News From ACFAS

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Experience the ACFAS Perspective on best-in-class arthroscopic training. Register now for Arthroscopy of the Foot & Ankle, held at the renowned Orthopaedic Learning Center in Rosemont, IL, just minutes from Chicago O’Hare International Airport.

Participate in didactic and hands-on laboratory learning led by a rotating lineup of ACFAS thought leaders. Spend more than nine hours in the lab while working with four different brands of scope and advanced surgical and audiovisual equipment. Be sure to also bring your own arthroscopic radiographs to dinner the first night of the course for discussion and feedback.

Space is still available in our October and November courses. Visit acfas.org/skills to secure your spot and get ready to refine your arthroscopic technique, no matter your skill level. Take your latest groundbreaking research out of the lab or operating room and present it in poster format at ACFAS 2020, February 19–22, 2020 in San Antonio.

The College’s annual poster competition showcases the newest advancements in foot and ankle surgery and always draws a crowd. Winners will receive the following prize amounts in each poster category (Case Study, Scientific and Student Club):

First Place: $1,000
Second Place: $700
Third Place: $500

Poster abstracts for this year’s competition are due to ACFAS by September 10, 2019 to be eligible for review. Submission guidelines and criteria will be available on acfas.org during the summer—check back soon! ACFAS Student Clubs have a presence at all nine podiatric medical school campuses and provide valuable ways for students to get involved in the profession beyond their courses.

Student Club presidents also fill an important role as a liaison between their school and ACFAS. Presidents facilitate club activities and are instrumental in welcoming podiatric medical students into the ACFAS community.

ACFAS Student Club presidents for the 2019–2020 school year are:

AZPod: Ross Groeschl, Class of 2021
Barry: Justin Carney, Class of 2021
CSPM: Christopher Zimmer, Class of 2021
DMU: Joseph Brown, Class of 2021
Kent State: Deana Lewis, Class of 2021
NYCPM: Michael Rutkowski, Class of 2021
Scholl: David Warciak, Class of 2022
Temple: Samuel Strass, Class of 2021
Western U: Katherine Hu, Class of 2022

For details on each of the Student Clubs, visit acfas.org.

Foot and Ankle Surgery

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A retrospective study was conducted to compare operative outcomes between the lateral approach (LA) and the central approach (CA) to insertional Achilles tendinopathy. A total of 39 patients in the LA group and 32 in the CA group were reviewed, and average visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Scale scores improved significantly in each cohort. Short Form Health Survey scores exhibited the most improvement.

No significant differences were observed in baseline score, average AOFAS Scale score at each visit, mean VAS score preoperatively and at last visit, satisfaction rate and overall complication rate. The average VAS score in the LA group at three months postoperatively was significantly lower than that in the CA group, and significantly more cases of delayed wound healing were noted in the LA group versus the CA group.


A retrospective study compared nylon sutures and skin staples for wound closure in foot and ankle surgeries, as they related to complications and patient satisfaction. A cohort of 61 patients underwent different operations in the fore-, mid- and hindfoot areas, performed by one surgeon. Twenty-nine patients got staple wound closures, while 32 received nylon suture closures using the Donati back-and-forth technique.

A substantial between-group difference was seen in terms of surgery time and verbal numeric rating scale for pain, with improvements noted for staples. Four patients with skin staple and five with nylon sutures had wound dehiscence 14 days after the operation, but all patients had completely healed wounds at their six-week follow-up, without any revisional surgeries required.


A study was conducted to identify the prognostic factors affecting correction angle changes following supramalleolar osteotomy applied as a salvage treatment for varus ankle osteoarthritis. Fifty-three consecutive patients comprising 58 ankles were evaluated retrospectively, with average visual analog scale scores and the American Orthopaedic Foot and Ankle Society scores showing significant improvement at the final follow-up. The average tibial-ankle surface (TAS), talar tilt (TT) and tibial-lateral surface angles improved significantly postsurgically, versus preoperative assessments.

However, these angles had changed significantly at final follow-up compared to their immediate postoperative values, and the changes in the TAS and TT angles significantly influenced the clinical results. Male gender, high body mass index and the presence of lateral cortex breakages were significantly associated with the changes in the TAS and TT angle.

Practice Management

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Patient payment collection should be an area of continuous improvement for practices, with key concentrations on financial policies and procedures, employee training and patient engagement and communication. Recommendations to ensure upfront patient collections include drafting clear and reasonable financial policies, followed by ongoing staff training in collection policies. Keeping patients' credit card information on file is also suggested.

Tools and technological measures to remind patients of balances and other important information offer additional assurance. Finally, clear and up-front communication with patients is needed to uphold the effectiveness of all financial policies and procedures.


