News From ACFAS

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In an effort to protect the health and well-being of our team and members, ACFAS Headquarters is operating on a virtual basis until further notice. Please be assured, headquarters is not suspending or closing operations; our team will continue to serve you and conduct business on a remote basis for the foreseeable future. We ask members and vendors to be patient with us on response times as there may be a slight delay. All ACFAS team members are available during this time and a full directory of contact information listed at acfas.org.

As far as our upcoming educational programming and committee meetings, we made the difficult decision to cancel the March 28-29 Arthroscopy course and will continue to monitor the situation for committee meetings. Individual committees will be contacted with the status of their meetings in the near future. If you are looking for educational programming, remember ACFAS OnDemand is always open and ready to share the highest-quality educational programing virtually at acfas.org.

To help you keep communications open with your patients, we’ve also added an article on staying active at home during the COVID-19 situation to the spring issue of FootNotes as well as a feature article on FootHealthFacts.org. You can download the latest issue of FootNotes from the ACFAS Marketing Toolbox to share with your patients via email, on your website or social media channels and you can also link your social media channels and website to the article on FootHealthFacts.org. Millions of people are stuck at home adjusting to a new normal amid the COVID-19 crisis. Just because routines have halted for now, doesn’t mean education has to. You can still access our most in-demand online education resources from home with ACFAS OnDemand.

Access a variety of clinical sessions designed to help keep you on top of your surgical game, complimentary podcasts for quick, deep dives into a wide range of topics from clinical to practical, surgical techniques available for purchase to download and share with your staff and a medical bookstore our e-book series accessible from laptop, desktop, tablet or smartphone.

Class will start when you’re ready. Visit acfas.org/OnDemand to access your new learning portal today! While the unfolding COVID-19 situation has caused anxiety and uncertainty, it’s important to focus on the positive as communities are banding together during this crisis. While our March Arthroscopy course has been canceled, we do have four additional chances to join us for another one of our highly interactive programs where you’ll get the latest techniques, didactic lectures and surgical demonstrations.

Here at ACFAS we will keep you updated on programming if there are any changes.

July 11-12, 2020
(Saturday/Sunday)
Chicago, IL
Register

August 29-30, 2020
(Saturday/Sunday)
Chicago, IL
Register

October 4-5, 2020
(Sunday/Monday)
Chicago, IL
Register

October 24-25, 2020
(Saturday/Sunday)
Chicago, IL
Register

In the meantime, ACFAS members can stay connected with excellent clinical programs and podcasts via ACFAS OnDemand. CME is available to those in need of a few stray hours to complete their license renewal. Please watch your communications from ACFAS and our website for the latest information on our educational programming schedule. This issue of FootNotes is timely with some tips on how your patients can stay physically and mentally fit amid the COVID-19 situation. It is available now to download in the ACFAS Marketing Toolbox.

Also, the spring issue is a great resource for patients as we ease into warmer temps and a new season! From the cover story on COVID-19 to common foot conditions that could affect your golf swing to managing heel pain throughout spring as activity starts to increase, the newsletter has something for everyone.

All issues of FootNotes can be customized to add in your office’s contact info into the editable box on the second page. Take advantage of this free resource to promote your practice and educate your patients! Log into acfas.org/marketing to access the latest issue now. The mind is a terrible thing to waste—keep yours sharp over the next few weeks by catching up on the latest research with the Journal of Foot and Ankle Surgery. Shake up your time at home and make the journal your source for original, clinically-focused articles on the surgical and medical management of the foot and ankle.

Accessing the journal is easy – first log in via the ACFAS website (acfas.org/jfas) and then click on the link to "Read current and past issues online." If you run into issues logging in, please contact membership@acfas.org for further assistance.

Foot and Ankle Surgery

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This retrospective case series evaluated stage one of a planned two-stage approach to Charcot deformity correction, consisting of gradual modification with the use of computer-assisted external fixation. The gradual correction aims to safely and accurately correct the Meary and calcaneal inclination angles, which were measured using preoperative and postoperative digital radiographs. The procedure was performed on 18 Charcot foot deformities in 18 patients; each of the feet had a notably significant rocker bottom deformity, and 13 contained an ulceration. Complete ulcer healing was noted in all feet with an ulcer, and all deformity corrections achieved Meary's and calcaneal inclination angles corrected to within a normal range, with few postoperative complications. Researchers conclude that gradual Charcot deformity correction through the use of computer-assisted hexapod external fixation demonstrates safe, accurate and reproducible characteristics that adequately prepares the lower extremity for stage two, the implantation of rigid internal fixation.


The study evaluates the clinical efficacy and safety of nano-hydrogel embedded with quercetin and oleic acid in the treatment of lower limb skin wound in patients with diabetes mellitus (DM). Fifty-six DM patients unsuccessfully treated with mechanical compression were enrolled and randomized to receive an add-on treatment with hyaluronic acid or nano-hydrogel embedded with quercetin and oleic acid. The treatment with nano-hydrogel significantly reduced the wound healing time in comparison to hyaluronic without the development of adverse drug reactions, suggesting the formulation could be used to manage would healing, though more testing is needed to validate this observation.


This trial assessed the role of platelet-rich plasma (PRP) gel as a treatment of clean, non-healing diabetic foot ulcer (DFU) in comparison with regular dressing with saline as a control. Twenty-four patients with DFU and a mean age of 55.2 were randomly assigned to receive dressing with PRP gel or regular saline dressing. Only 25 percent of the patients in the PRP gel group achieved complete healing compared to none of the patients who received regular saline dressing. The longitudinal and horizontal dimensions on the DFU decreased by 43.1 percent and 42.3 percent, respectively, for the PFP gel group, compared to 4.1 percent and 8.2 percent, respectively, for the saline group. The time required to maximum healing was 6.3 weeks in the PFP group and 10.4 in the saline dressing group.

Practice Management

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The article discusses risks that medical practices should consider amid the COVID-19 outbreak. One specific risk is the loss of a labor force, whether due to illness, quarantine, fear of exposure or the effects of school closures. Leaders should also consider the effect that the long-term illness or death of key personnel could have on the practice. Loss of revenue is another serious risk, especially for practices that offer any elective or delayable treatment. It is also wise to be wary of cash flow, discretionary spending and debt service obligations, which may mean setting up lines of credit, adjusting spending and compensation and freeing up cash reserves and liquidity.


Large hospitals across the United States are quickly expanding the use of telemedicine to safely screen and treat patients for coronavirus. They hope it will help contain the spread of infection. This could mark a turning point for telemedicine as more people see the benefits of virtual doctor's visits, and health insurers already offer the option as an alternative to emergency room or urgent care center visits. Telemedicine got an additional boost under the $8.3 billion emergency funding measure from Congress, which loosened restrictions on its use to treat people covered under the Medicare program. In a meeting with President Donald Trump, private health insurers also said they would pay for the virtual visits for people who may have coronavirus to improve access to care for their customers.


The Trump administration announced new rules that let patients use smartphone apps to retrieve their medical records directly from providers. Doctors and medical centers will be required to send a core set of medical data to third-party apps, once a patient has authorized the exchange. However, the American Medical Association and other organizations warn that the new rules could jeopardize patient privacy without attendant federal protections. Few safeguards means patients' data can be licensed for marketing purposes or leased or sold to third parties. Still, Rucker said when patients initiate data sharing with apps, providers will be able to alert them to privacy risks.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) announced the Part D Senior Savings Model, a voluntary model that enables participating Part D enhanced plans to lower Medicare beneficiaries' out-of-pocket costs for insulin to a maximum $35 copay per 30-day supply throughout the benefit year. Beneficiaries who take insulin and enroll in a plan participating in the model should save an average of $446 in annual out-of-pocket costs for insulin, or over 66 percent, relative to their average cost-sharing for insulin today. The model's initial projections assume it generates over $250 million in savings over five years for the federal government, largely due to pharmaceutical manufacturers paying additional coverage gap discounts.


The US Centers for Disease Control and Prevention (CDC) has updated its recommendations regarding the face masks that front line healthcare workers should use to prevent infection from the novel coronavirus, or COVID-19. A shortage of the specialized N95 respirators, which filter out about 95 percent of airborne particles, has prompted new CDC guidelines which state that "the supply chain of respirators cannot meet demand" and that looser fitting surgical face masks "are an acceptable alternative." The surgical masks will limit, but not eliminate, the likelihood of inhaling large, infectious particles circulating near the face. CDC had previously recommended that healthcare workers interacting with COVID-19 patients or suspected cases wear N95 respirators, as well as gowns, gloves and eye protectors.


Members of the Medicare Payment Advisory Commission (MedPAC) say the opaque finances of nearly 6,000 same-day surgery centers are making it impossible for them to do their jobs. Medicare-per-enrollee spending at these centers increased about 5 percent each year between 2013 and 2017, but because the facilities do not provide annual cost data, MedPAC can't document the centers' growth over time or determine their profit margin, meaning they cannot evaluate the adequacy of Medicare payments. In its March 13 report to congress, MedPAC recommended eliminating an expected 2.8 percent increase in the centers' Medicare payment rate for 2021. The panel also recommended that the centers be required to submit annual cost data.

Medicine, Drugs and Devices

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Affordability continues to be a problem and prices continue to rise for all diabetic treatments. Unlike other countries, there are no price controls on medicines in the United States, and drugmakers contend that higher prices enable them to carry out more innovative research and development. The price of branded diabetes drugs has also soared in the past five years, up 40 percent to 50 percent since 2015, according to data from research firm Elsevier. Of adults prescribed a diabetes medication, 13.2 percent skipped doses or delayed filing a prescription, and 24.4 percent asked their doctor for a lower-cost alternative, according to a 2019 survey by the National Center for Health Statistics, based on the previous 12 months.


Nurses say they fear their health is not being made a priority in the fight against coronavirus in the United States. According to National Nurses United, 29 percent of the 6,500 nurses they surveyed said their hospitals had a plan in place to isolate potential coronavirus patients; 63 percent had access to N95 face masks, and only 44 percent had received guidance from their employers about how to handle the virus. National Nurses United has demanded that the federal government ensure all healthcare workers receive the highest levels of protective equipment, that any vaccine developed is offered to the public for free and that Congress immediately pass an emergency spending package in response to the virus. At least eight US healthcare workers have been diagnosed with coronavirus.


US trade officials have exempted more than 100 healthcare products made in China from trade-war-related import tariffs in response to soaring demand amid the coronavirus outbreak. The exemptions, given in response to requests made by medical supply companies, were posted on the website of the Office of the United States Trade Representative. Disposable lab coats, protective masks, medical drapes, exam gloves, medicine cups and stethoscope covers are among the products exempted.