News From ACFAS

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The January poll in This Week @ ACFAS asked readers what changes they are planning to make to their practices in 2018.

The majority of respondents (41 percent) plan to hire more doctors and/or staff while 29 percent plan to increase their practice marketing efforts. Reducing the number of doctors and/or staff, extending office hours and changing locations each came in at 6 percent. The remaining 12 percent of respondents said they intend to reduce their office hours.

If you are looking to hire more doctors or staff members at your practice, visit PodiatryCareers.org to view potential candidates and also stop by the bulletin boards at the Job Fair during ACFAS 2018 in Nashville to browse jobseekers' resumes.

To learn how to boost your practice marketing efforts and increase referrals, log in to the ACFAS Marketing Toolbox and listen to the free recording of the recent Take a New Look at Practice Building webinar.

ACFAS thanks everyone who voted. Be on the lookout for the February poll in next week's issue of This Week @ ACFAS! To help you, your staff and your families maintain your financial wellness, ACFAS Member Benefit Partner HealthCare Associates Credit Union (HACU) brings you the new Enrich Financial Wellness Platform.

ACFAS members can use this online program to develop a manageable spending plan, increase savings, reach their goal of home ownership, avoid bankruptcy, consolidate debt and more.

To get started with Enrich:

1. Create a free account with HACU and take the personal assessment.
2. Explore the platform and its tools.
3. Create your Enrich account today and see the difference that making your personal finances actually personal can do.

Learn more about this new HACU service by contacting a personal Enrich financial counselor at (866) 676-4385, Monday through Friday from 10am to 7pm (CST). Rise and dine with FH Ortho on Friday, March 23 during the ACFAS 2018 satellite breakfast, “CALCAnail—A Reproducible Intraosseous Approach to Calcaneal Fractures & Primary Subtalar Arthrodesis: Six-Year International Outcome.” Join your colleagues from 6:30–7:30am in Room Governor C at the Gaylord Opryland Hotel in Nashville for rousing discussion combined with a delicious meal to help you jumpstart your day.

Amniox Medical also is welcoming attendees with a satellite breakfast on Saturday, March 24. Watch for further details on this event in a future issue of This Week @ ACFAS.

Foot and Ankle Surgery

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Incomplete sesamoid reduction is a potential risk factor for the recurrence of hallux valgus. The purpose of this study by researchers at CHA University in South Korea was to radiologically investigate changes in sesamoid position following chevron osteotomy and the open lateral soft-tissue procedure. Sixty-eight feet from 52 patients who underwent operative correction of hallux valgus deformity from 2010 to 2016 by a single surgeon were reviewed retrospectively. Twenty-three of the 68 feet underwent proximal chevron osteotomy, and 45 underwent distal chevron osteotomy. The mean age of the patients at the time of surgery was 52. Both feet were affected in 19 patients, while unilateral disease was noted in 30 patients. The mean follow-up was 18 months. The hallux valgus angle (HVA), first to second intermetatarsal angle (IMA), tibial sesamoid position (TSP), distance of the fibular sesamoid (DFS) and translation of the metatarsal head (TMH) were evaluated preoperatively and at final follow-up. While most parameters were significantly decreased after surgery, no significant change in DFS was noted. The difference between preoperative and postoperative TSP values has a moderately positive correlation with difference in TMH values. Other parameters were similarly correlated. The researchers concluded that metatarsal bone realignment reduced the sesamoid, but its position relative to the second metatarsal axis was unchanged. Moreover, the sesamoid is reduced by the lateral translation of the first metatarsal but not by medial sesamoid migration.


Chronic Achilles tendon ruptures can lead to reduced power of plantar flexion in the ankle with impaired gait ability. The open one- or two-incision technique for flexor hallucis longus transfer has proven good functional outcome, but it has the disadvantage of comparatively substantial surgery performed at a vulnerable location. To reduce the risk of soft-tissue problems, the flexor hallucis longus transfer can be performed endoscopically. An endoscopic technique for flexor hallucis longus transfer was presented together with the experiences from the first six patients operated on with this method. No wound healing problems or infections resulted. Five of six patients managed single leg heel raise on the affected side 12 months after surgery. The functional results are promising. The soft-tissue dissection is minor, and no patients had postoperative wound healing problems or infection. Endoscopic flexor hallucis longus transfer may be an operative procedure that can also be considered in patients with potential wound healing problems, the findings indicate.


The objective of this study was to quantitatively and qualitatively assess relative arterial contributions to the calcaneus. Fourteen cadaveric ankle pairs were used. In each specimen, the posterior tibial artery, peroneal artery and anterior tibial artery were cannulated and used for contrast-enhanced magnetic resonance imaging (MRI) and computed tomography (CT). Quantitative MRI analysis of the pre- and postcontrast MRI scans facilitated assessment of relative arterial contributions. Postcontrast MRIs were also used to measure all perfused arterial entry points and scaled to a three-dimensional calcaneus model. Contrast-enhanced CT imaging was assessed to further delineate the extraosseous arterial course. Two pairs underwent infusion of diluted BaSO4 through a constant-pressure pump using extended infusion duration. Quantitative MRI findings indicated the peroneal artery provided 52.6 percent of the calcaneal arterial supply, 31.6 percent from the posterior tibial artery and 15.8 percent from the anterior tibial artery. The researchers found that the peroneal artery provided the largest calcaneal arterial contribution, followed by the posterior tibial artery and anterior tibial artery. A rich, anastomotic arterial network was found supplying the calcaneus. This study offers insight into the relative arterial contribution to the calcaneus. This knowledge can help facilitate understanding of calcaneal vascularization, demonstrate the vascular impact of calcaneal fracture and surgery and encourage future research on the arterial anatomy of the calcaneal soft-tissue envelope.

