News From ACFAS

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If you’re joining us in Vegas for ACFAS 2021, TODAY is the last day to get your hotel room reserved with onPeak, ACFAS’ official housing partner.

To make your reservation, visit acfas.org/LasVegas and select the Hotel Registration onPeak button to access the housing reservation site. Reservations can also be made by calling (800) 950-5542.

Remember, booking through onPeak guarantees you the lowest hotel rate and protects you from unauthorized third-party vendors or “hotel poachers.” ACFAS will not be responsible for any room reservations or deposits made through other companies or websites, so please book through onPeak for your own safety. Now's your chance! Get the insight on the new coding changes for 2021 in the live-streamed event, Coding and Billing for the Foot and Ankle Surgeon, on May 17 from ACFAS 2021. Register now to get expert tips and insights on simplifying your coding and reimbursement practices in this condensed, information-packed five-hour program, all from the comfort of your home or office. The program also includes an interactive Q&A session.

Visit acfas.org/LasVegas to register and for more information. ACFAS’ popular Arthroscopy of the Foot and Ankle Surgical Skills Course is back in full-force in 2021! Join us at one of these upcoming courses and get the latest techniques, didactic lectures and surgical demonstrations at the Orthpaedic Learning Center (OLC) in Rosemont, Illinois.

August 14-15, 2021
October 2-3, 2021
December 11-12, 2021

Visit acfas.org/skills for more information and to secure your spot at one of these highly interactive course dates.

Foot and Ankle Surgery

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An observational study sought to assess the recovery of older children with relapsed congenital clubfoot who received an Achilles tenotomy for the second time as part of the Ponseti treatment. Thirteen patients (19 feet) underwent Achilles tenotomy where magnetic resonance images (MRIs) of the severed tendons were taken after one, three and six weeks post-procedure. Participants were categorized into older children who underwent tenotomy for the first time (group A) and older children who underwent tenotomy for a second time (group B). Three weeks post-tenotomy, both groups had clinically intact tendons in nine out of 11 and two out of eight feet, respectively. From the first week to the third week post-tenotomy, computational analysis indicated that the mean high signal intensity area of group A decreased by 88.5 percent plus or minus 15.2 percent, which differed significantly from the 69 percent plus or minus 24.9 percent reduction of high signal intensity area of group B.


A study was performed on 236 patients undergoing bone transport surgery for tibias using the Ilizarov external circular fixator from 2008 to 2018. Forty-nine patients had an additional treatment for ankle osteoarthritis (OA) following Ilizarov technique treatment. The occurrence of postoperative ankle OA was 20.8 percent, with 19 patients classified as K&L grade 3 and seven patients as grade 4. The five leading risk factors included double-level bone transport, an external fixator index of greater than 50 days/cm, more than 45 years of age, osteoporosis and a body mass index (BMI) higher than 25. Independent risk factors included male gender, BMI higher than 25, diabetes, osteoporosis and American Orthopaedic Foot and Ankle Society ankle-HF scale scores. The likelihood of developing ankle OA among patients having three or more risk factors is 50 percent to 70 percent.


A quality improvement initiative evaluated safety and functional outcomes for 20 patients with plantar fasciitis treated with radial shockwave therapy and 18 treated with radial and focused shockwave therapy. Most patients were runners, average age 43.3 plus or minus 12.9 years and average symptom duration 12.1 plus or minus 11.1 months. All patients were prescribed an exercise program focusing on foot intrinsic strengthening and received a similar number of total treatments. Within group score changes for the Activities of Daily Living and Sports subscales were observed for both the radial and combined cohorts. No difference was noted in the proportion of patients meeting the minimal clinically important difference between radial and combined groups concerning the Activities of Daily Living and Sports subscales. These observations suggest that most patients with chronic plantar fasciitis may realize functional improvements with either shockwave therapy regimen.

Practice Management

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A Washington Post-Kaiser Family Foundation survey found about three in 10 healthcare workers have considered exiting their profession, with more than half citing burnout and about 60 percent saying stress from the pandemic has adversely affected their mental health. Danger to their health is not the only factor respondents cite, with many also pointing to the betrayal and hypocrisy they feel from the public, which has vacillated from applause and admiration to defiance of basic precautions. A majority of healthcare workers say they feel the general public and the patients they interact with respect them, yet about six in 10 say most Americans are not taking enough precautions to prevent the spread of the virus. About seven in 10 say the country has done a "poor" or "only fair" job of managing the pandemic. The US was facing a looming shortage of doctors and nurses even before the pandemic, and additional losses due to pandemic-related frustrations could seriously undermine the healthcare system.


