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. We’ve added a new addition to the infographic library! Visit the ACFAS Marketing Toolbox to download the newest infographic, It’s NOT Just an Ankle Sprain.

This infographic shows the different severity levels of an ankle sprain and the differences between high-ankle and low-ankle sprains, highlighting symptoms and different treatments for each. It also covers why you should have your ankle evaluated immediately to avoid long-term complications.

This colorful, easy-to-read infographic is available now at acfas.org/marketing and is yours to share however you wish! Print it as a handout for patients or keep copies in your practice waiting room, share it on your social media channels or on your practice website. Recently the Council of Podiatric Medical Education (CPME) released draft changes to its 320 document Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies. This document lays the foundation for institution and program standards and requirements for residency education and oversight. The Council is in the final stages of reviewing this important document and is requesting comments from the community of interest before they complete the editing process. The deadline to submit comments to CPME via their online survey is February 15.

The Council recently hosted three Town Hall Meetings, allowing interested parties to ask questions and make comments regarding the draft edits. Understanding the gravity of this process, the ACFAS Board of Directors assigned a task force to review the draft edits, attend all Town Hall Meetings, and recommend changes and comments to communicate to the Council.

The ACFAS task force created a list of concerns, including:

• Mandatory ABPM and ABFAS in training exams for all PGY-3 residents (Standard 7.3)
• Mandatory wound care clinical experience MAVs (Appendix A)
• Adding milestones for resident evaluation (Appendix C)

A complete review and rationale for all noted comments by the task force can be found at acfas.org. The ACFAS Board is submitting comments to CPME voicing their concerns regarding the eight draft edits listed on the site.

Your Call to Action:
Every individual within the community of interest has the opportunity to voice their concerns regarding the draft re-write: please take this as your call to action to positively affect the foot and ankle surgical training that will shape our profession into the future. Take the time to visit CPME’s survey by the February 15 deadline and make your opinions known.

For more information on the entire CPME 320/330 documents re-write process, including the entire draft re-write documents, please visit the CPME website.
Join us for another opportunity to get the latest in research with the next ACFAS Virtual Journal Club. Flatfoot Reconstruction will be hosted by the Reconstructive Rearfoot and Ankle Surgical Fellowship and presented by Henry D. Spingola III, DPM, AACFAS at 7PM CT on February 18.

Stay tuned for March's Journal Club hosted by the Pediatric Foot & Ankle Fellowship, and access archived Journal Club sessions using your membership login at acfas.org/JournalClub.

Foot and Ankle Surgery

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Lateral ankle sprain in childhood can result in lateral malleolus avulsion fractures and bone nonunion. It is unknown how changes in physical functionality attribute to physical maturity affect young soccer players with abnormal lateral malleolus (ALM) morphology. Hence, the present study aimed to investigate the bone morphology of the lateral malleolus in young soccer players and to examine its relationship with physical functionality at different maturity levels. The study included 290 young soccer players. The presence of ALM was assessed with ultrasonography, and subjects were allocated to three groups based on physical maturity: pre-, mid- and post-peak height velocity age (PHVA). The prevalence of ALM was 17.6 percent. For physical maturity, the post-PHVA group showed a decrease in ankle dorsiflexion and eversion and an increase in one-leg hop distance compared to the pre-PHVA group. In the ALM group, the center of pressure during heel raising was distributed laterally in the post-PHVA, and the weight-bearing dorsiflexion angle was decreased in the mid- and post-PHVA.


Osteochondral defect of the talus is traditionally described to involve the anterolateral and posteromedial portion of the talar dome in patients with chronic lateral ankle instability. The study investigated whether the morphology and severity of osteochondral defects may be different in the Asian population, given that they are more prone to ligamentous laxity. Intra-operative records of 272 patients undergoing modified Broström-Gould procedure were reviewed for arthroscopic evidence of osteochondral defects. Talar osteochondral defects were seen in 52 patients, with a double lesion present in one patient. Medial sided lesions account for nearly three-quarters of all lesions and tend to be larger. There was no osteochondral defect seen in the central zones, and there were no significant age or gender differences between patients with medial and lateral lesions. The most commonly performed procedure was microfracture.


