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January 26, 2011

News From ACFAS

ACFAS to M.D.: Remove Inaccurate Video

Last week ACFAS sent a cease and desist letter to an orthopedic surgeon who had posted an Internet video of himself that contained inaccurate and disparaging information about the training and qualifications of DPMs. The surgeon is involved in negotiations over a state's scope-of-practice legislation.

The College warned, “ACFAS intends to hold you personally responsible for any and all damages accruing to its more than 6,000 members from the untrue statements and other defamatory material in the video. Your continued dissemination of the video will only increase the damages due to ACFAS and its members.”
Board of Directors Election Results

In balloting that concluded on Jan. 24, members of the College elected two new members to the ACFAS Board of Directors:
  • Laurence G. Rubin, DPM, FACFAS, of Mechanicsville, Va., for a three-year term
  • John S. Steinberg, DPM, FACFAS, of Washington, D.C., for a three-year term
In March, these new members will join the continuing members of the 2011–12 board.
Keep Current on Recent Research

You may not have time to read all the research you’d like to, but in just a few minutes you can catch up with ACFAS’ Scientific Literature Reviews. These abstracts have been prepared for active foot and ankle surgeons by podiatric residents. Some of the latest are:

Comparison of Standard Screw Fixation Versus Suture Button Fixation in Lisfranc Ligament Injuries, from Foot and Ankle International.
Reviewed by Sophia Barnett, DPM, Botsford Hospital Podiatric Medicine and Surgical Residency.

Preliminary Results of Calcaneofibular Ligament Transfer for Recurrent Peroneal Subluxation in Children and Adolescents, from the Journal of Pediatric Orthopedics.
Reviewed by Shirley M. Catoire, DPM, Yale/ VA Podiatric Residency Program.

Find a variety of abstracts to feed your interests at Scientific Literature Reviews.
The State of the Union and Healthcare Impact

Last night President Obama delivered his third State of the Union address to the nation. For foot and ankle surgeons there were clues to the administration’s leanings on healthcare and reform.

Obama stated he wants to further reduce healthcare costs, especially Medicare and Medicaid, which are the biggest contributor to our nation’s long-term deficit, and he said the new health insurance law will slow these rising costs. He also indicated interest in a Republican idea, medical malpractice reform to rein in frivolous lawsuits.

Foot and Ankle Surgery

Association Between Plantar Fasciitis and Isolated Contracture of the Gastrocnemius

Researchers set out to determine the proportion of patients with plantar fasciitis that have an associated isolated gastrocnemius contracture. A total of 254 patients with plantar fasciitis were included in the study. Patients with acute plantar fasciitis were defined as having symptom duration of nine months or less, while those with chronic plantar fasciitis were identified as those with over nine months of symptoms.

Eighty-three percent (211 of 254 patients) had limited ankle dorsiflexion. Fifty-seven percent had an isolated contracture of the gastrocnemius, 26 percent had a contracture of the gastrocnemius-soleus complex, and 17 percent did not have a dorsiflexion limitation. Equinus contracture was noted in 83 percent (129 of 155) of acute cases, and 82 percent (82 of 99) of chronic cases. An isolated contracture of the gastrocnemius was found in 60 percent of acute and 52 percent of chronic cases. A gastrocnemius-soleus complex contracture was noted in 23 percent of acute cases and 30 percent of chronic cases. Patients with chronic plantar fasciitis had a significantly higher number of medical comorbidities than those with acute plantar fasciitis.

The researchers concluded that limited ankle dorsiflexion is commonly associated with plantar fasciitis and more than half of these patients had evidence of an isolated gastrocnemius contracture. These findings can be utilized to develop and further refine non-operative and operative treatment strategies for those with recalcitrant plantar fasciitis.

From the article of the same title
Foot & Ankle International (01/11) Vol. 32, No. 1, Patel, Amar; DiGiovanni, Benedict
Web Link - May Require Paid Subscription

Foot and Ankle Strength, Range of Motion, Posture, and Deformity Are Associated With Balance and Functional Ability in Older Adults

Researchers investigated associations between foot and ankle strength, range of motion, posture, and deformity with balance and functional ability in 305 participants (age range, 65–93). They found that most of the associations between the foot and ankle musculoskeletal measurements and performance on the balance and function tests were statistically significant. The most significant finding was that the association between hallux plantar flexion strength and ankle inversion-eversion range of motion with balance and functional test performance. The researchers concluded that foot and ankle characteristics, particularly plantar flexor strength of the hallux and ankle inversion-eversion range of motion, are important determinants of balance and functional ability in older people.

