April 1, 2020 | | JFAS | Contact Us

News From ACFAS

COVID-19 Legislation Update
On March 27, 2020 President Donald Trump signed the third coronavirus relief package totaling $2.2 trillion. It is the largest-ever injection of federal cash into the struggling US economy.

The package will deliver hundreds of billions of dollars in emergency aid and loans to floundering businesses and industries, as well as funding to states and federal agencies as they work to fight COVID-19.

Two of the seven buckets of spending could help foot and ankle surgeons with the challenges they face as a result of this pandemic. The bill also reauthorizes a critical telehealth program to extend the reach of virtual doctor appointments.

Under the stimulus package, Small Business Administration will distribute $350 billion to small businesses, which can be partially forgiven if the companies meet certain requirements. The loans will be available to companies with 500 or fewer employees.

Hospitals also secured $100 billion in grants to help fight the coronavirus and make up for dollars they have lost by delaying elective surgeries and other procedures to focus on the outbreak.

The bill also provides approximately $1.32 billion in funding for community centers, $4.3 billion for CDC programs and response efforts, $20 billion for Veterans Affairs, $16 billion to the Strategic National Stockpile and $11 billion for the biopharmaceutical industry.
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Managing Anxiety & Stress Amid COVID-19
As the numbers of those affected by the coronavirus rises, the uncertainty of this pandemic has many feeling out of sorts and anxious about what lies ahead. Everyone manages stress differently and it’s important to take your mental health seriously, especially in situations with so many unknowns.

The Center for Disease Control (CDC) has published resources for managing stress and anxiety in yourself, but also as a first responder coping during this situation.

No one should suffer in silence. Visit the CDC website for more helpful resources and contact information in case you need someone to talk to during this unprecedented situation.
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Almost Sold Out – Tonight’s Webinar
There are only a few slots available for tonight’s free webinar, Practice Survival During COVID-19. If you miss tonight’s viewing, a recording of the webinar in its entirety will be available online tomorrow on

Listen in as the College brings together essential experts, physician compensation attorney Robert Wade, Barnes & Thornburg, LLP and Ross Taubman, DPM, president and CMO of PICA to break down how you can keep your practice open and thriving through this unprecedented time.

For more information or to register, visit
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Stay Ahead of the Latest Research with SLRs
Now is the perfect time to stay ahead of the latest research in foot and ankle surgery right from your home—Scientific Literature Reviews (SLRs) are now available for April!

Each month ACFAS releases short, digestible summaries of studies from other medical specialty journals covering the latest developments that could impact your practice of foot and ankle surgery. SLRs are a variety of published articles including clinical studies, case reports, literature reviews and more.

Catch up on the latest research. Check out the latest articles for April available now at Here you can also view all archived SLRs.
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Foot and Ankle Surgery

Peroneal Tendon Dislocation in Talus Fracture and Diagnostic Value of Fleck Sign
The study examined the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis thereof. Researchers retrospectively reviewed 93 consecutive talus fractures, including only cases where the patient underwent open reduction and internal fixation, had a pre-operative CT scan that was available for review and three view ankle plain radiographs. Fifty ankles with a mean age of 32.5 years met the inclusion criteria, with 49 patients being male and the predominant mode of injury being fall from height. Authors identified peroneal tendon dislocation in 20 percent of these patients, and risk of dislocation increased with severity of the fracture and neck fractures. Most dislocations were missed by surgeons and radiologists, and no additional procedures were done to address such an injury. The Fleck sign had a statistically significant correlation with peroneal tendons dislocations.

From the article of the same title
International Orthopaedics (03/17/20) Attia, Ahmed Khalil; Mahmoud, Karim; Taha, Tarek; et al.
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The Use of Percutaneous Screw Fixation Without Fracture Site Preparation in the Treatment of Fifth Metatarsal Base Nonunion
The study evaluated the efficacy of closed intramedullary screw fixation for nonunions of the fifth metatarsal base after a fracture. Authors performed a retrospective study of all such nonunions treated in their department over two years, considering only minimally-displaced adult fractures. The fracture pattern was categorized according to the Dameron classifications (zone one, styloid process; zone two, metadiaphyseal area; zone three, proximal diaphysis), and all nonunions were fixed percutaneously under radiographic guidance without fracture site preparation. Zone one injuries were fixed with a three millimeter headless compression screw, and injuries in zones two and three were fixed with an intramedullary four millimeter screw. A minimum six-month clinical follow-up was obtained for 30 patients in the study, including 12 zone one injuries, nine zone two injuries and nine zone three injuries. All patients achieved union by three months after screw fixation, with 29 of 30 achieving union by six weeks, and all patients had resolution of symptoms.

