News From ACFAS

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Register today for an Arthroscopy of the Foot and Ankle course and experience the ACFAS education difference with the opportunity to learn and practice cutting-edge techniques in surgery for the foot and ankle. Rotate to a minimum of two of the four companies with scope products at the OLC in Rosemont, IL.

Experience didactic and hands-on laboratory learning in this interactive course designed for DPMs of all skill levels—taught by ACFAS thought leaders. Enjoy more than nine hours of lab time plus the opportunity to rotate to four different brands of scope to refine your arthroscopic technique.

A debriefing and case discussion the first night of the course will allow you to share and discuss your own arthroscopic radiographs.

Arthroscopy of the Foot and Ankle fulfills privileging requirements and is worth 16 continuing education contact hours. Courses are still available for 2019—secure your spot now at acfas.org/skills!
Long road trip or time to yourself this summer? Add ACFAS’ monthly Scientific Literature Reviews to your reading list and stay-up-to-date on the latest developments in foot and ankle surgery.

Written by podiatric surgical residents, SLRs are short, digestible summaries of studies from leading medical journals and include podiatric relevance, methods, results and conclusions.

June SLRs are live at acfas.org/SLR and you can also browse the SLR archive for other articles and topics you may have missed.
Feeling stressed about your finances? You’re not alone. Members of the College often express concerns about financial stress and lack of financial security. To help combat these increased financial stresses, ACFAS partnered with Healthcare Associates Credit Union (HACU), the official credit union of the College, to offer a solution – free access to the Enrich Financial Wellness platform for members and their families.

The Enrich platform is an online program designed to offer each individual user customized information based on their personal financial needs. It engages users with a variety of methods including tools, quizzes, videos, articles and a library of multimedia content to help achieve their financial goals.

Learn about ways to set a budget, manage your student loan debt, achieve your financial goals, and more by setting up your free Enrich profile by visiting hacu.enrich.org. Members can also speak with certified personal finance experts who can help with specific life stages. For additional banking or financial needs, visit HACU.org.

Foot and Ankle Surgery

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A study was conducted to assess rotational change in the first metatarsal bone (1MT) of the foot during natural standing using an upright computed tomography (CT) scanner with 320-detector rows. Fifty-two feet of 28 asymptomatic subjects were evaluated in the natural standing position with or without weightbearing. The 1MT pronation angle was found to be significantly greater in the single leg full weightbearing (s-FWB) condition than in the nonweightbearing (NWB) condition. No sex difference was observed in the magnitude of the 1MT pronation angle as a consequence of weightbearing. This demonstrated that pronation of 1MT occurs because of natural full weightbearing in asymptomatic feet. The 1MT's rotational movement under weightbearing conditions may relate to the onset and pathogenesis of the hallux valgus.


A study characterized the overall incidence of—and risk factors linked to—postoperative complications following operative repair of acute Achilles tendon rupture. Also assessed were specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. A total of 615 adult patients underwent operative repair for an acute Achilles tendon rupture, with 72 developing a postoperative complication.

Risk factors included advancing patient age, active tobacco use and specific subspecialty training, with no difference in overall complication rate observed between the open and MIS approaches. Subgroup analysis among orthopaedic subspecialties revealed that patients treated by trauma surgeons had higher rates of wound complication and rerupture versus those treated by other subspecialties. Patients treated by trauma surgeons were more likely to be younger or have a body mass index lower than 30, although neither factor was an independent predictor for postoperative complications.


A systematic review was held to compare surgical and conservative treatment of isolated medial malleolar fractures, considering complication rates and functional outcomes. Eighteen studies were included involving 2,566 isolated medial malleolar fractures, which showed a mean Methodological Index for Non Randomized Studies score of 8 plus or minus 2. Mean nonunion rate was 1.7 percent following surgical treatment and 3.5 percent after conservative treatment.

Comparable functional outcomes were observed after both treatment methods, and one study comparing surgical and conservative treatment yielded similar functional outcomes for 1- and 2-mm displaced isolated medial malleolar fractures. The other had a nonunion rate of 3.5 percent and a good mean functional outcome in 57 conservatively treated isolated medial malleolar fractures, with a mean displacement of 3.8 mm.

Practice Management

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Medical office remodeling is important for making practices adaptable to the fluid healthcare landscape, with space, appearance and productivity critical to identifying makeover priorities. Space is typically the most obvious barometer, as it is often clear when a practice can no longer accommodate patient and provider needs. Freshening up an office's appearance, especially in the patient waiting area, is a frequent driver of practice makeovers.

Once a makeover is deemed necessary, practices must decide on specific modifications. With small practices, the physician-owner and office manager should check rooms, equipment and furnishings and list everything they want fixed, changed or eliminated. Larger practice remodels should be determined by input from clinicians and staffers. Patient suggestions also can be beneficial. To increase productivity, practices should remove bottlenecks that slow the flow of patients through the office.



