News From ACFAS

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After 24 years with ACFAS, Mary Meyers, director of Education and Curriculum Alliances is retiring from the College! Many of you have worked with Mary in the trenches as she and her team of staff and members helped to build ACFAS’ educational programming into the primary leader for podiatric surgical education as well as taking the Annual Scientific Conference from 200 attendees with 35 table-top vendors to where it is today – a record-breaking, premier educational program for foot and ankle surgeons with over 3,000 attendees (1,900 DPMs) and 141 vendors in over 168,000 square feet!

Mary will continue to be with the College on a full-time basis until October 1 and then part time through the Annual Scientific Conference in February 2021.

Please join us at the College in thanking Mary for her years of dedicated service to the College and to helping to moving the profession forward. She has worked alongside many members as they’ve started their careers and built their practices and she will be truly missed. Watch for a more extensive profile on Mary’s successful tenure with the College in an upcoming issue ACFAS Update. The search for the next Director of Education is underway, more information is available at acfas.org/DOE. Easing back into normal life post-COVID-19 can seem scary, but the College is hoping to help ease those fears with a new “Welcome Back” national social media public relations campaign.

The College embarked on this campaign to show how foot and ankle surgeons are welcoming patients back to the office amid new office procedures. To restore patients’ peace of mind, a video showing how foot and ankle surgeons have created safe, CDC- and state regulation-compliant office environments will be circulating ads on Facebook. Not only will this help to show the changes with pictures submitted by members, but to make patients feel comfortable with returning to the office to take care of their foot and ankle needs.

If you have photos of you and your staff welcoming patients back, please share them with us. We’d love to keep showing the great work you all are doing to keep people healthy and on their feet. Students and Residents can now continue accessing ACFAS OnDemand Learning Portal through July 20. The College has extended access to our premier virtual learning resources to continue supporting education during the ongoing COVID-19 crisis.

Visit the ACFAS OnDemand library for a variety of podcasts, webinars and clinical sessions at acfas.org/OnDemand. If you have any questions, please contact the ACFAS Membership Department, membership@acfas.org. We want to see how you’re staying active and healthy while staying safe and socially distant as we head into summer. Share photos of your feet getting exercise, outside for a break, throughout the day while working or relaxing at home. Post your photo on your social media accounts and use the #KeepYouOnYourFeet hashtag to show how foot and ankle surgeons help keep the world active and “on their feet.”

You can also send your pictures to erin.morrison@acfas.org along with your name, the location or action in the photo and where you practice so we can post it from the College’s social media accounts.

Follow the #KeepYouOnYourFeet campaign on our Instagram, Facebook, Twitter and LinkedIn accounts, and encourage your patients to share their #KeepYouOnYourFeet photos too!

Foot and Ankle Surgery

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The study compares the clinical and radiological outcomes of medial malleolar (MM) fractures with either bioabsorbable magnesium (Mg) screws or conventional titanium screws. In a cohort of 48 patients with MM fractures who underwent compression screw fixation, 23 patients were treated with bioabsorbable Mg screws, and 25 patients were treated with conventional titanium screw fixation. All patients were followed up for at least one year, with a mean time of 24.6 ± 10.5 months (12–53 months). The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to evaluate the clinical results, and the Kellgren–Lawrence (KL) osteoarthritis grading was used to evaluate posttraumatic osteoarthritis on final ankle radiographs. Age, sex, side, MM fracture type, associated fractures and follow-up periods were similar between the groups. At final follow-up examination, AOFAS score was similar between groups, and fracture union was achieved in all cases. Grade of posttraumatic osteoarthritis, according to KL, was equally distributed in both groups. No deep infection or osteomyelitis was seen. Five patients in the titanium screw group underwent implant removal, due to pain in three of them and difficulty in wearing shoes in the other two.


The study aimed to define the outcomes of persons with diabetes and foot ulcers (DFUs) managed through a specific triage pathway during the COVID-19 crisis. All patients were managed using a specific triage system. Subjects with severely complicated DFUs were urgently referred to hospital regardless of the concomitant comorbidities. Subjects with complicated DFUs received outpatient evaluation and were admitted to hospital if required, then followed according to the number of comorbidities. Patients with uncomplicated DFUs were managed by telemedicine after outpatient evaluation. The study group included 151 patients; 58.7 percent had severely complicated DFUs, 21 percent had complicated DFUs and 20.3 percent had uncomplicated DFUs, while 78.8 percent presented with at least three comorbidities. One hundred and six patients had regular clinical follow-ups, while 45 were managed through telemedicine. Forty-one patients healed, three had major amputations and three died. One patient reported COVID-19 positivity due to infection acquired at home.


The study evaluates the clinical and functional outcomes of varying minimally invasive techniques in treating unstable distal fibular fractures, including minimally invasive plate osteosynthesis (MIPO), intramedullary (IM) nailing and IM screw fixation. Researchers reviewed 20 studies, eight of which used IM nailing as the fixation of choice with a total of 211 patients. Out of the 211 patients, 33 experienced complications. Six articles using MIPO were reviewed with a total of 264 patients, of whom 39 experienced complications. Six articles using IM screw fixation were reviewed with a total of 219 patients, and there were 30 cases of complications from 132 patients. Additionally, mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores amongst all fixation types was 88.4, while the mean Olerud and Molander Score among all fixation types was 76.7.

