News From ACFAS

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If you’ve taken a basic foot and ankle arthroscopy course, we have the next course for you! Join us for the Advanced Arthroscopy and Cartilage Restoration course and take the next step to sharpening your surgical skills.

Learn the latest techniques as well as more recent cartilage restoration from leading surgeons—arthroscopic lateral ankle ligament repair, classic OATS resurfacing and particulate cartilage resurfacing techniques, en bloc resection and replacement techniques, subtalar joint arthroscopy and arthroscopic STJ fusion technique.

To attend this course, you must have previously taken a basic foot and ankle arthroscopy course. If it wasn’t an ACFAS program, fax your certificate and agenda from the program attended to ACFAS’ Education Department at (773) 693-9304.

Visit acfas.org/Skills for more information and to register now. ACFAS Regions are Zooming for 2021! All College Members and ACFAS Student Club Members are invited to attend their local Region Meetings via Zoom. Meetings are scheduled to be held evenings in May, either the week before or the week after the ACFAS Annual Scientific Conference in Las Vegas. Meetings are one hour in length.

Meeting agendas include new Region CME programming, support of local research, plans for the upcoming year and open officer positions. Also, all members who attend their meeting will be placed in a raffle to win one of two $100 Amazon gift cards.

To see your Region’s Membership Meeting agenda, learn who your local officers are, and to register, please go to acfas.org/Regions. Congratulations to the 2021 ACFAS Region Scholars! Each Student Scholar earned a scholarship from his or her respective ACFAS Region in recognition of their strength as a podiatric medical student, future promise as a foot and ankle surgeon, and appreciation for their leadership of their local ACFAS Student Club on their school’s campus. Funds are most often used to support their travel to the ACFAS Annual Scientific Conference on an annual basis. Individual scholar photos can be found on each regions webpage at acfas.org/Regions.

Big West Region: Shadi Mattar, AZPod ‘23

Great Lakes Region: Kiara Francis, Kent State ‘23

Midwest Region: Erica Reed, DMU ’23 and Carly Goehring, Scholl ‘24

Northeast Region: Gregory Rose, NYCPM ‘23

Pacific Region: Jake Loitz, CSPM ’23 and Mereat Askander,
WesternU ‘24

Southeast Region: Adam McAteer, Barry ‘23

Tri-State Region: Emily Cziraky, Temple ‘23

Foot and Ankle Surgery

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The study examined the relationship between ankle joint laxity and general joint laxity (GJL) in relation to the menstrual cycle, which was divided into four phases based on basal body temperature and ovulation. Participants were 14 female college students (21–22 years) with normal menstrual cycles (cis gender). Anterior drawer stress (AD%) to a magnitude of 120 N was applied for all participants. Anterior talofibular ligament (ATFL) length was measured as the linear distance between its points of attachment on the lateral malleolus and talus using ultrasonography. Data on ATFL length from each subject were used to calculate each subject’s normalized length change with AD%. There was no statistically significant difference between AD% in each phase. GJL score was significantly higher in the ovulation and luteal phases compared with the early follicular phase. AD% and GJL showed a positive correlation with each other in the ovulation phase.


A previous three-dimensional computerized tomography imaging study determined that, when treating zones two and three fifth metatarsal fractures with an intramedullary fixation, the screw should stop short of the bow of the metatarsal and be larger than 4.5 millimeters. This study determines how these guidelines translate to operative outcomes, measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference surveys. Researchers identified 23 patients who met inclusion criteria, of whom 18 completed PROMIS surveys before surgery. Metatarsus adductus angle was shown to exhibit a significant moderate inverse relationship with postoperative PROMIS PF scores in the overall cohort. Metatarsus adductus angle, lateral talo-first metatarsal angle and medial cuneiform height demonstrated significant inverse relationships with change in PROMIS PF scores for the overall cohort.


For this study, seven ankles with varus alignment underwent total ankle arthroplasty with a third generation prothesis (INBONE-2) and Anatomic Lateral Ankle Stabilization (ATLAS) using a synthetic graft between September 2018 and February 2019 at a single institution. Medical records and charts were reviewed for revisions, reoperations and complications. Survivorship for INBONE-2 with ATLAS was 100 percent; recurrent instability was not observed. Symptomatic talonavicular joint arthritis was recorded for a single patient 12 months postoperatively; no revisions or reoperations were performed. Coronal alignment improved significantly, and all ankles achieved neutral alignment in a single stage. Regarding sagittal alignment, two ankles were translated anteriorly and the rest were neutral preoperatively. Significant posterior translation was observed and during the latest follow-up, four ankles were neutral and three posterior.

Practice Management

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The US government on April 5 will for the first time implement laws intended to counter the healthcare industry's practice of damming the flow of patient information between providers through a final rule issued by the Department of Health and Human Services' Office of the National Coordinator. Leigh C. Burchell at electronic health record supplier Allscripts said the rule's ambiguous and confusing language will necessitate an adjustment period for industry stakeholders. "Practices need to take a look at their processes for responding to requests that come in for patient data to the best of their ability...for capturing information about those instances when a request cannot be honored in order to explain the decision to any investigator from [the Office of the Inspector General] who comes knocking," she added. Burchell further said healthcare providers need to determine what changes they need to make to successfully respond to data requests, including health information technology tools they are using, which may entail additional investment.


