News From ACFAS

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It’s your last chance to register for the ACFAS 2022 On-Demand Package to access content from this year’s meeting in Austin! Access over 20 hours of learning recorded at this year’s Annual Scientific Conference from your computer wherever you are.

The On-Demand Package includes:

• 13 recorded ACFAS 2022 sessions totaling 23 CME hours
• Ability to view session recordings for up to one year
• Convenient 24/7 online access

Registration ends tomorrow, March 31, so don’t wait! Visit acfas.org/Austin now to register for access to this year’s on-demand package. On March 14, President Joe Biden signed H.R. 2545 into law which amends Title 38 of the United States Code and clarifies the role of Doctors of Podiatric Medicine (DPMs) within the Department of Veterans Affairs (VA) and the Veterans Health Administration (VHA) (see Public Law No: 117-96).

The VA bill updates the MISSION Act (also called the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018) and addresses an oversight. The MISSION Act reclassified DPMs within the VHA as podiatric surgeons and placed them in the same compensation range as their Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) colleagues. However, it did not include the position of Director of Podiatric Services, as they had not been included in the compensation reclassification. This VA bill becoming law updates the position to Podiatric Medical Director and makes it so that DPMs within the VHA will be fully regarded as physicians. This change helps amplify parity efforts for DPMs across the health care system.

ACFAS thanks Representative Brad Wenstrup, DPM (R-OH), ACFAS member, and his colleagues Representatives Frank Mrvan (D-IN), Thomas Suozzi (D-NY), Janice Schakowsky (D-IL) and Senators Bill Cassidy, MD (R-LA) and Kyrsten Sinema (D-AZ), President Biden, and the American Podiatric Medical Association (APMA) for the parts they played in this significant win for the profession. Get the latest research in foot and ankle surgery right from your home. Scientific Literature Reviews (SLRs) for April are now available.

ACFAS makes it easy to catch up with these short, digestible summaries of research from non-podiatric journals on the latest developments in foot and ankle surgery. The latest topics include Simple Algorithmic Approach Allows the Safe Use of Cephalosporin in "Penicillin-Allergic" Patients without the Need for Allergy Testing, Fate of the Uninsured Ankle Fracture: Significant Delays in Treatment Result in an Increased Risk of Surgical Site Infection, Percutaneous Forefoot Decompression in a Foot Compartment Syndrome Model, Postoperative opioid prescribing practices in US adult trauma patients: A systematic review, and many more.

Get your research roundup for April now at acfas.org/SLR. And keep checking back, we add more each month!

Foot and Ankle Surgery

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A study looked at whether three-dimensional (3D) printed models can shorten operation time and improve the quality of reduction for calcaneal fractures. Forty-eight patients with unilateral intra-articular calcaneal fractures were retrospectively case-matched according to Sander's classification, age and sex, with Group A (24 patients) treated with 3D printed models as a preoperative and intraoperative tool and group B (24 patients) treated using standard techniques with no 3D printed models. Operation time was significantly shorter for group A than group B. Both cohorts had similar differences between the radiological parameters of operated calcaneus, compared to the normal side. The number of screws projecting over five millimeters from the cortex was lower in group A than in group B, while the number of screw holes of the plate cut intraoperatively was significantly fewer for group A than group B. While group A began weight-bearing three to four weeks earlier than group B, the radiological parameters were similar between cohorts so that early weight-bearing was possible for group A using the 3D printed models.


A cohort study of 11,5071 hospitalizations for diabetic foot ulcerations among racial and ethnic minority adults associated Medicaid expansion related to the adoption of the Patient Protection and Affordable Care Act (ACA) with lower major amputation and hospitalization rates in early-adoption states versus non-adopters. There were 36,829 hospitalizations for Medicaid beneficiaries and 10,500 for uninsured patients. Hospitalizations rose three percent in early-adopter states and 8 percent in nonadopter states after expansion. Despite no change in the amputation rate in early-adopter states after expansion, a nine percent increase in nonadopter states was observed. The amputation rate for uninsured adults fell 33 percent in early-adopter states and remained the same in nonadopter states after expansion. The change of amputation rate among Medicaid beneficiaries between state types did not differ after expansion.


A retrospective study sought to assess transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles through oblique axial magnetic resonance imaging (MRI). The patients diagnosed with syndesmosis injury via MRI within a week of trauma were included, while patients with concomitant fractures were excluded. In all, 34 patients (one woman and 33 men) with an average age of 22 years were included. Eight ankles (23.5 percent) ankles had an intact transverse ligament, 21 (61.8 percent) had a partial tear and five (14.7 percent) had a complete tear. Twenty ankles (58.8 percent) had an intact posterior inferior tibiofibular ligament, 12 (35.3 percent) with a partial tear and two (5.9 percent) had a complete tear. Half of the transverse ligament injuries transpired without posterior inferior tibiofibular ligament involvement. According to the MRI scans, the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles were 76.5 percent and 41.2 percent, respectively.

