News From ACFAS

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However you’re joining us for ACFAS 2021–in-person or virtually–we’re welcoming you all back home at the Annual Scientific Conference May 18-21 in Las Vegas!

ACFAS is excited to be able to bring you all the high-quality educational programming you expect from the College in your own way. There are a few spots left for the in-person event in Vegas, but the virtual program has unlimited attendance. You can register for either by visiting acfas.org/LasVegas. All in-person attendees will also get access to the virtual sessions.

Whether you attend in-person or online, here’s what’s in store for ACFAS 2021:

• Keynote speaker Zubin Damania, MD (or how you may know him as ZDoggMD) an internist and founder of Turntable Health as he speaks about Health 3.0
• The College’s first-ever Hallux Valgus International Symposium
• Cutting-edge clinical sessions
• Award-winning research presented in manuscripts
• 300+ scientific posters
• And much more!

Watch acfas.org/LasVegas for the latest information about ACFAS 2021 and we can’t wait to get together again (in-person or online) in May! If you’re joining us in-person in Las Vegas, make sure you reserve your hotel room today with onPeak, ACFAS’ official housing partner.

To make your reservation, visit acfas.org/LasVegas and select the Hotel Registration onPeak button to access the housing reservation site. Reservations can also be made by calling (800) 950-5542. Booking through onPeak guarantees you the lowest hotel rate and also protects you from unauthorized third-party vendors or “hotel poachers.” ACFAS will not be responsible for any room reservations or deposits made through other companies or websites, so please book through onPeak for your own safety. The Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response recently released a new amendment to the Public Readiness and Emergency Preparedness (PREP) Act, which authorizes DPMs, retired DPMs (with inactive license within the past five years), and podiatric medical students to prescribe, dispense, and administer COVID-19 vaccine if certain conditions are met. The amendment became effective immediately.

For more information visit phe.gov and/or whitehouse.gov.
Join coding and billing experts from your home or office in a virtual live-streamed workshop on May 17 designed to help you and your office staff learn about the latest coding changes, which hit January 2021.

Get expert tips and insights on simplifying your coding and reimbursement practices in this condensed, information-packed 5-hour program. Learn what you need to know to code and document properly in 2021. The program will also cover the new E&M coding changes and includes an interactive Q&A session.

For more information or to register for this valuable program, visit acfas.org/LasVegas. You have another chance to get the latest in research with the next ACFAS Virtual Journal Club. Join us tomorrow, March 18 at 7pm CT for the next installment on Pediatrics hosted by the Pediatric Foot & Ankle Fellowship in Cedar Knolls, NJ and presented by Gan Golshteyn, DPM.

You can also access archived Journal Club sessions using your membership by logging in at acfas.org/JournalClub.

Foot and Ankle Surgery

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Posttraumatic ankle osteoarthritis (OA) represents a significant challenge to orthopedic surgeons, especially in cases of anterior talar translation and concomitant impaction of the anterior distal tibial plafond. This study sought to evaluate the clinical outcomes of an intra-articular osteotomy for the management of these patients. A total of 21 patients meeting the criteria were retrospectively reviewed. Sixteen patients sustained initial pilon fractures, while five patients had Weber type C ankle fractures. Anterior distal tibial plafond-plasty was performed to address the impaction and anterior translation of the talus. The American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were utilized as clinical outcomes. The lateral talar station (LTS), tibial lateral surface (TLS) angle, tibial anterior surface angle and talocrural angle were evaluated pre- and postoperatively. The AOFAS hindfoot score increased from 26 to 71, and the VAS score improved from 7 to 2. The LTS improved from 9.0 to 2.3 millimeters, and the TLS angle improved from 72 degrees to 81 degrees. Of the 21 patients, 18 showed improvement in or no worsening of ankle OA on the sagittal plane, while 3 developed advanced ankle OA.


The sagittal plane relationship of the hindfoot and midfoot joints is a primary determinant of proper alignment in flatfoot reconstructive surgery as assessed both clinically and on postoperative weight bearing (WB) lateral radiographs. A retrospective investigation was performed assessing the correlation of Meary's angle, calcaneal inclination angle and calcaneal-1st metatarsal angle as demonstrated on intraoperative simulated WB lateral foot imaging to 10- week postoperative full WB lateral radiographs. A consistent simulated WB imaging protocol was used with 46 consecutive cases of flatfoot reconstruction in this analysis of secular trends. The average change in Meary's angle between intraoperative simulated WB and postoperative full WB was -1.09 degrees with 89 percent of cases within 5 degrees. The average change in calcaneal–1st metatarsal angle between intraoperative simulated WB and full WB was -2.61 degrees with 85 percent of cases within ±5 degrees. The average change in calcaneal inclination angle between intraoperative simulated WB and full WB was -2.62 degrees with 88 percent of cases within ±5 degrees.


Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible and hospitalist-orthopedic co-management during the perioperative period. Charts were retrospectively reviewed for medical comorbidities, complications and length of stay. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk. On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values and congestive heart failure. There were 22 complications, though only 10 were serious, including six acute kidney injuries, two cases of sepsis, one cardiac event and one pulmonary embolism. Overall, the accuracy of predicting a complication using the ACS NSQIP Risk Calculator was 74 percent.

