News From ACFAS

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Since 2018, the Joint Task Force of Orthopaedic and Podiatric Surgeons has worked on mutually beneficial policy goals. The four participating organizations are the American Academy of Orthopaedic Surgeons (AAOS), the American College of Foot and Ankle Surgeons (ACFAS), the American Orthopaedic Foot & Ankle Society (AOFAS), and the American Podiatric Medical Association (APMA).

Now after years of thoughtful discussion and deliberation, the task force has unanimously endorsed a white paper, which addresses the goal of equivalency in education pathways and certification. The next step in this process is a resolution that was recently submitted for consideration at the June 2021 Special Meeting of the American Medical Association (AMA) House of Delegates.

Both the white paper and resolution demonstrate the goal shared by orthopaedists and podiatrists in standardizing education and accreditation for care of the foot, ankle, and lower leg. We are proud of our combined efforts to date and look forward to continued valuable collaboration between our professions to benefit our members and our patients in the future. It’s launch day for ACFAS’ newest journal Foot & Ankle Surgery: Techniques, Reports & Cases (FASTRAC). As the College’s first case study, open-access journal, it will feature the latest advances in cutting-edge surgical techniques for correction of foot and ankle disorders.

FASTRAC is the place to access clinically relevant articles, reviews and case reports for in-depth coverage of all areas of the medical and surgical treatment of foot and ankle disorders. The new journal is electronic and free to access at FASTRACjournal.org.

ACFAS is proud to have two journals and we encourage you to share both with your colleagues and consider submitting your research. ACFAS members receive a discount on author fees charged upon acceptance of a paper. If you have a case study or other type of article you’re interested in having published, visit acfas.org/FASTRAC for more information. Your ACFAS 2021 Program is here! Take a look to see what’s in store for you this year!

Get the full list of sessions, exhibitors, speakers and posters while seeing an overview of the convention center, ACFAS Digital Portal, Exhibit Hall information and new safety protocols to keep everyone safe and healthy.

We’re less than a week out from Las Vegas, so flip through this year’s program and get ready for another great conference! Please note, printed copies will not be available onsite. Visit acfas.org/LasVegas to download the program and for more information on this year’s meeting. Make the most of your ACFAS 2021 experience with the mobile app—your guide to navigating the ACFAS Annual Scientific Conference. In the palm of your hand, you’ll find the entire conference schedule, a list of your pre-selected sessions, a listing of over 200 posters, important meeting alerts and announcements, session evaluations, convention center maps, live social media feeds and more!

To Download and Log In:

1. Search your Apple or Google Play app store (iOS or Android) for eventScribe—it’s a blue icon with a white eS.
2. Enter the app and at the bottom of the home page, select ACFAS 2021 icon under the Upcoming Events or search ACFAS 2021 in the search bar.
3. Enter your email as your Username:
4. Enter your Attendee ID as your Password:
5. Tap Login

When you registered for the ACFAS Annual Scientific Conference, you made your selection of the educational sessions most beneficial to you. We have already loaded the sessions you selected and you’ll have access to them under the My Schedule icon. An email was sent to conference registrants on Monday with more detailed information on downloading and accessing the app.

Visit acfas.org/LasVegas for more information on this year’s meetings.

Foot and Ankle Surgery

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A retrospective radiographic review sought to assess surgical correction of hallux valgus deformity acquired via chevron and minimally invasive distal metatarsal osteotomy (MIDMO) at a single institution between 2012 and 2017. Radiographic parameters, including intermetatarsal angle (IMA), hallux abductus angle (HAA) and tibial sesamoid position (TSP), were compared on weight bearing anterior-posterior and lateral radiographs. Sixty-one patients who underwent distal first metatarsal osteotomies were split into two groups: Group A had 30 patients with a chevron bunionectomy performed by Surgeon A, while Group B included 31 patients who had MIDMO performed by Surgeon B. Group A's mean follow-up was 26.6 months while Group B's was 18.7 months. Both cohorts had statistically significant radiographic correction for pre- and postoperative IMA, HAA and TSP. Post-surgical retrospective radiographic review indicated that both chevron and MIDMO procedures deliver comparable radiographic correction of those three parameters.


