News From ACFAS

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They say records are made to be broken, and ACFAS proved this to be true! Nearly 1,900 foot and ankle surgeons from across the country, plus 140+ exhibiting companies, attended ACFAS 2019 in New Orleans last week, shattering the previous attendance record set in Las Vegas in 2017.

Uplifted and inspired by former Blue Angel John Foley’s keynote address, attendees dove into a robust three-day lineup of sessions and workshops on new surgical technologies and concepts, interactive labs and special events. A sold-out Wrap Party at the National World War II Museum made for a memorable ending to an incredible week.

“The Annual Scientific Conference has always been ACFAS’ crown jewel. ACFAS 2019 set records in both attendance and vendor space for the fifth consecutive year and featured an academic program that is second to none, making this the meeting for foot and ankle surgeons,” says ACFAS President Christopher L. Reeves, DPM, MS, FACFAS.

Watch for full conference coverage and photos in the March issue of ACFAS Update, and saddle up for the 78^th Annual Scientific Conference, February 19–22, 2020 in San Antonio! Congratulations to Barry I. Rosenblum, DPM, FACFAS, recipient of the 2019 ACFAS Distinguished Service Award presented last week during ACFAS 2019 in New Orleans.

Each year, this prestigious honor recognizes an ACFAS member who goes above and beyond in serving the College in a wide variety of volunteer roles.

“Barry has been a great friend to ACFAS for many years now, and he serves the College with a clear and selfless approach,” says ACFAS Immediate Past President John S. Steinberg, DPM, FACFAS. “He is just the person behind the scenes whom this Distinguished Service Award is designed to recognize, and I was so proud to be able to present it to him.”

Read more about Dr. Rosenblum’s volunteer experience with the College in the next issue of ACFAS Update. Download the free Fill-in-the-Blank press release from the ACFAS Marketing Toolbox and use it to let your patients know you attended last week’s record-breaking Annual Scientific Conference in New Orleans.

Once you have populated the press release template with your information, distribute it to your local media, include it in your newsletter or post it on your practice’s website and social media sites.

Visit acfas.org/marketing for many other free resources to promote your practice, educate your patients and increase referrals to your office.

Foot and Ankle Surgery

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A study was conducted to detail a case of bony mallet injury of the hallux that was treated with a modified extension block technique using three Kirschner wires. The method was determined to be simple and effective for enabling anatomic reduction of the displaced articular fracture fragment, without requiring incision, residual hardware or complications associated with open surgical treatment.


A study was conducted in which 13 patients with diabetes and peripheral neuropathy underwent an attempt at primary ankle arthrodesis following the early postfracture development of acute neuropathic deformity of the ankle after sustaining a low-energy unstable ankle fracture, over 14 years. Eight patients with open wounds and osteomyelitis received single-stage debridement of the osteomyelitis and primary ankle fusion with an ankle fusion construct circular external fixator. Five patients who lacked evidence of infection underwent primary arthrodesis with a retrograde locked intramedullary nail used for fixation.

A successful clinical outcome was realized with either successful radiographic arthrodesis or stable pseudarthrosis, when community ambulation was accomplished via commercially available therapeutic footwear and a short ankle orthosis. Eight patients experienced a successful clinical outcome at a mean follow-up of 48 months after initial surgery, while three achieved clinical stability following a second surgery and one following a third. One patient with radiographic nonunion died from unrelated causes, and one underwent transtibial amputation because of persistent infection. Of the five patients exhibiting failed radiographic union, three successfully ambulated in the community with a short ankle orthosis. Postoperative complications included wound and pin site infection, infected nonunion, chronic wounds and tibial stress fracture.


