News From ACFAS

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Honor your colleagues and hear from ACFAS leadership at the virtual ACFAS Membership Meeting tomorrow 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 and the new ACFAS Fellows will be recognized as well. To register for the ACFAS Update & Member Recognition Program, visit acfas.org. As 2021 has brought new and continuing challenges to everyone, whether it’s health, financial or otherwise, ACFAS is helping to lighten the load by extending the dues renewal deadline to June 30, 2021.

If your dues are still outstanding, you can renew your membership online today or contact the College at (773) 693-9300 to pay with a credit card over the phone.

Remember we are stronger together, so please reach out to the Membership Department at membership@acfas.org if you have any questions about your membership benefits. A new month means another chance to get the A to Zs of foot and ankle research! Join us on Thursday, March 18 at 7pm CT for the next ACFAS Virtual Journal Club on Pediatrics. This installment will be hosted by the Pediatric Foot & Ankle Fellowship in Cedar Knolls, NJ and presented by Gan Golshteyn, DPM.

Visit acfas.org/JournalClub to register for this month’s webinar. You can also access archived Journal Club sessions using your membership login at acfas.org/JournalClub.

Foot and Ankle Surgery

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This case series aims to correlate intraoperative nerve location on direct viewing with preoperative nerve localization to assess the accuracy of a specific nerve palpation technique. One hundred consecutive patients undergoing elective Lapidus fusion were prospectively evaluated. Preoperative nerve localization and intraoperative comparison was performed along with assessment of nerve position in relation to the cuneiform and first tarsometatarsal joint. Preoperative nerve identification correlated with intraoperative findings in 99 of the cases. In one case, the palpated nerve was proximal to the zone of dissection and was not visualized. The medial branch of the medial dorsal cutaneous nerve crossed the dorsal Lapidus incision at the medial cuneiform or first metatarsal base level in 95 cases, at the mid metatarsal level in two cases and proximal to the medial cuneiform in three cases.


This study aimed to evaluate the effect of preoperative peripheral nerve blockade on pain outcomes after ankle fracture surgery. After approval from our institutional review board, a Current Procedural Terminology code search was performed of all patients within one institution from August 2016 to June 2019. This resulted in 177 subjects who underwent isolated closed ankle fracture open reduction internal fixation, of which 71 subjects met inclusion criteria. The primary outcome measures showed no difference in the mean postoperative care unit (PACU) pain scores between the groups nor the frequency of those who reported only mild pain. Subjects who received a peripheral nerve block spent more time in the PACU before discharge. Subjects receiving a peripheral nerve block were more likely to be given no analgesics in the PACU and less likely to receive a narcotic analgesic in the PACU.


The study assessed the current scientific evidence on the effectiveness of human amniotic membrane to act as an allograft in healing diabetic foot ulcers. Pubmed, Cochrane library and Google Scholar were searched using the search terms, “Amnion” OR “Placenta” AND “Diabetic foot” (MeSH terms) in the title or the abstract field from from January through March 2020. When searched with the MeSH terms, 12 citations in PubMed, 22 citations in Cochrane library and 30 in other data bases were found. After screening the studies and their reference lists, 12 studies met the inclusion criteria and the others were excluded. There were eight randomized control trials (RCTs), two prospective studies and two retrospective studies employing different preparation methods of the amniotic membranes. A wide variation in study end points were noted. Almost all of the RCTs were concluded with significantly higher wound closure rate compared to the conventional treatment groups. In prospective and retrospective studies, it was shown that large chronic ulcers which were resistant to closure with standard therapy achieved wound closure with amniotic membrane allografts.

Practice Management

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Transitions from a practice's founding physician to the succeeding child tend to fail, usually due to a lack of will, planning or viability. To avoid these pitfalls and develop a robust succession plan, founders should establish open, honest communication with their family members in the practice. After establishing a sense of who is interested in taking on leadership of the practice, it can be helpful to provide some structure around a path for onboarding. This process can help to clarify the expectations for each family member who joins the group. One way to do so is to first identify the qualities or attributes a successor must possess to succeed in the practice. Having a talent development plan in place for onboarding family members into the practice is important, but it must have structure and accountability. Finally, practice founders need to be ready to step back when necessary and let the new leadership take over.