Practice Management

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Physician practices can strengthen their resistance to escalating ransomware attacks with a strategy outlined by the US Cybersecurity & Infrastructure Security Agency. The agency recommends visiting the StopRansomware.com webpage, which provides key preventive tips and resources. Best practices include maintaining offline and encrypted backups of data, along with deploying a cybersecurity user awareness and training program that features guidance on identifying malicious email. Also recommended is installation of a basic cyber incident response and communications plan incorporating procedures for a ransomware incident.

Scans for identifying and addressing vulnerabilities, particularly those on Internet-facing devices, should be regularly conducted, while proper device configuration and security features enablement should be confirmed. Moreover, organizations are advised to employ best practices for use of remote desktop protocol and other remote desktop services and to keep antivirus and anti-malware software up to date. Finally, multifactor authentication should be deployed for as many services as possible, and the principle of least privilege should be applied to all systems.


A Survey Healthcare Global (SHG) survey of doctors in six Western nations, including the United States, found chronic staffing shortages affecting their mental health and patient care, with 34 percent of responding physicians reporting more medical errors. Sixty-five percent of physicians report feeling frustrated, 54 percent burnt out and 52 percent unappreciated in the past three months. More than half are so aggravated by chronic stress that they say they have considered quitting their profession. Top contributors to their strained mental health include constant stress and staff shortages, with 18 percent of respondents saying they are more likely to drink, smoke or use/abuse substances. Yet almost three-quarters say their organizations do not offer employees any wellness resources and programs. "When physicians voice such strong concern about medical errors and the quality of patient care, healthcare leaders must take notice and redouble efforts to address the root causes of the staffing shortage," said Daniel S. Fitzgerald, CEO of SHG parent company Apollo.

Health Policy and Reimbursement

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A new survey by MedicareGuide.com found that four out of 10 Medicare Advantage (MA) customers mistakenly believe they don’t have to stay in-network for care, a key difference between the program and traditional Medicare. The survey found that some MA members are switching back to traditional Medicare due to issues such as claims refusals. It found that 11 percent of respondents left MA because a plan didn’t authorize a procedure while another 11 percent said they were billed for an out-of-network charge. Another 10 percent said it was due to skipping a procedure and 8 percent because a claim was refused. The survey results come as MA continues to grow in popularity. A recent study from the Chartis Group found that enrollment grew by 2.3 million for 2022, making up 45 percent of all Medicare enrollment thanks to 1.3 million people transitioning from traditional Medicare to MA.


The US government announced that over 14.5 million Americans signed up for Affordable Care Act (ACA) health insurance for 2022, a 21 percent year-over-year gain and the highest since ACA's signing 12 years ago. Roughly 10.3 million people enrolled from the 33 states that use the federally funded online marketplace and about 4.3 million from states that sell the insurance directly to residents. President Biden stated that his administration had posted a 26 percent increase in ACA insurance enrollment for Hispanic Americans and a 35 percent increase for African Americans. He added that more than 18.7 million adult Americans in 39 states are now insured under expanded eligibility criteria of Medicaid.

Medicine, Drugs and Devices

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The US Federal Communications Commission (FCC) has announced nearly $30 million in funding for 16 projects in 15 states through its Connected Care Pilot Program, which marks the effective closure of the $100 million initiative. FCC Chairwoman Jessica Rosenworcel said the program will help the agency chart a strategy for future connected care and federal support. The program was viewed as way to back healthcare organizations in launching or expanding programs via telehealth and digital health channels that focus on critical health disparities and access issues. Maternal mortality and pediatric healthcare, veterans' service, behavioral health and substance abuse programs and broadband connectivity were among the issues the program explored. The latest award recipients include the Boston Community Medical Group, which will roll out a Health Insurance Portability and Accountability Act-compliant telehealth platform to serve 22,000 low-income patients across Massachusetts.


Nearly 50 million people in the United States had their sensitive health data breached in 2021, a threefold increase in three years, according to an analysis of the latest data from the US Department of Health and Human Services. Experts say the increased hacking can be attributed to the healthcare industry’s rapid move to digital services, particularly amid the pandemic, an increase in remote work, the financially lucrative information for cybercriminals in healthcare and greater awareness of attacks across the industry, thus more reporting.


While COVID-19 survivors often face persistent respiratory and cognitive problems, growing evidence suggests many are also likely to develop cardiometabolic complications, including diabetes and heart or kidney trouble. A just-published study, for example, looked at records for 181,000 patients in the Veterans Health Administration system who were diagnosed with COVID-19 within the past year. Compared with 8 million controls who were not infected, the recovered COVID patients were 40 percent more likely to receive a new diagnosis of diabetes. The finding, reported in The Lancet Diabetes and Endocrinology, suggests that 1 percent of people who contract COVID-19 — millions of individuals worldwide — could also become diabetic despite having no risk factors for or history of the disease. The trend may also portend new research into treatments for COVID-specific diabetes, which appears to differ in some respects from type one and type two disease.