The purpose of this study was to determine if suture tape (ST) augmentation provides an advantage over the traditional modified Broström (MB) procedure for the treatment of chronic lateral ankle instability (CLAI). The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm. Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST. At 26 weeks, 12.5 percent of patients in the MB group and 3.6 percent of patients in the ST group had not managed RTPAL. The complication rate was 8.5 percent in the MB group vs 1.7 percent in the ST group. Four patients in the MB group and one in the ST group failed to complete the ARP,

Practice Management

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It is crucial to effectively communicate the vaccine rollout process across all patient populations. Healthcare providers will likely encounter some hesitancy from patients as they are surrounded by conflicting statements about the vaccine. Providers must act as trusted sources for disseminating healthcare information. As a credible authority, providers can help patients who are confused or uncertain about where to find reliable information around the pandemic and vaccines. Providers should proactively provide current and easily digestible information on vaccine distribution and protocols, simultaneously reiterating its social distancing measures and precautions in place to keep patients safe. Reaching patients during the pandemic and beyond happens via patient hotlines, online scheduling, virtual check-in and text reminders and should be a combination of human interaction and online self-service. In the event the vaccine requires a booster after the first dose, practices should remind all patients to return for a second dose. Providers must also have a strong social media presence to break through the noise and dispel misinformation that users can obtain through social postings and other media.


The issue of unpaid patient debt can be minimized with patient engagement, which begins by recognizing that greater responsibility for payment has also led to greater expectation and choice on the part of patients. Patients expect more information about their patient visits and more access to their medical records, both of which can be provided through efficient use of electronic health records and patient portals. Staff should be trained to effectively communicate a practice's financial policies and answer patient questions, and the billing process itself should be as simple as possible. Practices can improve patient collections by verifying patient eligibility at different stages, reviewing their coverage, providing their payment policy upfront and collecting copays at the time of service. It also helps to offer flexible payment options and ensure that one can take payments in the office, over the phone and online.

Health Policy and Reimbursement

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The "No Surprises Act," which will go into effect on January 1, 2022, will prohibit surprise medical bills and eliminate out-of-network balance billing, and Moody's Investors Service said companies that directly bill patients for healthcare will have "some level of exposure." Physician staffing companies and air ambulance operators are among those that the new legislation will likely have an adverse impact on. Moody's forecast that staffing firms will see a loss of cash flow, especially those that staff operating rooms, provide anesthesiology and radiology services and hospitals that rely on outsourcing. Moreover, air ambulance operators that "rely on their ability to directly bill patients" for remaining funds due after commercial insurers pay will also see losses from the statute, as they often deliver services out of network.


The White House has ordered the Affordable Care Act’s health insurance marketplaces reopened to give people impacted by the pandemic a new chance to obtain coverage. Under the executive action, a new “special enrollment period” will open on February 15 and run through May 15. About 15 million Americans are uninsured and are eligible for marketplace coverage, according to a recent analysis from the Kaiser Family Foundation, which has also estimated that as many as 3 million people have lost employer-based coverage during the pandemic. About 4 million could sign up for Affordable Care Act plans that would cost them nothing in premiums.

Medicine, Drugs and Devices

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The US Food and Drug Administration (FDA) is reissuing the Emergency Use Authorizations (EUAs) for decontamination systems that are authorized to decontaminate compatible N95 respirators for use by healthcare personnel (HCP). The reissued EUAs for certain decontamination systems are now only authorized to decontaminate each compatible N95 respirator up to four times. When a decontamination system has been authorized for multiple-user reuse, healthcare facilities and applicable parties are also required to ensure that HCP receive the same model of decontaminated compatible N95 respirator for which they have been fit tested. The decontamination systems are not authorized to decontaminate respirators containing cellulose-based materials and/or antimicrobials, duckbill respirators, pr respirators with exhalation valves. The FDA recommends that HCP perform an OSHA self-seal check to ensure an adequate seal is achieved each time a respirator is donned.


A RAND Corporation study estimated that prescription drug prices in the United States are an average 2.56 times higher than those in 32 other nations, although brand-name drug prices are significantly higher than those of generics. Generic drug prices constitute 84 percent of the average paid in other countries. Even after adjusting US drug prices downward based on an approximation of negotiated rebates and other discounts, RAND said prices remained "substantially higher" than those in other countries. Total drug spending across all nations amounted to $795 billion, with the US accounting for 58 percent of sales and 24 percent of volume.


The focus on battling coronavirus over the past year has had the unintended consequence of making it easier for other types of dangerous infections to flourish. Prevention, testing and monitoring for drug-resistant bacteria and fungi—notoriously prevalent in nursing homes and hospitals—largely took a back seat as resources were prioritized for fighting the pandemic. At the same time, healthcare providers have relied heavily on steroids, which help treat COVID-19 but can leave the immune system vulnerable to attack. In addition, critically ill patients often are placed on ventilators, where drug-resistant infections can harbor and spread. The result has been a rise in infections including Candida auris and carbapenem-resistant Acinetobacter baumannii.