Practice Management

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The rapid emergence of telehealth during the COVID-19 pandemic has been good but uneven, as research shows disparities in access, particularly for marginalized groups that might not have internet access. In developed urban areas, 97 percent of people have high-speed internet access. But when considering health inequalities in rural and remote areas, that proportion falls to 65 percent. People who have disabilities are 14 percent less likely to have quality broadband access; Black patients suffering from certain chronic conditions were 51 percent less likely to have internet access than their white counterparts; and Hispanic patients were 42 percent less likely. Moreover, many communities don't trust healthcare institutions because of a history of discrimination. Providers can begin addressing these problems by digitizing paper processes whenever possible, working to improve care continuity and making telehealth platforms more inclusive.


Physicians should consider the legal and compliance implications of any podcast efforts. This includes considering the type of information that is being shared with the audience, ensuring that it does not qualify as practicing outside one's license. Physicians should also be careful to comply with HIPAA and may need to obtain legal consents that comply with state or federal laws. Physicians filming podcasts should also be wary of intellectual property laws, avoid disparaging any third parties and be careful selling products. If they work for a practice or a hospital, physicians should also check employer policies on ownership of intellectual property, use of social media and other issues that could affect the podcast.

Health Policy and Reimbursement

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The pandemic has only intensified the burnout that physicians already faced before the pandemic. A 2018 literature review of 10 years of research published in peer-reviewed journals showed that physician suicide was twice the rate of the general population. At 28 to 40 per 100,000, the loss was higher than the military. In most states, once a physician seeks help for mental health issues, they are obligated to report their condition on their application for a state medical license. Answering mental health-related screening questions honestly can raise a red flag, putting the physician’s license at risk. Advocates say state medical boards can go too far, violating a doctor's privacy and discriminating against them for seeking help. Mayo Clinic Proceedings found that 40 percent of physicians were reluctant to get help for a mental health condition because of the impact it can have on their medical license. To address the issue, the American Medical Association adopted a new policy in 2018 that encouraged state licensing boards to focus screening questions on a physician's current impairment rather than past medical history.


Six former commissioners of the US Food and Drug Administration (FDA) are calling on US President Biden to nominate a new FDA commissioner soon. In a new letter, the former commissioners—Scott Gottlieb, Robert Califf, Mark McClellan, Margaret Hamburg, Jane Henney and Andrew von Eschenbach—highlight the key role FDA will continue to serve in responding to the COVID-19 pandemic and stress that having a confirmed commissioner to guide that work is essential. "We urge you to prioritize securing its leadership team, including through seeking the formal nomination and confirmation of an FDA Commissioner," the letter reads. "The agency's experienced staff and its science-based regulatory processes will play a critical role in helping the nation confront the evolving pandemic." Although the former commissioners do not specifically endorse anyone for the role, they do praise Janet Woodcock, FDA's acting commissioner and a 36-year veteran of the agency.

Medicine, Drugs and Devices

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The US Food and Drug Administration (FDA) Office of Generic Drugs (OGD) reports that generic drugs have saved the healthcare system roughly $2.2 trillion dollars over the past 10 years. Sally Choe, director of OGD, said there are more than 10,000 generic drugs approved by the FDA, and roughly 90 percent of prescriptions in the United States are filled with generics. In 2020, FDA approved or tentatively approved 948 generic drug applications, including 72 first generics and 30 generics under the Competitive Generic Therapy pathway.


Amid the COVID-19 pandemic, the US Food and Drug Administration (FDA) significantly delayed its inspections of pharmaceutical companies, resulting in an extensive backlog that is hampering new drug approvals. FDA also curtailed its inspections of imported medicines, which represent more than 60 percent of the drugs sold nationwide. Mary Denigan-Macauley, director of healthcare, public health and private markets for the US Government Accountability Office (GAO), said: "Any drop in inspections or backlog is concerning." FDA conducted 52 inspections of domestic pharmaceutical plants between March 2020 and October 2020, compared with 400 during the same months in 2019, according to GAO. Denigan-Macauley says FDA postponed more than 1,000 surveillance inspections, adding: "Drugs that are waiting for pre-approval inspections will also have a backlog."


Experts say that due to the pandemic, the global demand for syringes is now between 8 billion and 10 billion for coronavirus vaccinations alone. In January, Brazil restricted exports of syringes and needles after facing domestic shortages. Meanwhile, Japan revealed last month that it might have to discard millions of doses of the Pfizer-BioNTech vaccine if it cannot obtain sufficient syringes able to extract a sixth dose from vials. Prashant Yadav, a senior fellow at the Center for Global Development, says prior to the pandemic, only 5 percent to 10 percent of the estimated 16 billion syringes used globally were designed for vaccination and immunization. He points out that when affluent nations invested billions into developing the vaccines, they largely overlooked the need to increase syringe manufacturing. Becton, Dickinson and Company, the largest maker of syringes worldwide, says it is producing 2,000 syringes each minute to fulfill orders of more than 1 billion. In November, the United Nations International Children's Emergency Fund (UNICEF) said it was facing a critical shortage of syringes, which needed to be smaller than usual and break if used a second time to prevent accidental infection.