A study was conducted to determine if manual therapy yields short-term improvements in range of motion, muscle stiffness, gait and balance for patients undergoing operative fixation of an ankle and/or hindfoot fracture. The researchers randomized 72 consecutive patients who had undergone an open reduction internal fixation of an ankle and/or hindfoot fracture, were receiving physical therapy consisting of exercise and gait training and were randomized to either receive impairment-based manual therapy (MT group) or sham manual therapy consisting of light soft-tissue mobilization and proximal tibiofibular joint mobilizations (control group). Both cohorts received three treatment sessions over seven to 10 days, with outcomes assessed immediately post intervention.

No significant differences were observed between cohorts for motion, gait or balance outcomes. A significant difference was noticed from baseline to the final follow-up for resting gastrocnemius muscle stiffness between the MT and control groups. No change in muscle stiffness for the MT group between baseline and final follow-up was seen, whereas muscle stiffness rose in the control group by about 9 percent.

Practice Management

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The National Council on Patient Information and Education notes approximately 125,000 Americans die every year due to nonadherence to health regimens, and 50 percent to 60 percent of those taking drugs for chronic disease do not take them as prescribed. The first step in addressing this issue is to recognize nonadherence, with physicians asking patients open-ended rather than closed-ended questions to bring the problem into focus. Judgmental responses to patients' answers or admissions of nonadherence are to be avoided, and physicians should try to learn the underlying reasons.

Patients rely on their own health explanatory models, where their understanding of their sickness or condition is shaped by prior experiences, social or cultural contexts, which helps them make decisions. A nonjudgmental approach can make patients feel more comfortable sharing. One expert advises physicians to focus on what they think the problem is, what their patient thinks the problem is and each of their goals, during interviews.


The American Medical Association's STEPS Forward open-access platform offers more than 50 modules suggesting actionable, expert-driven strategies and insights supported by practical resources and tools for alleviating physician burnout. The modules empower practices to spot areas or opportunities for improvement, set meaningful and achievable goals and deploy transformative changes to boost operational efficiencies, elevate clinical team engagement and improve patient care. A recent study cited 10 work factors that adversely affect physicians' well-being, including working too many hours, taking night or weekend calls, doing work-related tasks at home, work-home conflict and practicing in certain specialties.

Also contributing are being in a private practice, receiving incentive pay, being a midcareer physician and a career that is not aligned with what the practitioner finds most personally meaningful. The use of computerized physician order entry or other persistent clerical burdens were also identified as key burnout factors. The study authors recommended further research to address organizational and healthcare system factors that raise the distress risk for healthcare professionals, as well as to better understand the implications of healthcare professional distress and well-being for healthcare outcomes.


Few modern physicians have sufficient training on autism spectrum disorder (ASD), and practices can implement better communication with adults with autism by following certain suggestions. The first suggestion is to consider each patient on an individual basis, as adults with ASD are a heterogeneous group, with each patient having highly individualized needs. One helpful resource is the Academic Autism Spectrum Partnership in Research and Education's free online Autism Healthcare Accommodations Tool, which walks patients through an array of questions to identify what type of accommodations would help make physician visits easier for them. Providers should also know that adults with autism tend to have medical conditions that correlate to stress, such as sleep issues, anxiety or depression; collectively, they also are more likely to have connective tissue diseases and epilepsy.

A second tip is to rethink communication methods, for instance by waiting patiently for verbal or typed responses from patients or by offering multiple-choice answers for questions or examples of what other people might say in reply to a particular question. A third suggestion is to reduce sensory distractions like noise and light at visits, and physicians should explain their actions before making physical contact. Finally, practices should adjust appointment times, emphasizing punctuality and as little waiting time for patients as possible.

Health Policy and Reimbursement

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U.S. Sen. Debbie Stabenow (D-Mich.) and Rep. Brian Higgins (D-N.Y.) have revived legislation permitting Americans to buy into the Medicare program at age 50. Under the measure, Americans 50 to 64 could purchase Medicare plans via Affordable Care Act (ACA) exchanges. Federal funding would be unnecessary because enrollees would pay the premiums, but lower- and moderate-income participants could qualify for ACA subsidies to help defray their costs. The bill's cosponsors include several 2020 Democratic presidential hopefuls.