Research indicates that Health Insurance Portability and Accountability Act (HIPAA) compliant email can maintain open lines of communication to reduce liability risk and ensure that staffers have the information to function well. Studies by Watson Wyatt Worldwide determined that engaged employees perform better, miss 20 percent fewer days of work, support organizational change more and have reduced turnover rates. Meanwhile an Advisory Board study found that every 1 percent gain in hospital employee engagement correlates with a 0.33-point boost in the facility's Hospital Consumer Assessment of Healthcare Providers and Systems overall hospital rating, which impacts Medicare reimbursement. A 1 percent increase in hospital employee engagement is also associated with a 0.41-point increase in patient safety grades.


An analysis by the American Medical Association (AMA) estimated that over 30 percent of medical liability insurance premiums rose last year versus the previous year, the highest percentage since 2005. Between 2010 and 2018 the share of premiums that appreciated ranged from 12 percent to 17 percent, and almost doubled to 26.5 percent in 2019 before climbing to 31.1 percent in 2020. "Increases in medical liability premiums compound the economic stress on medical practices as the COVID-19 pandemic resulted in significant reductions to patient volume and revenue and higher expenses for scarce medical supplies,” said AMA President Susan R. Bailey. "Practice revenue has not fully recovered as the pandemic has stretched on and a protracted upward trend in medical liability premiums will threaten the viability of many practices that already face a difficult road to recovery." The AMA is working with state medical societies to implement traditional and innovative medical liability reforms to preserve premium stability and help millions of Americans who need affordable, accessible medical care.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) has delayed the request for applications release data for the accountable care organization (ACO) Transformation Track of the Community Health Access and Rural Transformation (CHART) Model from spring 2021 to spring 2022. CMS intended to allocate advanced payments to 20 rural ACOs for enrolling in the Medicare Shared Savings Program, along with $75 million in upfront seed funding to 15 rural communities through the Community Transformation Track. The ACO Transformation Track would let rural-focused ACOs receive a one-time payment of at least $200,000 plus $36 per beneficiary to join a five-year agreement period of the Shared Savings Program via the CHART Model. CMS also plans for those payments to help participating ACOs enroll in value-based payment programs that improve patient outcomes and quality of care for rural beneficiaries.


The White House is temporarily suspending Medicare claims with service dates on or after April 1 so providers will not be affected by the reinstatement of a 2 percent reduction in payments. The Senate passed legislation to extend the moratorium through the rest of the year about a week before the US Centers for Medicare and Medicaid Services' (CMS) notice, accompanied by a notice to Medicare Advantage and Part D plans that "CMS will resume standard sequestration reductions beginning with April 2021 payment for Medicare Advantage (MA) organizations and Part D sponsors." The agency also plans to make retroactive adjustments for MA organizations and Part D sponsors in "a future payment month as necessary and as consistent with the law." With the House in recess until April 13, the cuts will be re-enacted until the chamber passes the moratorium again.


A new survey by Gallup and West Health reveals that more Americans say they cannot afford healthcare, with 18 percent of respondents saying they would not be able to pay for quality care if they needed it today. The same number of Americans indicated someone in their household skipped or self-rationed healthcare due to the increased financial burden caused by the COVID-19 pandemic. Among Black adults, 29 percent said they could not afford adequate healthcare, while 21 percent of Hispanic adults and 16 percent of White adults, mainly those older than age 65 years, said so. Gallup said, "The practical ramifications of widespread reductions in basic household spending to offset the cost of care are considerable and should not come with great surprise given the substantial number of Americans who suffer its effects. Dovetailing with these realities is majority support for a number of public policies currently being considered, underscoring a public that continues to remain open to government action designed to provide relief from healthcare expenses." A total of 3,753 adults participated in the poll during February 15-21, with a margin of error of plus or minus 2 percentage points.

Medicine, Drugs and Devices

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A study in JAMA Internal Medicine by Johns Hopkins Bloomberg School of Public Health researchers found vouchers and coupons offered by pharmaceutical companies cover just a small portion of prescription drugs, excluding patients with the greatest need for discounts. Analysis of tens of millions of pharmacy transactions by more than 600,000 Americans during 2017-2019 determined that more than half of the over 4 million offsets were supplied by pharmaceutical companies and half by pharmacies or pharmacy benefit managers. Offsets were focused among a relatively small number of drugs, with no indication they diverged significantly based on local average income, ethnic/racial composition or level of insurance coverage. Diabetes, lung disease and cardiovascular disease were the ailments for which discounts for branded drugs were most common. "The most significant finding was that these offsets are not being targeted to people who likely need them the most—for the pharmaceutical company-sponsored offsets, the goal may be mainly to maintain market share," said the Bloomberg School's Aditi Sen.


A phase two clinical trial comparing basal insulin Fc (BIF) with insulin degludec in patients with type two diabetes found a once-weekly injection of the former medication yielded similar efficacy and safety and a lower rate of low blood sugar episodes. Patients administered BIF realized similar long-term blood glucose control as measured by hemoglobin A1c. Participants had an average A1c of 8.1 percent at the start of the study and A1c of 0.6 percent for BIF and 0.7 percent for insulin degludec at the conclusion.