News From ACFAS

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Your College’s website is new and improved! Not only has the look and style of the site been re-vamped aesthetically; it underwent a major re-structuring to ensure greater ease of use and user-friendly navigation. Rest assured, this is still your College’s website, just enhanced and re-designed to serve you better! We’ve also added some great new features and content, such as:

• New, Interactive Education Calendar
• An Enriched Marketing Toolbox to Help Market Your Practice
• Direct Links to the Latest JFAS Articles on the Home Page
• Enhanced Search Feature to Find the Content You Need
• Mobile Friendly Optimization for Viewing on Your Smart Phone
• Twitter Feed on the Home Page

As with any new website, we will be spending the next few weeks tweaking pages and links as needed, so thank you in advance for your patience. Be sure to visit the new acfas.org and see how it has evolved! Register for the latest in comprehensive, case-based lectures and discussion, the Minimizing Complications, Maximizing Results Seminar in New Orleans, October 11-12. This course is led by experts in the field of foot and ankle surgery. The stellar faculty will ensure that course participants are able to identify ways to avoid and analyze complications, identify and apply strategies to improve patient outcomes, analyze case-based approaches to deal with complications of the foot and ankle, and determine surgical approaches to deal with complications. Attendees are also urged to bring their own difficult complications cases to have the opportunity to consult with faculty members.

Participants of this course will earn 14 continuing education contact hours and there is special pricing for members of ACFAS, but hurry, space is limited. Be sure to register today before this class is filled. For the third year in a row, the ACFAS Student Club at Des Moines University (DMU) was named Student Club of the Year. The College of Podiatric Medicine and Surgery's (CPMS) first- through third-year student body voted for the club they felt best embodied the goals of CPMS, specifically keeping in mind the sponsored activities, educational experiences, and service to the community.

Educationally, students in this club made great use of the ACFAS surgical videos, while first year liaisons highlighted aspects of these procedures. The club also used an ACFAS video presentation to instruct members on performing a Z-plasty, and students had the opportunity to try the procedure on pig’s feet. Club members also benefited from a presentation by Past ACFAS President Michael S. Lee, DPM. “Dr. Lee included some challenging questions, great videos showing the use of ankle scopes, and his advice and suggestions from personal experience,” said the club’s First-Year Liaison and President-Elect Jordan Gardner.

The ACFAS Student Club at DMU also excelled in community outreach: from fundraising for the Toys-for-Tots Foundation to volunteering at booths to provide instructional materials for the community at a Senior Health Fair and a Community Action event. ACFAS is proud of the work and accomplishments of its Student Club at DMU!

Foot and Ankle Surgery

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Researchers analyzed the effectiveness of the Ilizarov technique in treating relapsed clubfoot in older children and found it to be a good management alternative based on the Beatson and Pearson numerical assessment. The researchers treated 42 clubfeet on children who underwent previous correctional surgery but relapsed. They used the Dimeglio classification for clinical assessment of the relapsed feet preoperatively as well as postoperatively. A follow-up that took place at an average of 4.6 years after the Ilizarov procedure found 37 clubfeet were still in excellent or good condition, while five feet had poor results. The researchers concluded the Ilizarov technique was a good alternative for severe clubfoot deformities.


A study was held to determine whether delays to open reduction and internal fixation of ankle fractures due to excessive swelling could be reduced through utilization of preoperative application of an intermittent pneumatic foot pump (IPF). Twelve patients managed with an IPF were compared to 12 matched historical controls who were not. Those managed with the pumps exhibited a statistically significant 50 percent reduction in time from presentation to surgery versus those managed without. Patients with IPFs also spent less time in the hospital, resulting in a net saving of 10,480 British pounds, or 953 British pounds per patient.


To determine the cost-effectiveness of operative treatment of Achilles tendon ruptures based on theater occupancy, clinic attendance and cast changes, operative complications and functional assessment score, researchers audited the cost-effectiveness of surgical management of such ruptures between 2005 and 2011 through comparison of 49 patients receiving percutaneous repair with 35 patients who received open repairs. In terms of complications, no significant difference was observed between the two procedures. Achilles Total Rupture Scores were comparable, while theater occupancy and hospital stay were substantially longer with open repair versus percutaneous repair. The researchers estimated the surgical costs of open repair and percutaneous repair to be 935 British pounds and 574 British pounds, respectively, not including the cost of running the operating theater.

Practice Management

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A new report from the American Medical Association (AMA) finds that use of computers and electronic health records (EHR) in an exam room does not have a negative effect on clinical encounters. Some had feared that EHRs could disrupt or undermine communication between patients and physicians, but it generally appears that this has not happened. The report found that disruptions are minimized by technical innovations which “focus required computer tasks on activities that meaningfully influence patient outcomes, or that streamline data input and reduce the time needed to complete common tasks in clinical work and decrease the potential for distraction.” The way a physician interacts with patients affects how distracting the EHR can be, the report found, as does a doctor’s attitude toward the technology. But some patients found EHR to be an improvement either way.


How practices pay their staff can be more valuable than what is paid in ensuring they are productive and are not seeking work elsewhere. Consultant Reed Tinsley says medical practices that excel the most at human resources are those that can generate the most revenue and have the more robust bottom line. These practices are distinguished by no turnover, and employees who are motivated to report to work every day. Although competitive salaries are an important factor for drawing and retaining staff, even more important to sustaining employee motivation is how money is paid out.

