News From ACFAS

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The generosity of corporate grants and sponsorships help sharpen our focus and support courses, symposia and the Annual Scientific Conference to help you do your best. Browse our Corporate Sponsorship Mall to learn more about our sponsors’ products and services and how they can assist you in your practice. Summer is almost here, and we want to see all the great places your feet will take you! Share photos of your feet exploring the outdoors, hard at work or relaxing at home through your own social media accounts and use the #KeepYouOnYourFeet hashtag to show how foot and ankle surgeons help keep people active and “on their feet.”

Also, send to melissa.matusek@acfas.org along with your name, the location or action in the photo and where you practice so we can post your photo on the College’s social media sites.

Follow #KeepYouOnYourFeet on our Instagram, Facebook and Twitter feeds, and encourage your patients to participate in our #KeepYouOnYourFeet campaign too! Help us maintain the quality and accuracy of the abstracts featured in each issue of This Week @ ACFAS by serving as a This Week content reviewer. We currently have an opening for one content reviewer.

As a content reviewer, you will receive a This Week preview every Friday. You would check the abstracts listed under each section for relevance and technical/medical accuracy and then email your changes and input to ACFAS staff for implementation.

If you are interested in this position, please submit your CV for consideration to Melissa Matusek, CAE, ACFAS director of Marketing and Communications, at melissa.matusek@acfas.org.

Foot and Ankle Surgery

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A retrospective study assessed the occurrence of postoperative bleeding, hematoma formation and wound dehiscence after perioperative aspirin ingestion prior to foot and ankle surgery. The medical records of 379 patients treated over a three-year period were reviewed, with patient demographics, surgical procedures, affected limbs, anatomical surgical sites and week 2 surgical site inspection data recorded. Average patient age was 60.12, and the overall wound complication rate was 0.80 percent.

Two of the three patients who developed postoperative bleeding complications were taking 81 mg aspirin, and one was not. Patients taking aspirin exhibited similar wound complication and healing rates as those not taking aspirin, and postoperative hematomas were evacuated in the clinic under sterile conditions and healed by secondary intention.


A study sought to evaluate the risk of cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes and peripheral arterial stiffness (AS) and its potential connection to atherosclerosis. The 264-patient population mean age was 35 plus or minus 11 years, with a disease duration of 19 plus or minus 10 years and mean hemoglobin A1c of 7.5 percent plus or minus 1.3 percent. Seventy-three patients had peripheral AS with 28 showing asymptomatic peripheral arterial disease (aPAD).

Prevalence of CAN among patients with AS was 48 percent, versus 23 percent in subjects with normal ankle-brachial index. Concomitant aPAD increased the odds ratio for CAN, and AS remained associated with parasympathetic dysfunction following adjustments for aPAD and relevant cardiovascular risk factors.


A study sought to evaluate radiographic measurements in feet with juvenile hallux valgus (JHV) in comparison with matched controls and to characterize foot alignment in JHV's possible relationship to flatfoot. A total of 163 patients with JHV, as defined as hallux valgus angle greater than 20 degrees and intermetatarsal greater than angle than 10 degrees, were reviewed, and patients with open physes of the feet and weightbearing radiographs of the feet were included. No significant difference in hindfoot alignment of patients with JHV and controls was observed.

Naviculocuboid overlap, lateral talo-first metatarsal angle and metatarsus adductus angle were substantially greater in patients with JHV than in controls, while the anteroposterior talo-first metatarsal angle was significantly less. Symptomatic and asymptomatic JHV patient subsets had no significant radiologic differences.

Practice Management

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James Legan, MD, a Montana-based internist, is taking steps to attract more Millennials and Generation Zers to his practice. He recently started using secure texting so patients could ask for prescription refills and request copies of reports, lab results and office visit summaries. His nurse signs patients up for text messages after taking their vital signs, and she responds to messages as they come in. Legan also says nearly 70 percent of his patients actively use the patient portal that is linked to his electronic health record (EHR) system. Legan is now exploring providing secure video chatting to address common medical problems.

Mike Morgan, chief executive officer at Updox, a patient engagement consultant in Dublin, Ohio, says younger patients expect their healthcare experience to resemble that of other industries. He adds, "Upon checkout, they'll want to know what specific costs they've incurred as well as instructions for next steps (e.g., tests or referrals)." In addition, Morgan says a practice's website needs to feature updated information and high-quality photos of staff and office while providing a robust user experience. "Some patients look at the website as a proxy for the experience they will receive at the practice," he notes.

Norm Schrager, senior content marketer and strategist at PatientPop, a practice growth technology provider in Santa Monica, Calif., points out that many products allow practices to put parameters on online scheduling options and can fully integrate with EHR scheduling systems.


Healthcare law attorney Ericka L. Adler had the opportunity to speak at the annual meeting of the American Society of Addiction Medicine. Adler and her colleague Effrem Grail shared recent national Drug Enforcement Administration (DEA) actions against physicians who prescribe opioids and what physicians can do to protect themselves and their practices. For example, practices can set or update protocols for surveillance of common areas and create a secure storage locker area for staff in relation to drug samples and prescriptions. The practice's electronic health record (EHR) system should be checked to see if it allows prescriptions to be canceled after a prescription has already been printed. One practice's EHR vendor started working to address this loophole and has created alerts as well as a cross-check system.

