News From ACFAS

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The ACFAS Clinical & Scientific Research Grant Program is back! Thanks to support from PICA and the ACFAS Regions, the College is offering funding of up to $75,000 each year for an established investigator and up to $25,000 for a new researcher.

Letters of intent should be submitted by September 15 at 5pm CT and final applications are due by October 15 at 5pm CT. The application submission process officially opens on July 15. Visit acfas.org/ResearchGrant for more information. Now's your chance to catch up on the latest research in foot and ankle surgery right from your home—June’s Scientific Literature Reviews (SLRs) are now available.

Get the latest set of short, digestible summaries of research from non-podiatric journals on the latest developments in foot and ankle surgery. This month’s topics include Application of Customized Talar Prosthesis for Revision Total Ankle Arthroplasty, Epidemiology, Management, and Outcomes of Large and Small Native Joint Septic Arthritis in Adults, 3D Printing Talar Protheses for Total Replacement in Talar Necrosis, the Effect of Kiwifruit Therapeutics in Treating Diabetic Foot Ulcers and more.

Get your research roundup for June now at acfas.org/SLR. The United States Bone and Joint Initiative (USBJI) is accepting applications for the Young Investigator Initiative Grant Mentoring and Career Development Program for the Fall Workshop taking place in Chicago October 22-24.

This grant mentoring and career development program is open to promising junior faculty, senior fellows or post-doctoral researchers nominated by their department or division chairs seeking to pursue a career in clinical or basic research. It is also open to senior fellows or residents doing research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards are also invited to apply.

Those selected will attend two workshops, 12-18 months apart, and work with faculty between workshops to develop their grant applications. The application deadline is July 15. Learn more about this program at USBJI.org. The ACFS Virtual Journal Club for June has been postponed. Please join us in July—through December—on the third Thursday of each month at 7pm CT.

Foot and Ankle Surgery

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To assess flatfoot reconstruction via augmented spring ligament repair using a suture tape, researchers reviewed 57 consecutive patients who underwent the procedure between July 2014 and August 2017. Substantial improvements were observed in terms of weightbearing radiographic parameters. Five patients had follow-up operations including one deep infection, two hardware removals remote to the spring ligament augmentation, one ankle arthrodesis and one triple arthrodesis. Concomitant spring ligament repair enhanced via a suture tape was found to be safe and helped in radiographic correction.


Research was conducted to determine musculoskeletal (MSK) podiatrists' use and views on real time clinical gait analysis (RTCGA) when assessing or treating patients with Posterior Tibial Tendon Dysfunction. Participating were 29 MSK podiatrists, and five themes were emphasized: RTCGA technique; working with RTCGA; RTCGA applications; factors to aid RTCGA; and RTCGA skill acquisition. Included in clinical observations were patient perceived experiences such as pain and orthotic comfort, with normative kinematic reference values not deemed important to that management goal. The most frequent RTCGA analyses concerned the rearfoot to leg angle, medial bulge, forefoot abduction and arch integrity. Yet there was much variation in many gait observations between participants. Documentation methods also showed variance, with a four-point scale system to grade motion and position most often utilized. RTCGA skills were most often acquired through experience, while clinical time and space limits were the biggest obstacles to performing RTCGA.


A study sought to examine how Kinesiotape (KT) with closed basket weave method and lace-up braces (LB) impacted the vertical time to stabilization, peak vertical ground reaction force (PvGRF) and time to PvGRF and on perceived stability during lateral landing of female collegiate athletes with chronic ankle instability before and after fatigue. Thirty participants with chronic ankle instability of three conditions (control, KT and LB) undertook lateral landing from a 30-centimeter high step on the plantar pressure platform pre- and post-fatigue. Pre-test findings on the rearfoot of LB negatively increased the PvGRF force and decreased the time to PvGRF. The Bonferroni post-hoc testing revealed LB condition boosted the PvGRF than the control and KT, while the post-hoc testing also indicated that LB condition shortened time to PvGRF force than the control and KT. The LB negatively extended vertical time to stabilization in the forefoot and rearfoot after fatigue. The post-hoc testing showed LB condition generated a slower vertical time to stabilization than the control and KT conditions, while KT did not positively elevate the PvGRF in the forefoot post-fatigue. KT enhanced the PvGRF compared to control LB, but had psychological effects at pre-fatigue that led to significantly greater perceived stability compared to other conditions.

Practice Management

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The interchangeable use of the terms telehealth and virtual care should be discouraged, as innovations in digital health technology no longer make them synonymous. Determining how best to provide a virtual patient care experience that encourages health, value and convenience demands a more expansive perspective of virtual care that encompasses telehealth, remote patient monitoring (RPM) and digital therapeutics. Time-strapped physicians must support better patient experiences and outcomes without additional operational burden, and RPM does this by balancing synchronous telehealth and in-person visits with asynchronous, digitally enhanced patient support. Meanwhile, collecting data in between patient visits eliminates the traditional constraints of in-office physiological assessments, ensuring a more accurate assessment of patient health because it does not rely on patient memory, transparency or context. Improving outcomes requires that providers use tools that accommodate proactive decision-making and interventions, and RPM delivers the ability to review real-time trends, insights and patient data. Moreover, the best RPM solutions will be part of replicated research published in peer-reviewed journals, indicating they offer significant clinical advances over time and at scale.