Rather than straight pay raises, thoughtfully considered and implemented merit raises and benefits, which can offer financial and other incentives to employees for fulfilling specific goals and expectations, may be a better approach. Tinsley notes that merit raises are a particularly viable option for most physician practices, which start out small. Merit incentives are a reward for optimum employee performance, and thus encourage greater productivity. Consultant Kevin Haeberle says a merit raise or bonus should first comprise at least 2 percent of an employee's salary to change employee behavior.

Haeberle also recommends offering an individualized merit program for each staffer, or permitting them to select from a “cafeteria plan” of various incentive options. Meanwhile, Steve G. Takacs at Nigro Dermatology in Houston, Texas, says nonbenefit salary perks can be an additional encouragement, and these perks should exhibit across-the-board consistency and avoid favoritism. Haeberle also observes that younger employees could be motivated by benefits other than money, such as time off, the opportunity to take a class or attend a conference, etc. Tinsley points out that keeping workers long-term may require the provision of alternative incentives as well, as constantly raising wages is impossible after a certain point.

Practices would do well to solicit employees for input as to what kind of incentives would motivate them. Haeberle says a survey can assess employee incentive priorities and employee perspectives on benefits, office workflow and procedures, while anonymous surveys tend to elicit more honest responses. Large practices might want to hire an outside consulting or research company to measure and communicate more specifically employee feelings concerning work processes, salary, pride in employment, motivation and other issues. Consultants found that employees value being recognized and appreciated by employers above all, while financial reimbursement comes in second in terms of job satisfaction.

Health Policy and Reimbursement

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Sen. Tom Coburn (R-Okla.) has introduced the Senate version of the Costly Codes Act of 2013, parallel legislation which was introduced to the House of Representatives by Rep. Ted Poe (R-Texas), which is aimed at blocking the U.S. Department of Health and Human Services from putting in place ICD-10 diagnostic and procedural codes on Oct. 1, 2014. Coburn, who is a physician, has teamed with optometrist John Boozman (R-Ark.) and fellow doctors John Barrasso (R-Wyo.) and Rand Paul (R-Ky.) to back the bill. Coburn maintains that ICD-10 implementation should be halted until healthcare providers have gained a better hold on other healthcare reform measures nearing actualization. Coburn cited a report that concluded implementing ICD-10 would cost smaller practices as much as $83,000, while larger practices with 100 physicians or more could spend about $2.7 million.


Skipping from ICD-9 to ICD-11 might not be a good idea, according to a recent report from the American Medical Association (AMA), called "Evaluation of ICD-11 as a New Diagnostic Coding System." The AMA report says skipping over ICD-10 completely and moving directly into ICD-11 is "fraught with its own pitfalls and therefore, based on current information available, is not recommended." The report lists several concerns with not implementing ICD-10 before ICD-11, including their estimation that it could take 20 years to fully implement ICD-11. "ICD-9 is outdated today, and continuing to use the outdated codes limits the ability to use diagnosis codes to advance the understanding of diseases and treatments, identify quality care, drive better treatments for populations of patients and develop new payment delivery models," the report states.


Some major health insurers, including UnitedHealth Group, are not participating in California's new state-run health insurance market, possibly limiting the number of choices for millions of consumers. UnitedHealth, the nation's largest private insurer, Aetna and Cigna are sitting out the first year of Covered California, the state's insurance exchange and a key testing ground nationally for a massive coverage expansion under the federal healthcare law. Meanwhile, the biggest insurers in the state — Kaiser Permanente, Anthem Blue Cross and Blue Shield of California — are all expected to participate in the state-run market for individual health coverage.

Medicine, Drugs and Devices

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A study published in the journal Arthritis & Rheumatism has found that vitamin C is not an effective treatment for gout. The study found that 500 mg doses of vitamin C per day did not enhance the ability of the gout treatment allopurinol to reduce serum urate levels, nor did vitamin C lower levels of serum urate when used alone. Researchers decided to carry out the study after a previous study found that 500 mg of a vitamin C per day helped to reduce serum urate levels in people without gout. Experts say that the differences in the findings between the more recent study and the earlier one may be explained by the small number of participants who took part in this latest research.


Researchers at National Jewish Health have developed a test that can detect an allergy to nickel. Nickel is commonly used in joint implants and can cause severe allergic reactions. The test, which is the first of its kind and has yet to be approved, involves drawing blood from the patient rather than using a skin patch. If the test comes back positive, patients can then choose a joint implant made of an alternative material. Researchers say that the advantages of using a blood test include speedy processing and no need for someone who knows how to perform a skin patch test.


A study published in Nature Medicine has found that the excessive production of bone following an injury is the primary cause of osteoarthritis, rather than problems with cartilage in joints. Researchers at Johns Hopkins University examined mice with anterior cruciate ligament (ACL) tears—a known cause of osteoarthritis in the knee—and found that the subchondral bone had been broken down by osteoclasts one week after the injury. The break down of the subchondral bone resulted in the production of large amounts of TGF-beta 1, which in turn resulted in the formation of so much bone that it placed too much stress on the cartilage. Treating the subchondral bone with a TGF-beta 1 inhibitor stopped the progression of osteoarthritis.


Researchers in Japan have found that Siglec-15 plays an important role in physiologic bone remodeling. The study examined Siglec-15 in mice, and found that it regulates osteoclast development and bone resorption by modulating receptor activator of nuclear factor kB ligand (RANKL) signaling in conjunction with the DNAX-activating protein 12kDa (DAP12). Researchers also examined the impact of Siglec-15 deficiencies, and found that mice that had low levels of the lectin had a mild form of osteoporosis caused by a reduction in osteoclast development. In addition to impaired osteoclast development, cells that lacked Siglec-15 also consistently showed defective resorptive activity in vitro.