A new study finds that hundreds of common medical practices are ineffective. The study, published June 11 in eLife, reviewed 3,000 article in the Journal of the American Medical Association, Lancet, and New England Journal of Medicine—all documenting randomized controlled trials and published in the last 15 years. It uncovered 296 medical reversals among these studies, most of which were conducted in high-income countries. Practices concentrating on cardiovascular disease were reversed 20 percent of the time, representing the highest rate of any medical category, followed by public health/preventive medicine and critical care. Researchers hope their findings will push for the de-adoption of these ineffective standards in what is known as a medical reversal.


Healthcare providers and staff should set up a non-judgmental, welcoming and inclusive atmosphere for LGBTQ+ patients, first by using inclusive language and non-stereotyped communication with sensitive interviewing and comfortable care delivery. Providers also should be prepared for questions with heightened sensitivity for LGBTQ+ patients, such as those concerning fertility services. Ensuring encounter safety for LGBTQ+ patients from the outset also is vital. The National LGBT Health Education Center supplies a toolkit to help facilitate dialogue about LGBTQ sexual health in primary care. The final requirement is guaranteeing primary and sexual healthcare has no bias.

Health Policy and Reimbursement

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If Medicare for All ever becomes law it could invite constitutional challenges, threatening or undermining the new system for years. Legal experts say that getting the law to work could prove an uphill battle in court. Many Democrats favor more incremental alternatives which stand on safer legal ground. The Affordable Care Act (ACA) faced many legal challenges and Medicare for All goes much further than the ACA--banning most private health insurance and transforming the entire healthcare sector into a single-payer system. Yet many health law experts say the legal basis for Medicare for All has already been laid by vast government health insurance programs like Medicare itself.


The U.S. Senate's health committee has proposed three options to prohibit surprise medical bills, but one bill could shake up industry practices by offering an "in-network matching guarantee." Under the guarantee, any doctor or clinician who treats a patient in an in-network hospital would be required to accept the patient's in-network rate. Network matching would not require hospitals to hire only in-network physicians, but hospitals would have to bundle out-of-network physician charges into an in-network hospital rate, even if the doctors they employ want to stay out of network.

Another bill would call on the Government Accountability Office to look at physician-staffing arrangements—like joint ventures—that could drive up prices. The GAO would be required to look at lab, radiology, surgery and pharmacy services delivered in a hospital and then report to Congress about the "potential" of various partnerships to drive up patient costs.


A new proposal from the U.S. Department of Health and Human Services would overturn a rule forbidding federally-funded healthcare providers from discriminating against patients based on gender identity or whether they have terminated a pregnancy. Proponents say that the rule restricts the independence of physicians to follow their religious or moral beliefs. Opponents say it encourages discrimination, empowering bad actors to be bad actors. The rule could set important precedents about the extent of civil rights legislation, how far its protections extend and how they are enforced.

Medicine, Drugs and Devices

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A report from the American Medical Association (AMA) suggests that physicians are seeing progress in reversing the opioid crisis – but that policy makers and regulators need to remove obstacles to medication-assisted treatment and nonopioid pain care. The AMA's opioid task force report urges payers, pharmacy benefit managers and pharmacy chains to eliminate treatment restrictions "based on arbitrary thresholds." The report notes, "Physicians must continue to demonstrate leadership, but unless and until these actions occur, the progress we are making will not stop patients from dying."


U.S. House Speaker Nancy Pelosi (D-Calif.) has agreed to revise her drug pricing reduction plan following complaints from the Congressional Progressive Caucus. The group took issue with the plan only requiring Medicare to negotiate prices on a minimum of 25 drugs annually, arguing it was too small a number and would not do enough to lower prices. In response, Pelosi said the plan would be amended, boosting the number of drugs to be negotiated to about 250. Supporters of Pelosi's strategy noted a small number of high-cost drugs comprise a large share of drug spending. One study estimated the top 25 most-costly drugs constitute about 30 percent of all Medicare drug spending.


About 400,000 medical professionals practice their craft through a series of smartphone games developed by Level Ex. The company's game products are specifically designed for doctors, medical students and other healthcare providers and currently include four free games for iOS and Android. Airway Ex is geared toward anesthesiologists; Gastro Ex is for gastroenterologists; Pulm Ex is for pulmonologists; and Cardio Ex is for cardiologists. The Level Ex games are based on actual cases submitted by physicians. Said Level Ex CEO Sam Glassenberg, "We give you the opportunity to take on very serious scenarios, but being able to do it in an environment where there's no consequences means you can try different approaches."