A cash balance plan is a type of defined benefit plan where an employee receives a statement of their account balance at the end of each year. This plan type includes employer contributions, but in this case the employer establishes a flat amount or percentage of employee salary. The owner can accumulate as much as $2.8 million to $3 million upon retirement at age 62 in a cash balance Plan. The SECURE Act at the very beginning of 2020 extended the deadline for small businesses to adopt cash balance plan by their tax filing deadline.


There are as many as 10,000 chronically unmatched doctors in the United States, people who graduated from medical school but are consistently rejected from residency programs. The National Resident Matching Program promotes its high match rate, with 94 percent of American medical students matching into residency programs last year on Match Day. However, the match rate for Americans who study at medical schools abroad is far lower, with just 61 percent matching into residency spots. Moreover, when including medical students who receive no interview offers, that match rate could be as low as 50 percent. Each year thousands of graduates emerge from medical schools with a virtually useless degree; without residency experience, they do not qualify for licensure in any state. Residency program directors said that in recent years they had increased their efforts to look at candidates holistically. Legislation allowing for assistant physician licensure is being considered in some states.

Health Policy and Reimbursement

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Xavier Becerra, President Biden's nominee for secretary of the US Department of Health and Human Services, has vowed to support Medicare Advantage, but has reservations about the program's more generous benefits. He said at a Senate Finance Committee confirmation hearing that he "will make sure that there is a level playing field" between traditional and private-sector Medicare and stressed the importance of avoiding overpaying private health plans, given Medicare's financial frailty. The number of Americans 65 and older preferring private health plans has risen significantly over the last decade, with Medicare Advantage covering 24 million people last year, or almost 40 percent of Medicare enrollees.


A study and commentary in Health Services Research found Medicare reimbursement policies for outpatient services have prompted physician integration with hospitals. Partly driving this trend is that Medicare reimbursement for physician services would have been an average $114,000 higher per physician per year for clinicians integrated with a hospital. Reimbursement for primary care alone would have been $63,000 higher per physician per year, while the average reimbursement difference was $178,000 for medical specialties and $150,000 for surgical specialties. Change Healthcare General Manager Dan O'Neill said these numbers indicate an astounding amount of waste. According to study author Brady Post at Northeastern University, "these results underscore that the factors driving integration are likely specialty-specific; that Medicare payment policy is one factor that affects consolidation in provider markets; and that tougher antitrust policy would be wise."

Medicine, Drugs and Devices

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The significant disruptions of essential goods during the pandemic has prompted President Biden to issue an executive order requiring his administration to review critical supply chains. Biden also ordered yearlong evaluations of six sectors and a 100-day review of four classes of products where American manufacturers rely on imports, including pharmaceuticals and their active ingredients. The executive order did not target imports from any specific country, but it is being viewed as an early effort to address China's economic effects. Early in the pandemic, China diverted exports of surgical masks and protective gear to its local governments and hospitals. China and India are also major sources for the active ingredients for making many drugs, including antibiotics and pain medicines.


Federal Judge Yvonne Gonzalez Rogers has ruled that hospitals that sued the US Department of Health and Human Services (HHS) need to use a new dispute resolution process to settle their dispute with drugmakers, which the hospitals cannot sue individually under federal law for 340B violations. The groups expressed satisfaction that HHS was critical of several drug companies' moves to restrict access of 340B-discounted pharmaceuticals to contract pharmacies.


A study by the University of Michigan National Poll on Healthy Aging published in Infection Control and Hospital Epidemiology found 90 percent of more than 2,200 adults 50 to 80 years old were cautious about using antibiotics, while nearly as many knew that overuse can nullify their efficacy. Meanwhile, almost 56 percent agreed that doctors overprescribe antibiotics, but about one-third believed wrongly that antibiotics could effectively treat colds or the flu, which are caused by viruses and not bacteria. Moreover, 13 percent of older adults who filled an antibiotic prescription said they had leftover drugs, even though patients are usually recommended to take all the medication.