Proposed regulations from the Trump administration look to improve patients' access to their own health data and to bolster efforts to bring information, including insurance claims and hospital and doctor records, to digital devices, such as smartphones. The draft rules outline technology standards to unlock digital data stored in electronic health records that are used by hospitals and doctors to track patients' care, which could help companies that are building tools for patients to store their own real-time health information on digital devices.

One rule says patients must be able to electronically access all of their health information, including doctors' notes, and not be charged for the information. The new proposals would also require health insurers offering government-backed plans, such as Medicare Advantage, managed Medicaid and Affordable Care Act exchange coverage, to open up new digital pathways to claims data for consumers, including information on costs of services.


A new report from the Council of Economic Advisers says that despite the Trump administration's changes to the Affordable Care Act, subsidies that help low- and middle-income customers pay their premiums will help keep HealthCare.gov afloat even if some healthy people drop out or seek alternative coverage. Nearly 90 percent of such customers receive taxpayer-provided assistance. The report also claims $450 billion in consumer benefits over the next 10 years as a result of wider availability of less costly insurance options, reduced taxpayer spending on subsidies and cancelled fines. However, it acknowledges that premiums will increase for some middle- and upper-income consumers.

Medicine, Drugs and Devices

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Hospitalized patients can cut their risk of developing superbug infections if they swab medicated ointment in their nose and use special soap and mouthwash for six months after going home, according to a study published in the New England Journal of Medicine. “It's a very simple solution. You don't have to swallow a medicine, you just have to clean the outside of your body for a little while longer,” said Susan Huang of the University of California Irvine School of Medicine, who led the study. The study involved more than 2,000 patients at hospitals in southern California who were found to carry methicillin-resistant Staphylococcus aureus (MRSA) bacteria. All were given information on ways to avoid infection, and half also got mouthwash, liquid soap containing an antiseptic and an antibiotic ointment to swab in the nose. They were told to use these Monday through Friday, every other week for six months.

A year later, 6 percent of those in the deep-clean group had developed a MRSA infection, compared to 9 percent of the others. They also had fewer infections from other germs. There were no serious side effects; 44 people had dry or irritated skin.


A study was conducted to investigate plantar loadings in hindfoot relief devices of different designs. Twenty-five healthy participants were recruited, and plantar pressure distributions were collected using a neutral shoe, a hindfoot relief shoe (HRS) and a hindfoot relief orthosis (HRO). Peak pressure values were quantified via dynamic pedobarography during walking and were analyzed from the hindfoot, midfoot, metatarsal I-V and forefoot. The normal walk using neutral shoes served as the condition for full weightbearing, as a reference standard.

Using the HRS and the HRO resulted in significant decreases in plantar pressures on the hindfoot, versus baseline values obtained with the neutral shoe. Significant increases in peak pressures were determined in the midfoot region for both devices. For the metatarsal region, peak pressures were decreased. A substantial reduction in peak pressures using the HRS was observed in the forefoot, but the HRO did not lead to significant changes.


The U.S. Food and Drug Administration (FDA) announced it approved 106 novel medical devices last year, surpassing the previous record of 99 in 2017. This marks eight years of steady improvement in novel medical device approvals. The agency said it strives to balance patient safety with the need to get innovative devices to market. FDA said it has also granted 112 Breakthrough Device Designation requests since the beginning of the program in 2015. Last year, it approved or cleared nine such requests.

In addition, FDA is proceeding with plans to implement the National Evaluation System for Health Technology, a surveillance and evaluation system operated by a public-private partnership. The agency also plans to issue a proposed framework for the Safer Technologies Program this year. For this program, FDA will consider how it could apply Breakthrough Device principles and features to products intended to treat or diagnose non-life-threatening diseases or conditions. At the same time, these devices will offer safety innovations that either reduce the occurrence of a serious adverse event or other safety issue, address a known device failure mode or common user error or provide for significant safety advantages for users.