Practice Management

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There are a number of ways doctors can understand and improve patient satisfaction. A recent article published in Medical Economics found that wait times, advance knowledge of treatment costs, not feeling rushed during appointments, providers providing a high level of care and easily scheduled appointments were the most important areas for patients. Gaining clarity in these areas can be achieved through careful observation and letting patients talk as much as they need to.


Calls for value-based healthcare have resulted in technology being used to automate certain elements of patient care. In particular, mobile apps have become popular among doctors. However, for technological innovations to be successful, patients must use them regularly. Following are some tips medical professionals can use to improve patient engagement when using new technologies: If a mobile app is being used, it is important to know who the users are. Younger patients may feel more comfortable using an app compared to older patients. Connecting devices to the Internet can also help keep patient engagement high. Collecting data generated by mobile apps is extremely helpful for learning about patients.


A new report by the Association of American Medical Colleges (AAMC) estimates women have comprised nearly half of U.S. medical student applicants for the past 15 years. The percentage of male applicants was slightly higher last year, but since 2015, male applicants declined nationally while female applicants increased. In 2017, women constituted 54 percent of entering students at the Howard University College of Medicine and 53 percent at Johns Hopkins University School of Medicine. Meanwhile, women made up 48 percent of entering students at the Georgetown University School of Medicine, but Dean for Medical Education Stephen Ray Mitchell says women claimed a majority for the first time in 2002, and classes since then "generally run about 53 percent women." Medical proponents see the increase in women entering medical schools as a result of growing emphasis on pipeline programs encouraging girls to pursue math and science from the time they are in grade school.

Health Policy and Reimbursement

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The U.S. Senate and House of Representatives approved legislation that would end a brief shutdown of the federal government until February 8, as well as fund the Children's Health Insurance Program (CHIP) for the next 6 years. President Donald Trump signed the bill Monday evening. Funding for CHIP technically expired October 1, although a temporary spending bill in December gave the program $2.85 billion. That was supposed to carry states through March to maintain coverage for an estimated 9 million children, but some states began to run short almost as soon as that bill passed. The measure also delays the collection of several unpopular taxes that raise revenues to pay for the Affordable Care Act's benefits. The taxes being delayed include ones on medical device makers, health insurers and high-benefit health plans. The bill does not, however, extend funding for Community Health Centers, another bipartisan program whose funding is running out.


The National Governors Association (NGA) has issued a list of more than two dozen recommendations urging the Trump administration and Congress to provide more money and coordination for the fight against opioids. The move marks the first coordinated, bipartisan response from the nation's governors since President Trump declared the U.S. opioid crisis a public health emergency in October. The governors applauded him for taking a first step, which included a promise to support states' efforts to pay for drug treatment through Medicaid, but also called for more action. The governors are requesting a requirement that drug prescribers undergo substance abuse training and register to use state prescription drug databases. They also want increased access to naloxone and asked that Medicare cover methadone treatment for older adults.


The Senate has advanced the nomination of Alex Azar to be U.S. Department of Health and Human Services (HHS) Secretary by a vote of 54 to 43. Most Democrats opposed his advancement, but seven Democrats joined Republicans to move his nomination forward. Azar will replace Tom Price, who resigned in September following a scandal surrounding his travel on private planes. Azar was deputy HHS Secretary under President George W. Bush, before his tenure at Eli Lilly. He says combating high drug prices will be a priority. He also espouses GOP-supported moves, such as increasing competition in the marketplace, instead of Democratic-leaning options, such as allowing Medicare to negotiate drug prices. Former HHS Secretaries Tommy Thompson and Mike Leavitt have endorsed Azar, claiming he has "the track record from his previous time at HHS to be a successful manager." Certain Democrats are less confident about Azar, with Sen. Patty Murray (D-Wash.) saying, "He failed to persuade me that he can effectively lead any effort to lower drug prices given his tenure at Eli Lilly, where he worked to raise drug prices." She also cites Azar's indications "that he would continue the administration's harmful plan to create Trumpcare by sabotage."

Medicine, Drugs and Devices

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Medical journalist Jeanne Lenzer warns of potential dangers for people with implanted medical devices, which she says are cleared with far less scrutiny than drugs and go to market without clinical trials. "One of the problems with devices is that nobody's really tracking the numbers of harm — or the rates of harm," Lenzer says. She cites as one instance the vagus nerve stimulator (VNS) for controlling epileptic seizures, for which the U.S. Food and Drug Administration gave conditional approval due to concerns about deaths. "The idea of conditional approval is that once the company proves it's safe after it's on the market, then its approval is complete," Lenzer says. She notes the five studies the device maker provided her did not record how many people died, if they died or when they died. Her request for them to release mortality data from the Social Security Death Index on behalf of the British Medical Journal was denied.


A new index shows that GlaxoSmithKline and Johnson & Johnson are the best of the large drug companies at combating the growing threat from superbugs. The Antimicrobial Resistance Benchmark, published by the Access to Medicines Foundation, rates companies on their contribution to preventing the spread of bacteria that are resistant to antibiotics. According to the index, Mylan was the best of the generic drug companies, while Entasis was top among biotechnology companies. Jayasree K. Iyer, executive director of the Access to Medicines Foundation, said that companies were judged on several criteria, including having new antibiotics in development and having measures to encourage prudent use of existing drugs. Johnson & Johnson was noted for its stewardship of its antibiotic bedaquiline. Rather than selling the drug to any customer for human or animal use, J&J has limited it to treatment of drug-resistant tuberculosis, which takes the lives of about 250,000 people a year.