Existing practice staff cannot cope with vacancies without cross-training, with experts also citing the need for detailed, written descriptions of office procedures and policies as critical for training new staff members and getting temps familiarized quickly. Although staffing agencies are an easy way to find credentialed temps, the pitfalls include expense and work restrictions. Still, temps can relieve staff from overwork and burnout while keeping the office functioning at a high level, and experts recommend that practices consult with other practices on recommendations for reliable staffing agencies.

Also useful is requesting that temps be versed in the electronic health records system that the practice uses, since training a temp on an unfamiliar system can take time and place an additional onus on the staff. To avoid the extra cost and uncertainties of a temp agency, some practices use their own "float pools" of employees who can fill in for a single shift, a week or even months.


The University of California, San Francisco (UCSF) and The Doctors Company have partnered to investigate the intersection of digital health and patient safety. USCF Professor Julia Adler-Milstein and The Doctors Company's Kerin Barshaw say artificial intelligence (AI) can improve patient safety in various ways, including the use of natural language processing to review clinical charts to check for omissions in patient assessments, predicting risk of harm by reviewing notes and incorporating AI algorithms into frontline clinical decision-making. Adler-Milstein notes AI will never fully supplant physician judgment, and an optimal balance between clinical judgment and incorporating an algorithm must be made. Central to this is weighing algorithm proof with all the other factors a clinician considers.

Health Policy and Reimbursement

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The U.S. Centers for Medicare and Medicaid Services (CMS) approved state plans to amend Medicaid 16 percent faster last year than they did in 2016, according to new federal data. The agency will improve the waiver process that allows states to make changes to Medicaid, such as eligibility requirements and rates, says CMS Administrator Seema Verma. CMS says 78 percent of state waivers were approved within the first 90-day review period during 2018, which was a 14 percent increase over 2016.


In March, the U.S. Centers for Medicare and Medicaid Services issued a request for information on how to eliminate barriers on insurers' ability to sell cross-border health plans. Only four states—Georgia, Maine, Oklahoma and Wyoming—currently have laws that allow such sales. A comment letter from the National Association of Insurance Commissioners said, "These states have each taken a different approach, none of which has, to date, resulted in insurers offering comprehensive health insurance in a state in which it is not licensed. This shows that the impediments to interstate sales are not in federal law but are inherent in the business of health insurance." State regulators are also concerned about the impact on coverage of preexisting conditions.


The U.S. Congressional Budget Office (CBO) said the implementation of a Medicare-for-All single-payer health system is rife with information technology (IT) challenges, including migrating to a standardized IT system across all providers. A lack of interoperability between health systems, and IT challenges in both the Department of Veterans Affairs and Medicare's systems, compound the problem. CBO cited the employment of utilization management by other countries with single-payer systems to monitor and reduce costs and to flag wasteful spending and inappropriate care. The office said a standardized IT system would be essential to a Medicare-for-All model, as it "could help a single-payer system coordinate patient care by implementing portable electronic medical records and reducing duplicated services." To realize benefits, CBO said the system "would need to accommodate all types of providers, particularly those in small practices or rural areas, and address compatibility issues between existing electronic medical records systems."

Medicine, Drugs and Devices

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A biomechanical study was conducted to assess spring ligament repair alone compared to augmentation with the FiberTape device in a cadaveric flatfoot model. Control specimen analysis indicated failures of 100 percent of spring ligament suture repairs, occurring via suture cut-through, suture fatigue and elongation or knot failure. One of eight FiberTape-augmented repairs failed following cyclic loading, and a statistically significant difference in number of repair failures was observed between the two groups.

At forces of 1,600 and 1,700 N, statistically significant differences were apparent between the FiberTape-augmented group and the control group, with a greater collapse in the lateral Meary talo-first metatarsal angle in the controls. No significant difference or abnormal increase in contact pressures of the talonavicular joint was seen in both cohorts.


Two bills were passed by the U.S. House of Representatives to enhance the usefulness of the U.S. Food and Drug Administration's (FDA) Orange Book and Purple Book. The legislation calls for the Orange Book, which is used by drug companies to obtain information on medicines, to be more timely by requiring manufacturers to share complete and up-to-date information with FDA. It would also ensure that the listed patents are relevant to the approved drug product, while invalidated patents would need to be promptly removed. The more recently created Purple Book includes information on when biosimilars and interchangeable biosimilars were licensed and whether FDA evaluated the product for reference product exclusivity. The legislation calls for issuing the publication of the patents of approved biologics in the Purple Book in a similar format and with similar requirements as in the Orange Book.


U.S. Department of Heath and Human Services Secretary Alex Azar announced a new rule to require pharmaceutical companies to reveal the prices of drugs they advertise in television advertisements. The new rule, from the U.S. Centers for Medicare and Medicaid Services, will force companies to disclose the prices of prescription drugs covered by Medicare and Medicaid that cost $35 or more for a month's supply. Addressing high prescription drug prices has been one issue that Democrats and the White House have agreed on over the last few years, with Congress calling pharmaceutical executives to testify.