News From ACFAS

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Manuscripts are now being accepted for the 80^th 2022 Annual Scientific Conference in Austin!

Submit your research to be included in this year’s Manuscript Competition for consideration to give an oral presentation in Austin February 24-27, and manuscript winners will divide $10,000 in prize money.

Visit acfas.org for policies, author instructions and to submit your manuscript today, but don’t wait—applications are due August 11, 2021. We’re heading to Dallas for the all-new Internal Fixation Course August 19-21!

The hands-on course (continuing from the previous AO/AAFAO workshops) is bringing together many innovators in the field of internal fixation surgery. This course has a great line-up of expert faculty ready to present thorough up-to-date information on osteosynthesis in lower extremity, including:

Gage M. Caudell, DPM, FACFAS
John A. Ruch, DPM, FACFAS
Michelle L. Butterworth, DPM, FACFAS (former ACFAS President)
Daniel J. Hatch, DPM, FACFAS (former ACFAS President)
George Tye Liu, DPM, FACFAS (ACFAS Board Member)
Asim Raja, DPM, FACFAS
Naohiro Shibuya, DPM, MS, FACFAS (current Annual Scientific Conference Committee Chair)
Mitzi L. Williams, DPM, FACFAS

Visit acfas.org/InternalFixationCourse for more information and to secure your spot at this hands-on course today. In early May, the orthopaedic section of the American Medical Association (AMA) submitted Resolution 303 “Improving the Standardization Process for Assessment of Podiatric Medical Students and Residents by Initiating a Process Enabling Them to Take the USMLE” for consideration at the June 2021 AMA House of Delegates (HOD) as a result of the work of the Joint Task Force of Orthopaedic and Podiatric Surgeons. The House of Delegates meeting was held virtually, making a number of resolutions for consideration more restrictive and requiring a prioritization review to be considered for the agenda. The next opportunity for the resolution is the November 2021 Interim AMA House of Delegates meeting.

In 2019, this Resolution 4-19 was authored and introduced by the California Podiatric Medical Association (CPMA) at the American Podiatric Medical Association (APMA) House of Delegates (HOD). It passed on consent agenda with multiple states and organizations signing on. Passage of Resolution 4-19 was a first step from which APMA and ACFAS agreed to pursue access to the USMLE.

“The National Task Force, comprised of ACFAS, APMA, AAOS, AOFAS leadership, put this into real action,” said Jon Hultman, DPM, MBA, CVA, Executive Director of the California Podiatric Medical Association. “CPMA is proud of the work of the National Task Force and fully supports the recently released white paper and AMA Resolution. This is exactly the actions CPMA hoped the National Task Force would take based on the passage of Resolution 4-19,” he added. Did you know membership as a PGY-1 resident is free? As you’re starting your next important step in your career path, don’t miss this opportunity to take advantage of all the College has to offer.

Resident Members receive:

• In-print and online access to The Journal of Foot & Ankle Surgery
• Discounts on education such as Arthroscopy of the Foot and Ankle Surgical Skills Course, and the College’s Annual Scientific Conference
• Information on over 50 fellowships with ACFAS Status
• Access to research resources and scientific literature reviews

Download a first year membership application today from acfas.org/join. Join us in July for another look at the latest in foot and ankle research. The ACFAS Virtual Journal Club is back July 15, 7pm featuring the next installment Use External Fixators in the Lower Extremity. This month’s club event is hosted by the MedStar Georgetown University Hospital Foot and Ankle Research Fellowship in Washington, DC and presented by Jayson Atves, DPM, AACFAS and John Miller, DPM.

Register for July's Journal Club now at acfas.org/JournalClub.

Foot and Ankle Surgery

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Researchers assessed the clinical outcomes of first metatarsophalangeal joint fusion among 28 patients (30 feet) treated with cup and cone-based fusion dorsal plate arthrodesis, with a mean follow-up of 35 months. Radiological and clinical assessment was conducted for each foot, with the visual analog scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). All cases realized consolidation, with radiographic union recorded within six months from surgery in nine cases and in one case after nine months. Comparing the preoperative and postoperative of VAS and MOFQ values yielded a statistically significant difference, while a complication of wound dehiscence occurred once.


A study was conducted to review intrasubject radiographic progression of the hallux valgus deformity by comparing the mildly and severely affected sides in individuals with bilateral asymmetric hallux valgus in the entire 186 patient cohort as well as the metatarsus adductus and the non-metatarsus adductus subgroups. Patients exhibited bilateral asymmetrical hallux valgus deformity with a difference of five degrees or greater in the hallux valgus angle, with 11 radiographic measurements were analyzed. The anteroposterior talo-second metatarsal angle did not show a significant difference between the mildly and severely affected sides. Changes in the intermetatarsal angle and sesamoid rotation angle had a significant connection to progression of hallux valgus angle in the whole cohort as well as the non-metatarsus adductus subgroup. Change in the intermetatarsal angle was the primary contributor to progression of hallux valgus angle in the metatarsus adductus subgroup. The anteroposterior talo-second metatarsal angle might help in assessing the overall foot shape in the hallux valgus deformity, while progression of the hallux valgus deformity might be pathophysiologically dissimilar between patients with and without metatarsus adductus.


