankles) who underwent surgery for chronic lateral ankle instability by a single surgeon between October 2014 and April 2016. Patients were followed for an average of 33.8 months and assessed for talar tilt angle and with both American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot scores and Karlsson-Peterson (KP) scores. The mean AOFAS Score increased from 68.85 to 91.56 points and mean KP Score increased from 50.9 to 88.11 points when compared pre-operatively to mean post-operative follow-up of 33.8 months. A Tegner Activity score was taken at the last followup and found to be 7.05.

Practice Management

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One of the easiest ways for practice leaders to build team unity is adopting a no gossip policy. Gossip is contagious and breeds disloyalty. Typically, team members that gossip about each other gossip about everybody and everything: staff, physicians, patients and business. As such, having an office full of gossip is a quick way to experience legal and professional ramifications. When introducing a no-gossip policy, it is critical to do so through a team meeting with a detailed explanation and opportunity to ask questions.


Employment in healthcare occupations is expected to grow 15 percent in the next decade, well ahead of 3.7 percent overall growth, according to employment projections released by the US Department of Labor. The aging baby boomer population will drive the growth. The number of nursing practitioners and physician-assistant jobs is expected to grow by 50 percent and 31 percent, respectively. Furthermore, by 2029, more than a quarter of the US workforce will be 55 or older, an increase from 23.4 percent last year.


A recent study by the Larry A. Green Center and the Primary Care Collaborative found that 35 percent of primary care physicians say hiring new staff is a big obstacle to their practice. Providers can employ a number of strategies to hire, motivate and retain clinical staff, starting with better compensation. The practice leader can also consider offering staff members growth opportunities such as enabling them to pursue more education through training. Personalized benefits can be a good recruitment tool and a motivator for current staff members. All these changes should be documented and formalized so that they do not appear to be capricious. Practices should also not overlook recent medical school graduates when hiring. When hiring millennials it is important to remember that the cohort tends to put a premium on work-life balance and the feeling that their work has purpose. Millennial physicians are also aware that they need feedback and mentoring and can see the value in picking a senior employee's brain to help them in their own work. Bhuyan says this new emphasis on mentorship is closer to coaching than in years past.

Health Policy and Reimbursement

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New work from Mayo Clinic has found that for the 20 most common orthopedic arthroscopic surgical procedures, inflation-adjusted Medicare reimbursement rates declined by almost 30 percent from 2000 to 2019. Co-author Anikar Chhabra, MD, MS, chair of the Division of Sports Medicine and Associate Professor of Medicine at Mayo Clinic College of Medicine in Phoenix, Arizona, said, “As arthroscopic procedures continue to grow at increasing rates, it is essential that the declining Medicare reimbursement rates are addressed by practitioners, administrators and policy makers so that high quality, effective care can persist in the United States without placing undue financial burden on patients."


According to a recent Urban Institute study, hospitals in Medicaid expansion states have saved an average of $6.4 million on uncompensated care since the policies took effect. The study found that uncompensated care comprised 6 percent of total expenses for hospitals located in non-expansion states in 2017, double the amount for those located in states that had expanded the program. Cash from Medicaid accounted for an average 15 percent of all revenue for hospitals in expansion states in 2017, compared to 10 percent of revenue for hospitals in states that had not expanded Medicaid. Researchers found that uncompensated care costs dropped $9.5 million over the six-year period studied.

Medicine, Drugs and Devices

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The US Centers for Medicare and Medicaid Services (CMS) issued a final rule on Tuesday called the Medicare Coverage of Innovative Technology (MCIT). The rule is meant to help smooth the Medicare coverage pathway for innovative products. The MCIT rule creates a new, accelerated Medicare coverage pathway for innovative products that the FDA deems "breakthrough," which the US Food and Drug Administration (FDA) approves on an expedited basis. Under the MCIT rule, Medicare can provide national coverage simultaneously with FDA approval, up to a period of four years. This four-year timeline may incentivize the manufacturers of these devices to develop additional evidence regarding the applicability of their products to the Medicare population. The rule will also clarify the standard CMS uses to determine whether Medicare should cover items and services.


The US Food and Drug Administration (FDA) has published its first Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device Action Plan, which is designed to further agency oversight of the technology. Said Baku Patel at the Center for Devices and Radiological Health's Digital Health Center of Excellence, "The plan outlines a holistic approach based on total product lifecycle oversight to further the enormous potential that these technologies have to improve patient care while delivering safe and effective software functionality that improves the quality of care that patients receive." The plan specifies five intended FDA actions: further developing the proposed regulatory framework; backing development of good ML practices to assess and enhance ML algorithms; nurturing a patient-centered approach, including device transparency to users; devising ML algorithm development and improvement techniques; and advancing real-world performance tracking pilots.


A report from the offices of US Sens. Chuck Grassley (R-IA) and Ron Wyden (D-OR), who lead the Senate Finance Committee, concluded that insulin prices are rising because of a "broken" system that rewards insulin makers for raising drug costs. The report states: "Rather than seeking to undercut its competitors’ pricing, from 2014 on Novo Nordisk engaged in a cat-and-mouse strategy of pricing that followed Sanofi’s price increases closely, sometimes mirroring them within days or even hours." The authors of the report analyzed more than 100,000 pages of internal documents from various companies. They found that companies "aggressively” raised the list prices of insulin products "absent significant advances in the efficacy of the drugs."