News From ACFAS

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The College sent a letter to congressional leaders advocating for financial support and personal protection equipment (PPE) for foot and ankle surgeons.

The letter acknowledges the strain the global crisis has put on healthcare and asks for additional packages that could extend relief to foot and ankle surgeons. The College requested Congress to find alternative ways to maintain salaries and benefits for DPMs and other surgical specialties as the suspension of non-essential surgeries has created a financial burden for many in private practices. As many foot and ankle surgeons are responding to traumatic surgical cases and high-risk diabetic patients, there’s an urgent need for personal protective equipment (PPE) and restrictions have made it almost impossible to obtain. Congress is urged to expand necessary PPE to foot and ankle surgeons to keep both physicians and patients safe and protected.
Congratulations to Raj Patel and Zackary Clor, the 2020 Mirmiran Family Scholars and members of the Scholl College of Podiatric Medicine Class of 2022!

The family of Roya Mirmiran, DPM, FACFAS, based in Sacramento, California, provides scholarships every year to top students who are hand-selected to attend the ACFAS Annual Scientific Conference. Raj and Zack received funds to offset their cost to attend ACFAS 2020 in San Antonio.

The Mirmiran Scholarship opportunity rotates to a different campus every year. For 2021, students from Temple will be recognized.
Congratulations to the 2020 ACFAS Region Scholars! Each Student Scholar received a scholarship from his or her respective ACFAS Region to attend this year's Annual Scientific Conference in San Antonio. Individual scholar photos can be found on each Region’s webpage.



Student Scholars with representatives of the ACFAS Region Presidents Council.

Big West Region:
AZPod: Kayla Weber, Class of 2022

Great Lakes Region:
Kent State: Hamidat Momoh, Class of 2022

Midwest Region:
DMU: Drew Anderson, Class of 2022
Scholl: Trevor Page, Class of 2023

Northeast Region:
NYCPM: Sherwin Shaju, Class of 2021

Pacific Region:
CSPM: Shane Hall, Class of 2022
Western U: Spencer Sterling, Class of 22

Southeast Region:
Barry: Karissa Badillo, Class of 2022

Tri-State Region:
Temple: Alexandra Brown, Class of 2022 As we all experience the daily challenges presented by COVID-19, it's important to find ways to lighten the mood. Head to the ACFAS Logo Store to think spring and get something new to brighten your day and wardrobe!

The ACFAS Logo Store has a variety of items in a wide range of colors and sizes, including t-shirts, sweatshirts, polo shirts, scrubs and more. Don’t know what size you need? Choose from a selection of drink wear, crew socks, dress socks and more.

Use promo code ACFAS10 to save 10 percent off your order until May 15. Visit acfas.org/logostore now to shop the full collection of ACFAS-branded merchandise.

Foot and Ankle Surgery

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Researchers investigated whether the severity of planvalgus deformity is associated with the discrepancy between the value of ankle dorsiflexion (ADF) evaluated by physical examination and three-dimensional (3D) gait analysis. In addition, they aimed to identify the radiographic parameters associated with this discrepancy and their relationships. Twenty-one limbs underwent operation for planovalgus foot deformity, and 56 limbs underwent operation for equinus deformity. Differences between ADF on physical examination and ADF at initial contact on gait analysis were significantly associated with the LAT talus-first metatarsal angle and calcaneal pitch angle, but not associated with the anteroposterior talus-first metatarsal angle, talonavicular coverage angle, talocalcaneal angle and naviculocuboid overlap.


The study investigated the performance of MRI findings to predict instability of osteochondral lesion of the talus in children and the association between skeletal maturity and lesion stability. Of the 48 ankles identified, 36 were stable and 12 were unstable lesions. None of the lesions presented as a detached fragment, and skeletal immaturity was significantly more common in stable than unstable lesions. No other MRI features were found to be significantly different between stable and unstable lesions, which included the presence of an effusion, intra-articular body, cartilage changes, subchondral disruption, T2-weighted signal intensity rim, cysts, marginal sclerosis and perilesional marrow edema.


Bone marrow stimulation with microfracture is an established form of treatment for symptomatic osteochondral lesions (OCLs). For recalcitrant OCL, results of microfracture combined with chitosan-based biomaterial have been reported favorably in hip and knee. Chitosan glycerol phosphate has cationic properties that enhance clot adhesiveness within the space of an OCL and prevent blood clot retraction. Researchers prospectively report chitosan blood implant with microfracture results in patients with recalcitrant talar OCLs who were previously treated with microfracture alone in a single-surgeon study. They find a statistically significant improvement in Foot and Ankle outcome score (FAOS) and EQ-5D..


Researchers hypothesized that a novel perineural catheter design would work just as effectively as the traditional method, which has barely evolved in the past 70 years. While the basic design has always introduced the catheter through or over a straight needle, regulators sanctioned a new design whereby the catheter is attached to the back of a suture-shaped needle. The inserted needle moves along the arc of its curvature, pulling the catheter past the target nerve before exiting the skin at a second location. To compare this new technique with the established standard, investigators designed a randomized clinical trial.

Participation included 70 patients scheduled for painful foot or ankle surgery with continuous supraparaneural popliteal-sciatic nerve block. Postoperative outcomes demonstrated the novel catheter to be noninferior to the conventional approach. At two days post-procedure, study participants assigned to the suture design boasted lower average pain scores than those assigned to the through-the-needle design. Moreover, none of the suture-style catheters became completely dislodged, while the tips of three traditional catheters were found outside of the skin before they were removed as planned on postoperative day three.