A study was held to assess the extent of cartilage debrided in single medial and two-incision approaches in double hindfoot arthrodesis in order to evaluate the competency of the deltoid ligament. The researchers obtained eight matched pairs of cadaveric specimens, with one limb from each pair randomly assigned to the single medial incision and the other to the two-incision technique. The single medial incision had substantially less cartilage debridement than the two-incision technique at the talar head and the posterior facets of the talus and calcaneus. Seventy-five percent of specimens receiving single medial incision approach showed increased valgus tibiotalar tilt postdissection, whereas none that underwent two-incision had a similar outcome. The average tibiotalar tilt among these specimens was 4.6 plus or minus 1.3 degrees, while the intraclass correlation coefficient was greater than 0.8 across all measurements.

Practice Management

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One-to-one coaching can help improve physician-patient engagement and patient management of chronic conditions. Health coaches work from a holistic framework that features the assessment of the patient's understanding of their chronic condition to ascertain barriers to treatment adherence; intrinsic motivators unique to each patient to specify how treatment is intrinsically linked to their motivations and goals; the knowledge patients need to develop an action plan to overcome impediments to treatment adherence; and regular check-ins to track progress, revise the action plan or revisit touchpoints as necessary. Personal health coaches can be complementary to physicians by evaluating patient literacy, providing support and guiding patients as they develop and undertake an action plan to reach their health goals. Virtual platforms can be a key component of coaching, using smart, individualized communications.


Drug prescription processes are lagging behind the pace of innovation in life sciences and pharmaceuticals, which can be addressed by setting up a seamless, streamlined infrastructure. This can be done by using new innovations to remove pitfalls in patients' therapeutic route. Identifying where these pitfalls exist in the patient and provider processes can be achieved by employing pharmaceutical patient support services or hubs. A poll found that key services perceived as most helpful are managing benefit verifications and patient assistance obstacles and determining the best affordability options for the patient. Also critical is addressing a lack of patient adherence to medication. Simplifying access to support services through mobile and similar channels lets patients interact in real time. Providers also gain valuable insights into patient habits. Realizing which services patients are using via which channels and how frequently allows providers to optimize efforts to reach them where they are.

Health Policy and Reimbursement

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The US Supreme Court rejected a challenge to the Affordable Care Act from Republican-led states, ruling that they lacked standing to bring the case. The states had sought to strike down the law on technical arguments after Congress reduced to zero the tax penalty for failing to carry health insurance. The Supreme Court, in its latest ruling, concluded that none of the plaintiffs suffered any injury from zeroing out the penalty and thus lacked legal standing to bring the lawsuit. It was the third time the court has preserved the law.


With more doctors and patients returning to in-person medical appointments as the pandemic winds down, US policymakers are debating over how much to continue spending on telemedicine. California's Legislature wants the state's Medicaid program for low-income residents to keep covering phone appointments at the same rate as for video and in-person visits, but Gov. Gavin Newsom's budget plan instructs the program to reduce the rate. A congressional hearing in April sought to determine whether Medicare should keep paying for phone visits, and a nonpartisan legislative agency has recommended maintaining payments for a year or two after the pandemic. Evidence on the quality of audio appointments is thin, and the few studies directly comparing video and audio visits determined that outcomes in behavioral healthcare were similar. Doctors at safety-net clinics that serve Medi-Cal beneficiaries and the uninsured say phone visits have been critical in keeping patients healthy during the pandemic and have been effective with patients with behavioral health issues and chronic ailments. California's Department of Health Care Services has proposed stopping payments for phone appointments at community health centers because the centers receive a flat rate for every visit by a Medicaid patient.

Medicine, Drugs and Devices

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Older adults increasingly are taking medications that are prescribed for valid reasons but that also elevate their risks for falls, results from a new study indicate. Based on government data, researchers found that the share of patients matching this profile surged from 57 percent in 1999 to a staggering 94 percent in 2017. Deaths attributed to falls among older adults more than doubled over the study period, meanwhile. Major contributors to the trend include more frequent use of antihypertensives and antidepressants within this demographic. Women—in particular, Black females overall and White females aged 85 years and older—appear to be especially vulnerable. Lead study investigator Amy Shaver and others do not necessarily believe older adults should be deprived of important medications solely because those drugs could increase the risk of falling; however, they do emphasize the importance of awareness.


A federal court's ruling that workers in the Houston Methodist hospital system must comply with a mandate to get vaccinated from COVID or lose their jobs is unlikely to end a fierce debate, with those opposed to the policy promising to bring their case to the US Supreme Court if they have to. Legal experts say courts will likely continue to uphold such requirements, particularly amid a public health crisis, provided employers offer reasonable exemptions, including for medical conditions or religious reasons. Houston lawsuit plaintiffs Jennifer Bridges and Kara Shepherd say they are not confident in the vaccine's safety, having allegedly witnessed patients and co-workers have severe reactions and claiming there is not enough knowledge about its long-term effects. They insist that the case is ultimately one of freedom. Their lawyer, Jared Woodfill, claims the hospital system is not allowing its workers to make their own healthcare decisions. Hospital employees and others have contended that such mandates are illegal because the COVID-19 vaccines are being dispensed under emergency use authorization from the Food and Drug Administration (FDA) and have not received final FDA approval.