From the article of the same title
Journal of Foot & Ankle Surgery (03/12/20) Grant, Michael J.; Molloy, Andy P.; Mason, Lyndon W.
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Treating AO/OTA 44B Lateral Malleolar Fracture in Patients over 50 Years of Age: Periarticular Locking Plate Versus Non-Locking Plate
The study compared radiological and functional outcomes in older patients with AO/OTA 44B lateral malleolar fractures after locking plate (PLP) or one-third non-locking tubular plate (TP) lateral fixation. Authors retrospectively reviewed the medical records of 72 patients with a mean age of 61.9 years. There were no significant between-group differences in demographic data, complication rates, immediately postoperative distal fibula lengths, ankle osteoarthritis (OA) grades, talar tilt angles (TTAs) = two degrees or reduction accuracy. The PLP group had significantly lower rates of distal screw loosening, fibula shortening, OA grade progressions and talar tilt angles (TTAs) = two degrees. They also had better visual analog scale (VAS) scores and foot and ankle outcome scores (FAOSs) than the TP group after one year of follow-up. The severity of OA, TTA = two degrees, and distal screw loosening were positively associated with VAS scores and negatively associated with FAOSs.

From the article of the same title
Journal of Orthopaedic Surgery and Research (03/20/20) Shih, Chien-An; Jou, I-Ming; Lee, Pei-Yuan; et al.
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Practice Management

COVID-19 Workers Get Training to Protect Their Own Health
The US National Institutes of Health (NIH) will launch a website with educational resources for workers dealing with the spread of COVID-19. The initiative emerged after Congress allocated $10 million for worker-based training to prevent and reduce exposure of workers who are at risk of exposure to coronavirus through their work duties. The worker-based training initiative is being led by NIH’s National Institute of Environmental Health Sciences, whose Worker Training Program (WTP) funds the development of training materials for employees in high-risk occupations who serve the public during emergencies. The WTP also acts as a clearinghouse among grant recipients to broadly share the training and educational resources developed with the grant money. The WTP is creating a COVID-19 virtual safety training initiative for frontline responders with the aim of delivering synchronized timely web-based training across the country in targeted high-risk industrial sectors.

From the article of the same title
National Institutes of Health (03/23/20)
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Responding to Patient Panic About the Coronavirus
The article relates some advice for clinicians about addressing the novel coronavirus with patients. Physicians should ask patients open-ended questions when they call the practice panicked about the outbreak to make sure their answers are appropriate in context. It is important to provide accurate information about COVID-19 testing, and practices may want to include this in the pre-recorded message that greets patients when they call. Mental Health America advised healthcare providers to screen all patients for anxiety at all visits, manage healthcare capacity to enable responses to mental health crises and refer patients to support resources for mental-health follow-up. However, an attorney notes that "overzealous words of reassurance and comfort can come back to haunt a healthcare provider" if it ends up providing a false sense of security. The practice administrator must plan staffing for answering the phone and ensuring the environmental cleanliness of the practice. Physician practices can use social media to educate patients about telehealth visits.

From the article of the same title
Physicians Practice (03/24/20) Cryls, Aine
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What Practices Need to Know About Cyber Insurance
Cyber insurance covers losses and damages resulting from the accidental or deliberate theft or exposure of patient data. Coverage typically applies only to the data itself and not the computer hardware a practice uses, which often are covered under a general business insurance policy. A complete policy includes first-party coverage, which pays for damages suffered by the policy holder and third-party coverage. Practices without cyber insurance often have some coverage through their malpractice or general business policies, but the amount is usually limited to about $30,000 in damages and contains exemptions. Before deciding whether to purchase additional cyber insurance, physicians should know what coverage they already have. The cost of a cyber insurance policy varies, but it is generally less expensive than malpractice and liability coverage. Some insurers will assess a practice's cyber security practices before deciding whether to write a policy and recommend ways to decrease risk.