A systematic review summarized existing evidence for soft tissue structural differences in the feet of people with and without diabetes mellitus. AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database and Web of Science electronic databases were mined for studies published from database inception until Oct. 1, 2020. There were 35 non-randomized observational studies deemed suitable for inclusion, of which 20 assessed plantar tissue thickness, 19 evaluated plantar tissue stiffness, nine evaluated Achilles tendon thickness and five evaluated Achilles tendon stiffness outcomes. No significant deviations in plantar tissue thickness were observed between people with and without diabetes in 55 percent of studies, while significantly greater stiffness was seen in people with diabetes in 47 percent. Significantly greater Achilles tendon thickness was found in diabetics in 44 percent of studies and no significant differences in Achilles tendon stiffness were noticed between people with and without diabetes in 60 percent. The researchers concluded that high-quality studies using standardized and validated assessment methods in well-defined populations are necessary to determine more fully understand structural tissue characteristics in the pathogenesis of diabetes-related foot ulcerations.


A study assessed the surgical treatment of Moebius syndrome (MS) with clubfoot (CF) in children, using data collected on 11 MS patients with unilateral or bilateral CF between 1990 and 2019, for 17 feet in total. Six patients (10 feet) were treated elsewhere, performing first surgery at an average age of nine months and in a hospital for relapse surgery at an average age of 4.5 years (Group 1). Five patients (seven feet), were primarily treated in the hospital with a peritalar release according to McKay at an average age of 9.4 months (Group 2). The average American Orthopaedic Foot and Ankle Society for Hindfoot (AOFAS), Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) scores were 82.8, 84.8 and 82.3 for Group 1 and 93.2, 94.7 and 95.1 for Group 2 at an average follow-up of 16.9 and 13.3 years, respectively. The average Diméglio score improved from 15.5 to 4.8 in the long-term follow-up in Group 1 and from 14.6 to 3.8 in Group 2. Comparison between cohorts indicated improved AOFAS, FAOS and FAAM scores for Group 2, particularly for pain, function and foot alignment and for the post-surgical Diméglio score. CF in MS had greater severity and presented a higher relapse rate than idiopathic CF. Peritalar release indicated no relapse and better subjective and functional outcomes in the long-term follow-up compared to other surgical procedures.

Practice Management

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Family physician Rebekah Bernard offers strategies that physicians can apply to help distressed colleagues, especially to prevent suicide ideation. "Take note if a colleague reports fatigue, somatic or physical complaints, appetite or weight changes or be short-tempered or irritable," she recommends. Sudden changes in behavior and a tendency to isolate from others also can be symptoms of distress. "The best time to interact with a distressed colleague is when the physician is not rushed and when you have enough time to give your complete attention," Bernard writes. A noncommittal response to questions should not be accepted, and physicians should probe deeper. "If the physician does start to open up or give hints as to their emotional distress, be prepared to listen and show empathy," she advises. "No matter what, don't start trying to problem solve." Bernard also recommends that physicians encourage distressed colleagues to seek professional help. "Consider sharing the Physician Support Line, where volunteer psychiatrists offer free and confidential support to physicians," she writes.


The COVID-19 crisis has inspired a wave of new applicants to medical schools, with the Association of Schools and Programs of Public Health (ASPPH) estimating that graduate-level degree programs in public health drew nearly 24,500 applicants for this fall, a 40 percent year-on-year boost. Meanwhile, Columbia University's Postbac Premed Program has attracted 437 applications so far for sessions starting in summer and fall, versus 297 by the same time last year. The ASPPH said medical schools have seen an 18 percent rise in applicants to enter this year, compared with the same time last year. Since it can take years to complete the science course requirements, school officials said much of that growth may reflect candidates' decision to endure the admissions process sooner than expected, because they had more time when college went virtual last year or jobs disappeared.

The Princeton Review disclosed a 22 percent increase in enrollment in preparation services for the Medical College Admission Test from January through mid-April, compared with a year ago. Harvard Medical School said 8,002 applications for this coming term have been submitted, a 19 percent uptick from the prior cycle. Harvard Medical School's Robert Mayer said some individuals who had previously expected to take gap years may have opted to apply because jobs vanished during the pandemic, while offering virtual interviews also made it easier to apply to more schools concurrently.