Medical malpractice data indicates that poor patient-provider communication most frequently correlates with medical malpractice claims. The New York Times cited 30 years' worth of studies showing that physicians who use humor in their care spend more time educating patients about their health and "try to get their patients to talk and express their opinions" face less litigation. According to the National Practitioner's Data Bank, two leading reasons underpinning the most common medical malpractice allegations made against doctors in 2019 are delay in diagnosis and failure to monitor, which can both result from poor doctor-patient communication. Practices that engage in communication that includes adamant follow-ups, rigorous explanations and ensuring patients feel heard are less likely to be sued.


The US Federal Communications Commission's Wireline Competition Bureau on April 29 will start to accept applications for Round Two of the COVID-19 Telehealth Program, a $249.95 million follow-up on the $200 million program established as part of the CARES Act. "For over a year, healthcare providers have fought on the front lines of this pandemic and have had to rapidly innovate to support the health and well-being of all Americans," said FCC Acting Chairwoman Jessica Rosenworcel. "Telehealth has been at the forefront of this effort and I'm pleased to announce that additional support is just around the corner."

Health Policy and Reimbursement

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A study in the Journal of the American Medical Informatics Association gave a failing grade to electronic health record (EHR) usability scores that indicate lower odds of burnout, with the usability score among 1,285 surveyed nurses averaging 57.6. In comparison, the mean vendor-reported EHR System Usability Scale (SUS) score was 75.0. Generally, 42 percent of the respondents were categorized as burned out, and those lacking burnout had a 3.5 higher score on the SUS. "Given the increasing use and dependence on technology for care delivery and the fact that nurses are the largest healthcare professional workforce, it is troubling that 98 percent of licensed nurses report never having been included in hospital technology design or decisions," the study noted. 'To design and implement technology that better meets nurses’ needs, it will be necessary to include input from and amplify the voice of nurses to better understand how technology can better meet their needs."


A Life Image survey suggests a lack of readiness for the US Department of Health and Human Services' (HHS) information blocking rule, with nearly half of 4,000 healthcare leaders having not implemented changes as of the April 5 effectiveness date. The poll determined that many organizations fall short of basic interoperability standards, with the HHS rule having sowed general confusion. The rule requires providers to let patients, upon request, access their protected health data in the individual's preferred form and format. "As [the HHS Office of the National Coordinator for Health Information Technology] starts enforcement, organizations must prioritize deepening their knowledge of these mandates and implementing changes to adapt to the evolving landscape, or run the risk of incurring significant penalties," said David Schoolcraft at law firm Ogden Murphy Wallace.

Medicine, Drugs and Devices

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A new Forrester Research survey on wearables in healthcare found such devices assist consumers rather than doctors, because "they offer data, not answers to consumer questions, diagnoses or treatment suggestions to help restore one's health." Physicians' lack of interest in monitoring information obtained remotely has exacerbated this situation, leading to the conclusion that "consumer technology and data may never play a leading role in helping physicians provide healthcare." The authors suggested that concentrating on smartphones' capabilities in terms of compiling and transmitting data may be the best source for making both patients and doctors accepting of wearables.


Novel antibiotics are essential to combat the emergence and spread of drug-resistant bacteria, which could potentially cause the deaths of up to 10 million people annually by 2050. However, a new report by the World Health Organization (WHO) indicates that adequate progress is not being made toward their development. Of the 43 antibiotics in the pipeline, none target the most harmful bacteria that are resistant to several antibiotics and easily share genetic material to enable resistance in other bacteria. Hatim Sati, a technical officer at WHO's International Research Coordination Initiative, said: "What's really alarming is the majority of drugs in development are redundant." Drug makers are facing challenges with monetizing antibiotic development, so are leaving the development of early-stage drugs largely to small companies with limited resources. Future legislation could potentially create better incentives for drug makers to invest in innovative antibiotics.