From the article of the same title
Medical Economics (03/24/20) Sweeney, James F.
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Health Policy and Reimbursement

To Treat COVID-19, Administration Expected to Relax Physician Licensing. But No Regulation, Yet
US Vice President Pence announced that the Trump administration has directed the US Department of Health and Human Services to permit doctors, nurses and other medical practitioners to practice across state lines even if they lack a license in a particular state, to treat COVID-19. A regulation has not yet been issued. Janis Orlowski, MD, chief healthcare officer at the Association of American Medical Colleges, said that the licensure guidelines "are evolving as we speak." She noted that states like Mississippi and New York are taking steps to expedite medical licensing given the pandemic's urgency. The American College of Physicians also said it supports the relaxation of some medical licensing restrictions.

From the article of the same title
FierceHealthcare (03/19/20) Finnegan, Joanne
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Doctors, Nurses and Hospitals Issue Open Letter Urging Public to Stay Home
The American Hospital Association, American Medical Association and American Nurses Association have released a joint letter imploring the public to stay home in order to limit the spread of the coronavirus. The organizations wrote, "Staying at home in this urgent moment is our best defense to turn the tide against COVID-19. Physicians, nurses and healthcare workers are staying at work for you. Please stay at home for us." The letter was released a day after President Trump said he would like to ease restrictions on movement and restart the country's economy. Experts say people staying home and limiting contact with others is vital to slow the spread of the virus.

From the article of the same title
The Hill (03/24/20) Sullivan, Peter
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Eleven States Now Letting Uninsured Sign Up for ACA
Eleven states and the District of Columbia have opened enrollment under the Affordable Care Act to allow laid-off workers to get subsidized health insurance, and the Trump administration may open the federal exchange to new customers. The states that have opened enrollment are California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington. The creation of a broad special enrollment period would mean that anyone without insurance could simply sign up for a health plan, without having to prove such special conditions. Though initially hesitant to reopen the federal marketplaces, health insurers have recently started to push for a special enrollment period to insure people who find themselves unemployed.

From the article of the same title
New York Times (03/23/20) Sanger-Katz, Margot; Abelson, Reed
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Medicine, Drugs and Devices

Trump Signs Executive Order to Prevent Price Gouging, Hoarding of Medical Supplies
As the coronavirus continues to spread, a new executive order from the president aims to prevent price gouging and hoarding of key medical supplies. According to US Attorney General William Barr, the executive order will prevent people from accumulating critical medical supplies during the outbreak in an effort to profit off of them. The order gives US Department of Health and Human Services (HHS) Secretary Alex Azar the authority to designate certain supplies as critical, so anyone found to be hoarding or price gouging such equipment could face criminal action. "Once specific materials are so designated, persons are prohibited from accumulating those items in excess of reasonable personal or business needs or for the purpose of selling them in excess of prevailing market prices," he explained. As yet, no materials have been labeled critical, but the US Department of Justice and HHS are working to identify possible situations in which hoarding is obstructing response efforts amid the outbreak.

From the article of the same title
The Hill (03/23/20) Chalfant, Morgan
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CDC Documents Strategies for Optimizing the Supply of Facemasks
The US Centers for Disease Control and Prevention has provided a series of strategies to optimize limited supplies of face masks in healthcare settings. Contingency capacity strategies may include selectively cancelling elective and non-urgent procedures and appointments for which a face mask is typically used; removing face masks for visitors in public areas; and implementing extended use of face masks. Crisis capacity strategies may include cancelling all elective and non-urgent procedures, using facemasks beyond the manufacturer-designated shelf life during patient care, prioritizing face masks for certain care activities and implementing limited re-use of face masks. When no face masks are available, facilities should designate convalescent healthcare professionals (HCP) to are for known or suspected COVID-19 patients, using a face shield that covers the entire front and sides of the face.

From the article of the same title
Healthcare Purchasing News (03/20)
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FDA Allows Expanded Use of Devices to Monitor Patients' Signals Remotely
As part of its response to the COVID-19 pandemic, the US Food and Drug Administration (FDA) has issued a new policy allowing manufacturers of certain FDA-cleared non-invasive, vital sign-measuring devices to expand their use so that health care providers can use them to monitor patients remotely. The devices include those that measure body temperature, respiratory rate, heart rate and blood pressure. “Allowing these devices to be used remotely can help health care providers access information about a patient’s vital signs while the patient is at home, reducing the need for hospital visits and minimizing the risk of exposure to coronavirus,” said FDA Principal Deputy Commissioner Amy Abernethy. “This policy reflects FDA’s commitment to ease burdens on health care providers and facilities as they face this public health emergency.” The policy is limited to the duration of the emergency.

From the article of the same title
FDA News Release (03/20/20)
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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