Electronic health record (EHR) implementation has unique challenges that healthcare providers can meet with proper preparation. Any provider hoping to integrate an EHR system with their practice should first learn how to mitigate cybersecurity risks and safeguard sensitive patient information. This includes having a data recovery and backup plan in place should a storage system crash, get attacked by cybercriminals or suffer a partial outage. Storing all EHR data with a cloud hosting provider that complies with regulations mentioned within the Health Insurance Portability and Accountability Act is a best practice. Data interoperability also should be supported, and state-of-the-art technology solutions like Natural Language Processing can enable providers to devote more attention to patients and less to paperwork. If a facility is using a virtual care delivery model, one best practice is to integrate its EHR system with the telehealth platform to enhance interoperability of patient records and other critical health data.


A survey of 1,000 people conducted on behalf of patient-experience software vendor Kyruus found most consumers still favor in-person care for long-term needs, while almost one-third are more likely to opt for virtual visits now than before the pandemic, and nearly two-thirds say telehealth access will be an factor in deciding where to get care in the future. "It is evident that the pandemic permanently re-shaped patient preferences and expectations in profound ways," said an accompanying report. According to the poll, 62 percent of respondents had a virtual care visit from March 2019 through March 2020, which was a first-time experience for 71 percent. In terms of mental healthcare and routine care especially, more than 40 percent of respondents preferred to access services virtually or through a mix of virtual and in-person visits. "This research underscores the importance of coupling clinical and consumer perspectives to maximize how much of the pandemic-driven innovation remains permanently," concluded Kyruus chief medical officer Erin Jospe.

Health Policy and Reimbursement

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Although telemedicine has been around for years, it was not until the pandemic that uptake rose significantly. US employers and insurers are now pushing to make telemedicine a first choice for most doctor visits. Amazon and several insurers have started or expanded virtual-first care plans to get people to use telemedicine routinely, even for planned visits like annual checkups. Advocates say this can keep patients healthy and out of expensive hospitals, which makes insurers and employers that pay most of the bill happy. However, some doctors worry that this could create an over-reliance on virtual visits. The goal of the virtual-first approach is to make patients feel more connected to their health and less reliant on Google searches for advice or the nearest urgent care center to treat something minor.


Doctors and dentists are concerned about the additional costs associated with COVID-19 protocols, which have made treating patients more expensive. Some have asked whether insurers should bear some of those expenses. Efforts to have the US Centers for Medicare and Medicaid Services (CMS) approve a new procedure code for personal protective equipment (PPE) failed, a move that could have prompted private insurers to follow suit. CMS said those costs are part of the payment for the rest of the appointment. Meanwhile, in California and Washington state, medical professionals sought legislation to require insurers to reimburse medical and dental practices for pandemic-related expenses like PPE, but insurance groups oppose those measures. Insurers say providers have received help from the federal government in the form of loans, state-based grants and programs that have distributed free PPE.

Medicine, Drugs and Devices

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US lawmakers have unveiled eight different antitrust bills designed to address the problem of excessively high drug prices. During a recent hearing of the House Judiciary Committee's antitrust panel, Democrat and GOP lawmakers from both chambers said that they had introduced bills intended to prevent pharmaceutical companies from curbing generic competition. Two of the bills seek to curb product-hopping, or making minor changes to a medication to obtain a new patent. Other measures call for prohibiting pay-for-delay patent settlements, where brand name drug companies pay generics to delay their entry into the market. Another bill would allow the Federal Trade Commission to bar fraudulent citizen petitions, where drug companies petition FDA about a generic company seeking approval for a competing drug in an effort to delay its approval. Finally, two other bills intend to make it easier to bring biosimilars to market. Each of the bills has both a Democrat and GOP lawmaker as a sponsor of both the House and Senate versions.


The White House confirmed it will support the temporary waiver of intellectual property provisions to allow developing nations to produce COVID-19 vaccines created by pharmaceutical companies. "The administration believes strongly in intellectual property protections, but in service of ending this pandemic, supports the waiver of those protections for COVID-19 vaccines," said US Trade Representative Katherine Tai. She confirmed the US government will support a proposal working its way through the World Trade Organization, but cautioned that the talks to approve the waiver policy might take some time.