Practice Management

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Small and independent practices are facing a significant cash crunch in the COVID-19 pandemic, and many may be forced to sell their practice or shut it down. Some doctors are reporting declines in revenue between 50-90 percent as hospital care for COVID-19 and social distancing measures take priority over primary care checkups and other non-urgent services. Twenty percent of primary care practices now believe they will temporarily close within the next month, according to a new survey of doctors. Moreover, the federally-backed Paycheck Protection Program, which provided relief payments to small businesses, ran out of funds in two weeks, and banks are facing severe backlash for their handling of the program.


Recent studies point to an urgent need for health care professionals to develop interpersonal skills to improve patient satisfaction, encourage loyalty and improve health outcomes. A first step in building trust with patients is to understand that communication is more nuanced than simply asking the right questions. Active listening is important in helping patients feel comfortable when communicating with their doctor. A few good techniques for building rapport with patients include asking open-ended questions, avoiding the temptation to interrupt and really listening to what patients are saying and how they are saying it. Physicians should also try to avoid multitasking, which can make them appear distracted, and try to build commonality with a patient.


Ambulatory surgery centers (ASCs) must prepare staff to function remotely in times of crisis, making sure staff can securely access the information they need. An ASC can redirect internal staff from the office into remote operations from their homes, but dependence on an on-premise server puts crucial information that the ASC needs to function in a precarious situation. While larger health systems may be able to purchase a virtual private network to allow staff remote access to their on-premise server, this may not be possible for smaller ASCs. A cloud-based platform eliminates the risks posed by a physical server in the event of an emergency. In addition, many healthcare organizations are unprepared to ensure secure and timely patient communication. Because data is encrypted and stored offsite, cloud-based software offers the highest degree of data security. ASCs should prioritize the adoption of software systems that are designed for interoperability with health systems.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) has released new guidance for health systems on resuming elective procedures that have been put on hold due to the COVID-19 outbreak. The agency cautions that any decision to resume procedures will be up to local and state authorities and calls for routine staff screening and quarantining, while keeping staff levels "adequate to cover a potential surge in COVID-19 cases.” A facility that decides to reopen procedures should also create areas to reduce the risk and exposure to COVID-19. CMS' guidance also said that facilities need to prohibit visitors and establish a plan for thorough cleaning and disinfection prior to using spaces for patients with non-COVID-19 cases. Facilities should promote social distancing by minimizing wait times, spacing chairs at least six feet apart and keeping patient volume low, among other measures.


The Trump administration unveiled a plan to start paying hospitals and doctors who care for uninsured patients with COVID-19. US Health and Human Services Secretary Alex Azar said hospitals and doctors would submit their bills directly to the government and they would get paid at Medicare rates, and uninsured people would not be liable for the costs of COVID-19 treatment. The money will come from a pot of $100 billion that Congress has approved to provide relief for the healthcare system. COVID-19 treatment for the uninsured could cost from $14 billion to $48 billion, according to a recent estimate from the nonpartisan Kaiser Family Foundation. About 28 million people were uninsured before the pandemic hit, and that number is expected to rise sharply.


A $100 billion Provider Relief Fund has been carved out of the $2.2 trillion CARES Act and includes $20 billion for Medicare facilities and clinicians, $10 billion to hospitals in COVID-19 hot spots, $10 billion for rural health clinics and hospitals and $400 million for the Indian Health Service. Facilities and clinicians who participate in Medicare are eligible for the $20 billion general fund and will receive an amount proportional to their share of 2018 net patient revenue. Providers who have already submitted cost report data to the US Centers for Medicare and Medicaid Services will receive an automatic payment as soon as April 24, while all others must provide revenue information to an online portal expected to open soon.

Medicine, Drugs and Devices

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Medical students throughout the United States and Europe are graduating early to enter the ranks of front-line healthcare staff battling the coronavirus pandemic. Early graduations are taking place in New York, Massachusetts, Oregon and Louisiana, with graduates often skipping elective courses. Although the graduates matched into residency programs in March are still scheduled to start them in July, many have signed contracts to work for hospitals affiliated with their medical schools or elsewhere, in any capacity they can for the time being. Association of American Medical Colleges Chief Medical Officer Alison Whelan, MD, said state licensing agencies have sanctioned this temporary employment, permitting graduates to practice with supervision. She added that many hospitals have established new roles for fresh graduates, including as scribes to take down notes for doctors conducting physical exams, organizing lab results or talking on the phone with people concerned about whether they need to be tested or who want to check on hospitalized loved ones.


A literal army of white-hat hackers is offering its skills to thwart cybercriminals attempting to exploit healthcare organizations' increased reliance on networks during the COVID-19 pandemic. For example, the nonprofit COVID-19 CTI League counts more than 1,400 volunteers throughout 76 nations, who apply their experience in information security, telecommunications and law enforcement to defend hospitals that are treating COVID-19 patients. An initial progress report from the CTI League indicated that members have assisted law enforcement in eliminating almost 3,000 cybercriminal assets online and identified more than 2,000 cyber vulnerabilities at hospitals, healthcare groups and supporting facilities.