From the article of the same title
Archives of Physical Medicine and Rehabilitation (01/01/11) Vol. 92, No. 1, P. 68 Spink, Martin J.; Fotoohabadi, Mohammad R.; Wee, Elin

Optimal Double Screw Configuration for Subtalar Arthrodesis: A Finite Element Analysis

Researchers investigated the optimal configuration of double screw fixation for subtalar arthrodesis. From the CT images, polygon models converted to tetrahedron finite elements were reconstructed to test four fixation configurations. The tested configurations were combinations of a neck screw and a dome screw inserted from one of four different locations: anterolateral (AL), anteromedial (AM), posterolateral (PL), and posteromedial (PM). External and internal rotation torques of 4 Nm were applied to evaluate the stability of each configuration.

The configuration of a neck screw plus a PM dome screw had the least translation (0.9 and 0.8 mm for external and internal rotational torques, respectively) and least rotation (5.0° and 4.8° for external and internal rotational torques, respectively). The divergence angle or the contact length did not correlate with stability independently, but combination of these variables correlated with rotational stability. The researchers concluded that a posteromedial dome screw combined with a neck screw was the best surgical choice.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (01/18/11) Lee, Jun Young; Lee, Yeon Soo

Practice Management

Suicidal Ideation Among American Surgeons

In a national survey of nearly 8,000 surgeons, one in 16 reported contemplating suicide, researchers reported. The results suggest that these self-destructive thoughts may result from medical errors, job burnout, and depression. The study also found that surgeons contemplate suicide at higher rates than the general public, and they're less likely to seek help. According to the study, fear of losing their jobs contributes to surgeons' reluctance to get mental health treatment.

From the article of the same title
Archives of Surgery (01/01/11) Vol. 146, No. 1, P. 54 Shanafelt, Tait D.; Balch, Charles M.; Dyrbye, Lotte

Surgical Checklists Could Cut Malpractice Claims: Study

A recent Netherlands study published in the Annals of Surgery reveals that surgical checklists can not only save lives by preventing medical errors, but also can reduce medical malpractice claims. According to data from the nation's largest medical liability insurer, nearly 33 percent of malpractice insurance claims stem from medical errors that could be caught by checklists. The checklist used in the study, SURPASS, ensures that the operating schedule is correct, double checks the availability of equipment, and marks on which side of the patient the surgery is to take place. According to the study, one of the contributing factors in 40 percent of the deaths in the claims database are addressed by the checklist. A 2010 study reveals that medical liability system costs the United States more than $55 billion per year or 2.4 percent of all healthcare spending.

From the article of the same title
Reuters (01/17/11)

e-Records Certification Expands

The EHR Alternative Certification for Hospitals (EACH) program from the nonprofit Certification Commission for Health IT (CCHIT) will allow hospitals to certify older or custom electronic health records (EHRs). A similar program for physicians is coming in the second quarter of this year, according to CCHIT. The program includes self-paced, online learning programs to prepare applicants for testing and certification; online inventory and self-assessment tools; and hands-on support from CCHIT.

From the article of the same title (01/20/11) Pulley, John

Health Policy and Reimbursement

CMS Changes PQRI to Align With Healthcare Reform

CMS has renamed the Physician Quality Reporting Initiative (PQRI) as the Physician Quality Reporting System (PQRS), while also altering a variety of reporting guidelines and verbiage in accordance with the Patient Protection and Affordable Care Act of 2010. Some of the major changes include:

• Eligible professionals need only report 50 percent of measures to CMS for claims-based reporting, reduced from 80 percent in previous years.

• Under the PPACA, CMS is required to establish a review process for eligible professionals wishing to appeal CMS decisions that the professionals did not satisfactorily submit quality data under PQRS.

• For radiology, a jointly developed American Medical Association and American College of Radiology reminder system for mammography screenings will record the percentage of women 40 years and over undergoing screenings and set target reminders for periodic screenings.

• Several code updates and terminology changes have been made to some measures potentially affecting diagnostic radiologists, interventional radiologists and radiation oncologists.

Click here for more information on the changes.