Practice Management

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The article provides some advice to clinicians who are deciding where to practice. Though large healthcare systems have much to offer, independent or smaller practice groups may offer greater reward potential, more autonomy and flexibility, less bureaucracy and an ability to limit payers. Physicians should explore multiple locations, including new areas, while keeping family considerations in mind. It is also important to find peers with similar outlooks, culturally and clinically and look for personal insight from clinicians in a considered area. If the goal is starting a private practice rather than joining an existing one, facilities planning should commence up to two years in advance. Moreover, the American Medical Association recommends creating a checklist for investigating and acting on practice choices. This list might include lifestyle factors, available practice options, steps in becoming practice-ready and key components of employment contracts.


Implicit bias can have a serious impact on patient care. Because most physicians are white and male, the unconscious assumptions they may hold about non-white and non-male patients can lead to inappropriate treatment decisions and eventually worsen disparities in health outcomes. As understanding of implicit bias grows, so do techniques for combating it. Many healthcare institutions are developing training programs to help doctors recognize unintended bias and prevent it from affecting their medical decision-making. Experts say it is not possible to eliminate implicit bias entirely; instead, doctors should focus on reducing their impact on patient interactions and medical decision-making. The process begins with acknowledging that the biases exist, then practicing consciousness of those biases while interacting with patients. It is equally important to find each patient's unique qualities or features, making it easier to see them as an individual. Another useful technique for lessening the impact of unintentional bias is by undermining stereotypes.


Medication-assisted treatment for opioid addiction can cut the risk of fatal overdose by up to 50 percent, but 40 percent of US counties still have no clinicians allowed to prescribe buprenorphine. To administer buprenorphine, physicians must complete an eight-hour training and obtain an "X waiver" from the US Drug Enforcement Administration. Less than one in 10 of the nation's physicians have received this waiver. Clinicians who receive waivers to prescribe buprenorphine for addiction must agree to limit the number of patients they treat with it. Advocates have proposed requiring all medical residents to receive training in treating addiction. A 2016 law allowed nurse practitioners and physician assistants to obtain X-waivers, increasing providers in rural areas, but some states require a physician's supervision to administer buprenorphine. In December 2018, clinicians published a call to "X the X waiver," a position since repeated by several medical societies. Bipartisan legislation was also introduced in the US House to deregulate the prescription of buprenorphine.

Health Policy and Reimbursement

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Researchers at Harvard Medical School and the City University of New York,'s Hunter College found that more than 18 million Americans, most of whom are minorities and low-income individuals, are uninsured or underinsured and are at an increased risk of developing severe cases of COVID-19. "Our study shows that minority communities face double jeopardy from COVID-19. On the one hand, they are at higher risk of severe complications from coronavirus, and on the other hand, they are more likely to be uninsured and underinsured, and hence to avoid care or to face potentially ruinous medical bills," said Adam Gaffney, the study's lead author and a pulmonary and critical care physician at the Cambridge Health Alliance and Harvard Medical School.


The Trump administration announced it would distribute $25 billion to health providers caring for Medicaid patients. The US Department of Health and Human Services (HHS) said about $15 billion will go to providers in state Medicaid and Children's Health Insurance Program (CHIP), and another $10 billion will go to safety-net hospitals that serve high volumes of Medicaid patients. Bipartisan members of Congress wrote HHS recently urging it to distribute emergency COVID-19 funding to Medicaid providers as soon as possible, noting their "serious concerns" with the delay. HHS has launched a "portal" that allows Medicaid and CHIP providers to report their annual patient revenue, which will be used to determine how much aid they will get.

Medicine, Drugs and Devices

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Hospitals nationwide are experiencing chronic shortages of opioid analgesics in injectable form, for which demand more than doubled between January and early April, says Vizient, a large hospital purchasing organization. Orders for the commonly used injectable fentanyl approximately tripled, but suppliers were able to ship only one-half of what hospitals requested, says Amanda Forster, a spokeswoman for Premier Inc., a hospital purchasing organization. Industry experts note that a small group of manufacturers operate at nearly full capacity to manufacture these injectables, with a high risk of mechanical failure or contamination. Adding another production line or opening a new plant can take a year or more, they say. Some pharmacists, anesthesiologists and other frontline medical professionals are substituting less effective drugs or injecting crushed opioid tablets into feeding tubes. An FDA-led task force says the harm to patients is difficult to gauge and most likely underestimated.


At the recent European League Against Rheumatism (EULAR) virtual meeting, researchers suggested that combining methotrexate with pegloticase may help patients experiencing acute gout attacks reduce uric acid levels. In a small open-label study of 14 patients experiencing acute gout attacks, use of the pegloticase/methotrexate combination reduced uric acid levels to near undetectable levels in 11 patients. Researchers noted that this was far below the 5 mg/dL level recognized as the threshold for development of inflammation that causes gout attacks. The study reported at the EULAR meeting showed an efficacy of 78.6 percent. However, one rheumatologist not connected with the study noted that pegloticase is very expensive and the population appropriate for it is small. "[Rheumatologists] are especially worried if patients miss dosing because that can result in anti-drug antibody development, and, in turn, anaphylaxis with the next dose," she noted.



The attorneys general of 46 US states, the District of Columbia and four territories on Wednesday filed suit against 26 drug manufacturers, alleging that the drugmakers conspired to reduce competition and drive up generic drug prices. The lawsuit specifically accuses Novartis’ Sandoz unit, Teva Pharmaceuticals’ Actavis unit, Mylan, Pfizer Inc., and other drugmakers of conspiracy to rig the market for more than 80 drugs between 2009 and 2016. The attorneys general alleged the defendants prioritized profits over the public interest, depriving millions of consumers of lower prices for needed medication. The lawsuit also names 10 executives, including many sales and marketing directors, as defendants in the case.