Bogus patient reviews posted on Google, Yelp and other sites have compounded the difficulty of finding legitimate medical help online, with such practices emboldened by lax security and little professional enforcement actions. Although New York state has the second-highest number of practicing physicians, neither the Office of the New York State Attorney General nor the Office of Professional Medical Conduct could cite a case that had been brought against an individual physician for manufacturing fake reviews. Objection Co. CEO Curtis Boyd said 20 percent of businesses in the healthcare industry, including doctors, have suspicious review activity on Google and Yelp. He added that his own research indicated that "physicians with their own personal private practices tend to have more suspicious reviews, versus physicians who might be an employee of a large medical center or a hospital." Although Association of Independent Doctors Executive Director Marni Jameson Carey despises physicians who post fake reviews, she can envision some independent medical doctors doing so as they are pitted against large hospitals buying up independent medical practices. The incentive for this is increasingly driven by patients' reliance on review sites to find doctors.


Physicians can take steps to bring their mental well-being back to normalcy in the wake of the COVID-19 pandemic. Psychologist Steven Cohen recommends that physicians realize that having negative feelings and emotions is normal. He also stresses the need to pay attention to one's emotions and clearly label them. "While it may feel uncomfortable to acknowledge these feelings, push through the discomfort," he suggests, adding that physicians should ask themselves if there is anything else triggering their feelings. Any negative thoughts should then be critically and logically analyzed. In order to regain a sense of calm, physicians should visualize how they want to feel and ask how they can accomplish this, by considering alternate explanations for their beliefs and then electing to think more positively. Cohen also advocates for daily mindfulness meditation, while the isolation of the pandemic should be countered by engaging in in-person communication on some level. Finally, reaching out to friends, family, colleagues or a primary care physician, psychiatrist or psychologist can go a long way toward recovering normalcy.

Health Policy and Reimbursement

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The US Department of Labor has published a new emergency temporary standard for healthcare workers. The rules require healthcare employers to draw up a virus protection plan and tighten requirements for recording and reporting COVID-19 cases among workers. Additionally, they require healthcare employers to give their workers paid time off for COVID-19-related absences, including getting vaccinated and recovering from the shot's side effects. Rather than issue mandatory rules for other workplaces, the White House released new nonbinding guidance that relaxed some recommendations.


The challenge of both technology and people occupying operating rooms is forcing a rethink of the surgical suite, with facilities looking for creative solutions. Joan Saba at the NBBJ architecture and design firm says older suites may have ceiling heights as low as 10 feet, while 12 to 16 feet is now considered optimum for containing electronics, cables and ductwork. In some cases hospitals have repurposed adjoining rooms to accommodate electronics and other infrastructure. Stanford University's Mary Hawn notes that "imaging management" is currently the biggest challenge faced by operating rooms, while hospitals are more eager to fit imaging in surgical suites to save time and lessen the danger of infection during complicated procedures. Saba notes that because magnetic resonance imaging scanners are too big to fit in operating rooms, some hospitals are placing them next to the operating rooms. Other factors fueling the operating room reinvention include the need to dampen noise, while a more modular approach to design makes the accommodation of equipment more manageable.


UnitedHealthcare has announced that it will delay a plan to deny coverage for emergency room (ER) visits that it deemed nonurgent, at least until the pandemic is over. The insurer was intending to review medical records of its customers' ER visits to determine if it should pay fort those hospital bills. Hospital and doctors groups have balked at the policy, especially given steep declines in ER visits that ironically boosted profits and savings for insurers. Critics further warned that it would compound a troubling trend of patients avoiding ERs in the last year or so, potentially contributing to heart attacks and other illnesses among those who not only feared infection but also medical costs because of the economic impacts of layoffs and joblessness.

Medicine, Drugs and Devices

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In a new report, the Biden administration has issued policy recommendations intended to strengthen the nation's pharmaceutical supply chains. Under the plan, the US Department of Health and Human Services will make an initial commitment of about $60 million from the Defense Production Act appropriation in the American Rescue Plan to develop innovative platform technologies to widen domestic manufacturing capacity for active pharmaceutical ingredients (APIs) and key starting materials (KSMs). By increasing API and KSM production domestically, the country will need to rely less on global supply chains for medications that are experiencing shortages. The report calls for strengthening local production and encouraging international cooperation, promoting research and development to develop innovative manufacturing processes and production technologies, achieving strong quality management maturity for drug manufacturing and leveraging data to enhance supply chain resilience.


AARP reports that a new study from its Public Policy Institute indicates that retail prices for popular brand name prescription drugs continue to overtake inflation, with prices for 260 commonly used medications rising 2.9 percent last year, versus a 1.3 percent general rate of inflation. The total retail prescription drug costs for the typical older American who takes four to five monthly prescription medications would be $31,000 annually, whereas the average annual income for Medicare beneficiaries is $29,650.


To encourage more people to purchase their medication online, Amazon is offering six-month prescriptions starting at $6. Insurance companies typically do not cover six-month prescriptions, so Amazon's new service would be attractive to people without insurance as well as insured people who pay cash because of high out-of-pocket costs associated with their plans. Amazon Pharmacy is targeting consumers who take about one or two daily medications to manage common diseases such as high-blood pressure and diabetes.