From the article of the same title (01/18/11)

Device Companies Dodge Controversial Changes at FDA

U.S. regulatory reviews of medical devices will not initially undergo the dramatic revisions device manufacturers were concerned about. The FDA has listed 25 steps it plans to take this year to guarantee the safety of medical devices approved under its 510(k) program and to make the process less unpredictable for companies and shareholders. The FDA reports that the list does not include the most controversial of 55 proposals made in August by an internal agency task force.

From the article of the same title
Bloomberg (01/19/11) Larkin, Catherine; Olmos, David

Educating Physicians to Prevent Fraud, Waste, and Abuse

HHS Office of Inspector General (OIG) Chief Medical Officer Julie K. Taitsman, MD, reports that medical schools and residency programs do not consistently educate trainees about fraud, waste, and abuse. Taitsman writes that the first step to guarantee that all future physicians are educated about fraud, waste, and abuse is to get medical educators to understand the value of teaching about the Medicare and Medicaid programs' integrity. The next step is to help them develop the tools to teach this subject effectively and comprehensively. For this purpose, OIG has created "A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse," an educational document that summarizes the chief federal fraud and abuse statutes and offers suggestions on how physicians should comply with these laws in their relationships with vendors, payers, and fellow providers.

From the article of the same title
New England Journal of Medicine (01/12/11) Taitsman, Julie K.
Web Link - May Require Paid Subscription

USPSTF Updates Screening Recommendations for Osteoporosis

The U.S. Preventive Services Task Force (USPSTF) has updated its screening recommendations for osteoporosis, now recommending that all women ages 65 and older be routinely screened for osteoporosis. USPSTF also recommends that younger women with increased risk factors for osteoporosis be screened if their fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. White women are used as the benchmark because they have a markedly higher rate of osteoporosis and fractures than other ethnic groups. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass and parental history of fractures. The USPSTF also looked at whether to recommend screening men for osteoporosis but found insufficient evidence to make a recommendation at this time.

Osteoporosis screening involves a measurement of bone density, which is currently covered by Medicare. The most commonly used bone density measurement tests are dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine, as well as quantitative ultrasound of the heel, although current diagnostic and treatment criteria are based on DXA tests alone. USPSTF noted that there is a lack of evidence about how often screening should be repeated in women whose first test is negative.

From "Screening for Osteoporosis: U.S. Preventive Services Task Force Recommendation Statement"
Annals of Internal Medicine (01/17/11)

Medicine, Drugs and Devices

Close Look at Orthotics Raises a Welter of Doubts

Benno M. Nigg, a professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta, has spent the last three decades studying how orthotics affect motion, stress on joints, and muscle activity. His overall conclusion is that the shoe inserts may be helpful as a short-term solution, preventing injuries in some athletes, but it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up. That opinion is shared by Joseph Hamill, who studies lower-limb biomechanics at the University of Massachusetts in Amherst, who said, "I guess the main thing to note is that, as biomechanists, we really do not know how orthotics work.”

From the article of the same title
New York Times (01/17/11) Kolata, Gina

Effects of Kinesio Tape Compared With Non-Elastic Sports Tape and the Untaped Ankle During a Sudden Inversion Perturbation in Male Athletes

Researchers examined the effect of two adhesive tape conditions compared to a no tape condition on muscle activity of the peroneus longus during a sudden inversion perturbation in male athletes (soccer, team handball, basketball). Fifty-one male premier-league athletes were tested for functional stability of both ankles with the Star Excursion Balance Test. Based on the results, those with the 15 highest and those with the 15 lowest stability scores were selected for further testing. Muscle activity of the peroneus longus was recorded with surface electromyography during a sudden inversion perturbation.

Significantly greater mean muscle activity was found when ankles were taped with non-elastic tape compared to no tape, while kinesio tape had no significant effect on mean or maximum muscle activity compared to the no tape condition. Neither stability level nor taping condition had a significant effect on the amount of time from perturbation to maximum activity of the peroneus longus muscle.

The researchers concluded that non-elastic sports tape may enhance dynamic muscle support of the ankle. The efficacy of kinesio tape in preventing ankle sprains via the same mechanism is unlikely as it had no effect on muscle activation of the peroneus longus.

From the article of the same title
Journal of Orthopaedic & Sports Physical Therapy (01/05/2011) Briem, Kristin E.; Eythorsdóttir, Hrefna; Magnúsdóttir, Ragnheidur G.; et al.

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