It is likely that other practices may have the same issue and are simply unaware. All workplaces face some of these challenges as long as there are individuals looking for opioids for themselves or to provide them to others. However, medical practices serve as an easier gateway to opioids and must be on alert at all times. Developing a strategy is key to protecting and reducing practices' liability. This can be done through a combination of safeguards, including video surveillance, EHR review and audit and random employee drug testing (if appropriate). Practices should turn to their legal advisors to discuss what challenges they may face and what legal options are available to avoid opioid misuse.


A study published in the Annals of Internal Medicine found U.S. physicians suffer burnout at almost twice the rate of other professionals. Physicians cited long hours, fear of litigation and mounting bureaucracy, such as arduously filling out electronic medical records as contributors. Burned-out physicians tend to make more medical errors, and their patients have poorer outcomes and less satisfaction. Physician suicides also occur more often than within the general U.S. population, and the overall economic effect is about $4.6 billion lost annually. "Marketing costs to advertise the position, costs of hiring, costs associated with training and starting out a physician—all of these really add up pretty quickly," said National University of Singapore Professor Joel Goh. An anticipated physician shortage in the United States is expected to compound these costs.

Health Policy and Reimbursement

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"Medicare for All" supporters are rallying to raise the single-payer issue into a working-class flashpoint that is designed to strengthen the economy and spur wage growth. Rep. Pramila Jayapal (D-Wash.) says as the cost of employer-sponsored healthcare continues to climb, “a lot of labor has come to understand that they're leaving wages on the table by having to pay for healthcare.” Among the organizations leading the grassroots Medicare for All charge is National Nurses United (NNU). NNU's Kelly Coogan-Gehr noted workers find the proposal's purported wage benefits especially appealing. Micro Trap President David Steil contended that promoting single-payer's potential as a low-cost strategy to bolster the free market should help convince Republicans and the working class of its value.


California lawmakers are attempting to close legal loopholes that would restrict how much hospitals outside of a patient's insurance network can charge for emergency care. So-called balance or surprise billing, when a patient receives out-of-network care from a provider who then bills the patient for the amount that insurance did not cover, can extend into the tens of thousands of dollars. The proposed legislation would ban out-of-network hospitals from sending surprise bills to privately insured emergency patients, requiring providers to work directly with health plans on billing. This would make patients only responsible for in-network co-payments, coinsurance and deductibles. "If we are able to move this forward in California, it could be a model and standard for what happens around the country," said bill sponsor Assemblyman David Chiu (D-Calif.).


According to eHealth, average Medicare Advantage (MA) premiums dropped by 33 percent in the first quarter, with an 87 percent year-over-year increase in the amount of MA and Medicare Part D applications received during the open enrollment period (OEP) from January to March. Although extra coverage options, including those with lower average monthly premiums, are available for MA enrollees, 51 percent of eHealth survey respondents were unaware of OEP prior to shopping for a new plan. The average monthly cost for MA plans during the OEP was $8, versus $12 in the first quarter of last year, and the average out-of-pocket limits slipped 11 percent from $5,815 to $5,164. Average monthly premiums for Part D plans declined by 4 percent, and average MA deductibles decreased by 13 percent while Part D plan deductibles rose by 5 percent from $292 to $308.

Medicine, Drugs and Devices

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Gov. Jared Polis of Colorado has signed into law legislation capping the price of copays for insulin, making it the first state to enact a law that combats the soaring costs for the medication that have doubled in the last seven years. The law goes into effect in January. The new law also requires state Attorney General Phil Weiser to investigate why insulin prices dramatically increased in recent years and to issue a report to the legislature.


New research shows that patients find being able to read the electronic health record notes that clinicians write following medical visits helped them with medication management. In the study, three health systems that share notes with patients online conducted a web-based survey of a combined 20,000 adult patients between June and October of 2017. In the survey, 64 percent of patients reported that the system improved their understanding of why a medication was prescribed. Furthermore, 62 percent said they felt more in control of their medications, 57 percent found answers to questions about the drugs and 61 percent said they felt more comfortable with medications. The study authors, who reported their findings in the Annals of Internal Medicine, noted that sharing clinical notes is a simple and relatively low-cost way to improve medication adherence.


Countries at the World Health Organization (WHO) agreed to a draft resolution backing clearer drug pricing but stopped short of requiring pharmaceutical firms to disclose the cost of making medicines. The draft resolution calls on governments to share more information about the prices they pay for drugs. It was praised by WHO chief Tedros Adhanom Ghebreyesus and "enthusiastically welcomed" by the United States, but the United Kingdom, Germany and Japan said the debate had been rushed and called for the issue to be studied more closely. The latter countries have healthcare systems that involve negotiating steep discounts from drug companies to keep their costs low. The resolution, first proposed by Italy, calls on governments to publicly share information on net prices.