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News From ACFAS

Joint Letter Sent Requesting ICD-10-CM Database Modifications
On June 10, the American College of Foot and Ankle Surgeons (ACFAS), the American Podiatric Medical Association (APMA) and the American Society of Podiatric Surgeons (ASPS) sent a joint letter to Donna Pickett, MPH, RHIA, Co-Chair of the ICD-10 Coordination and Maintenance Committee at the National Center for Health Statistics requesting modifications to the ICD-10-CM database to accommodate reporting of progressive collapsing foot deformity.

As you may know, there is currently no ICD-10-CM code to represent progressive collapsing foot deformity as it is defined in peer-reviewed literature. Should the request be considered a meeting would be scheduled for September 2021. If you have any questions about the letter, contact Erin Ravelette.
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August Residents’ Internal Fixation Workshop
Join expert faculty in Dallas, August 19-21 for a three-day deep dive into the foundations of internal and external fixation.

ACFAS has aligned with AAFAO to continue producing this very important resident course on fixation techniques of the foot and ankle. To make this course even more relevant to first and second year residents, we have combined the critical components of both the basic and advanced courses to provide a complete and very intense workshop covering all areas of foot and ankle surgery. This three-day course remains the foundation of internal and external fixation.

This three-day workshop covers all aspects of internal fixation including arthrodesis, reconstructive surgical techniques and trauma of the foot and ankle. At the end of the workshop, participants will walk away with the skills to:
  • