News From ACFAS

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Catch us On the Road in Orlando (April 26–27) and Houston (May 3–4) and see how when you work together with your colleagues “In the Trenches,” no surgical challenge is too great.

This workshop and seminar kicks off on Friday night with the presentation, “Controversies and Complications,” followed by a panel discussion and refreshments. Bring your own work cases to share with panelists and attendees.

Saturday continues with dynamic lectures and immersive hands-on sawbones labs then closes with faculty’s “Tips, Tricks and Quips” you can put to use the minute you return to the office.

This course is worth 12 CME contact hours. Register now at acfas.org/ontheroad and we’ll see you on the road soon! Nothing ruins a spring break vacation faster than a foot or ankle injury. Give your patients handy tips and tools to protect against sunburn, wounds, sprains, strains and more with our two free infographics, Keep Your Feet Safe at the Beach and Protect Your Feet from the Sun, available for download in the ACFAS Marketing Toolbox.

Post these infographics on your practice website and social media pages, display them in your office, include them with billing statements or distribute them at spring health fairs.

Visit acfas.org/marketing regularly for these and other free products designed to help you educate your patients and promote your practice. New infographics are in the works—stay tuned for updates! With so many different opinions on the Lapidus procedure, how do you know which surgical approach is best for your patients? Our latest Clinical Session, “Dissecting and Debating the Lapidus,” explores this question through a series of videos featuring your colleagues’ own personal experiences with the procedure. Hear them compare and contrast specific techniques using hard data, X-rays images, case photos and more.

Presentations in this Clinical Session include:

• Joint Preparation: Contour vs. Wedge Resection
• Frontal Plane Deviation: Does It Matter?
• Sesamoid Realignment: Mountain or a Mole Hill?
• Hypermobility Is Fact, Not Fiction
• Double Arthrodesis

After you watch the presentations, complete and submit a short exam to earn 1.25 CME contact hours. Visit the ACFAS e-Learning Portal for this and other Clinical Sessions plus monthly podcasts, Surgical Techniques videos and e-Books to enhance your learning anytime, anywhere.

Foot and Ankle Surgery

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A study was conducted to describe a new surgical method of lateral wall osteotomy combined with an embedded biodegradable implant for treating displaced intra-articular calcaneal fractures and evaluate clinical and radiological results. Seventeen patients with 19 calcaneal fractures underwent surgical treatment from May 2013 to December 2015. Radiographic images, computed tomography scans and magnetic resonance images of the operative limb were acquired to assess fracture healing and biodegradable implant degradation. American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score at the last follow-up was obtained to assess functional result for all cases. Böhler's and Gissane's angles, width and height of the injured calcaneus were analyzed via preoperative and last follow-up radiographic images.

All radiological parameters showed significant improvement at the last follow-up, with an increase of 15.58 degrees, 8.38 degrees and 7.65 mm in Böhler's angle, Gissane's angle and calcaneal height, respectively, and a decrease of 2.51 mm in calcaneal width. Average AOFAS score at the last follow-up was 84.37 plus or minus 9.98, with nine, six and four feet having excellent, good and fair rates, respectively. None had nonunion, delayed union or malunion after a mean follow-up of 34.69 plus or minus 5.22 months. One superficial infection occurred six days after surgery.


A study was conducted to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. Two randomized controlled trials (RCTs) and three observational studies were identified, totaling 187 subjects with acute Lisfranc injuries and a mean follow-up duration of 62.3 months. ORIF was associated with a significantly higher need for revision surgery and a significantly higher rate of persistent pain compared with primary arthrodesis. However, no significant difference was observed between the groups in terms of visual analogue scale pain score, American Orthopaedic Foot & Ankle Society (AOFAS) functional score or rates of infection.

Separate RCT analysis revealed that ORIF was associated with a more frequent need for revision surgery, higher visual analogue scale pain score and lower AOFAS score. The results imply that primary arthrodesis may be associated with better pain and functional outcomes and a reduced need for revision surgery versus ORIF, but the available evidence is limited and is not adequately robust to make explicit conclusions.


A study was conducted to probe the average 10-year follow-up clinical and radiologic outcomes for the treatment of symptomatic hallux valgus (HV) with moderate to severe metatarsus adductus (MA). Seventeen patients with symptomatic HV with moderate to severe MA were operatively treated, with an average postoperative follow-up duration of 114.4 months. All feet had an MA angle of 20 degrees or higher on dorsoplantar weightbearing radiograph. The procedure included a proximal crescentic osteotomy of the first metatarsal and abduction osteotomy of the proximal third of the second and third metatarsals.

The average American Orthopaedic Foot and Ankle Society scale score improved significantly postoperatively, and the mean postoperative visual analog scale score was 2.0. Preoperative metatarsalgia was severe in two feet, moderate in 17 and mild in two. At the latest follow-up evaluation, 11 feet had no pain, nine had mild pain and one had moderate pain. The average HV angle, intermetatarsal angle and MA angle significantly decreased postoperatively, and recurrence of HV was seen in four feet.

Practice Management

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About 66 percent of Americans older than 65 suffer from multiple chronic conditions, and capacity coaching is designed to help older patients with comorbidities become more adaptable. According to researchers, healthcare providers should consider capacity coaching rather than traditional health and wellness coaching, which is not designed for overwhelmed patients dealing with multimorbidity. Capacity coaches look at patients holistically, starting by understanding what is happening in their life and in their healthcare.

The coaches then work simultaneously with the patient's healthcare team to reduce treatment burden and to increase the patient's capacity for self-care. A capacity coach can help orient care in several areas, with treatment burden reduced by actions like reducing numbers of appointments, simplifying medication taking and improving overall coordination of patient care.


Physician practices everywhere must prepare for the possibility of an active shooter in the office, yet few have the knowledge or the qualified personnel to develop an adequate plan. The first step is to hold a security vulnerability assessment by a qualified healthcare security professional to identify possible threats, vulnerabilities and risks. The second step involves drafting an active shooter plan, which must be tailored specifically to the office environment, culture and surroundings. The third step is to test the plan, typically with a tabletop exercise involving a limited number of office staff, who go through an active shooter scenario using the plan as a guide. As this process is followed, the plan should be modified accordingly.

The fourth step is to devise a training program that is consistent with the written plan. Training should be founded on the final revision of the plan, with training both compulsory and periodically reinforced. The final step is to organize a recovery plan, so the practice can revert to some kind of normality following an active shooter incident.


Physicians are hosting podcasts featuring interviews, instructional segments and in-depth documentaries. Pennsylvania trauma surgeon Ni-Daako Darko runs the Docs Outside the Box podcast, showcasing interviews with physicians who have explored their skills in unexpected ways, such as writing for TV. Darko says he was inspired to start the podcast because he felt that, as a doctor, he was not in complete control over his life and had not considered other talents in his repertoire.

Meanwhile, Colorado pediatric gastroenterologist Carrie Reynolds runs the Hippocratic Hustle, originally as a forum for women physicians who were practicing their careers creatively, and later as a platform to help them realize financial independence. Among the basic costs of running a podcast are buying a microphone and a computer, although most computers now come with software for recording, editing and uploading a podcast. Another expense is subscribing to a media-hosting package, which can support podcast files and facilitate editing, with a range of $5 to $30 monthly.

Health Policy and Reimbursement

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The Trump administration has proposed a plan to require hospitals and insurers to publicly disclose negotiated prices for medical services in an effort to lower U.S. healthcare costs. Providers say the administration does not have the authority to require these disclosures and that the disclosures would be of little use to consumers, who just want to know what they need to pay out of pocket and not the full price of services. While hospitals fear new demands from insurers to lower prices, insurers could also face price pressures if hospitals that get lower reimbursements demand the higher rates their competitors have won. Also, insurers that have wrangled the steepest discounts may not want those rates exposed to competitors that would then be able to push for similar pricing. Moreover, negotiated rates that insurers pay hospitals and other healthcare providers often vary widely. If a proposal goes forward, providers that do not comply could potentially face fines. The administration seeks public comment through May 3.


House Democrats sent letters to 12 insurance companies seeking information about short-term health coverage. The lawmakers want to know how companies market the short-term plans, what percentage of applicants are denied coverage and what brokers who sell the insurance are paid. They also asked for plan applications and underwriting documents. An Urban Institute study earlier this year found that brokers received higher commissions when selling short-term plans than Affordable Care Act-compliant plans. Brokers selling these plans often decline to provide written information when asked by potential consumers to do so, the report found.


President Trump's proposed fiscal 2020 budget includes capping out-of-pocket prescription drug expenses for seniors covered by Medicare. A cap appears increasingly popular in the government, and its advocates include U.S. Secretary of Health and Human Services Secretary Alex Azar. The proposal would restrict spending on prescription drugs for seniors with Medicare coverage, delivering financial certitude to both beneficiaries and drugmakers. Meanwhile, the government would foot the bill for anything seniors spend on drugs beyond a certain threshold.

Medicine, Drugs and Devices

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Many of the most frequently prescribed oral medications in the United States contain at least one inactive ingredient that could cause an adverse reaction, new research shows. The study, reported in Science Translational Medicine, looked at more than 42,000 oral medications and identified more than three dozen inactive ingredients that have been described in medical literature to cause allergic symptoms following oral exposure. These ingredients are added to improve the taste, shelf-life, absorption and other characteristics of a medication. Researchers reported that 92.8 percent of the medications they studied contain at least one of these inactive ingredients.


National Cancer Institute Director Norman "Ned" Sharpless has been appointed acting commissioner of the U.S. Food and Drug Administration (FDA). Sharpless will succeed Scott Gottlieb, who announced his resignation last week. Sharpless is expected to start at FDA within weeks. The administration has started a search for a permanent replacement to Gottlieb, and Sharpless may be considered.


Executives from five pharmacy benefit managers (PBMs) have been invited to testify at the Senate Finance Committee's April 3 hearing on rising prescription drug costs. Pharmaceutical companies say they are pressured to provide rebates to PBMs to get their products included on preferred coverage lists. The Trump administration and lawmakers say there needs to be greater transparency about how drug prices are accelerating, and the effect of rebates on PBMs is of particular concern.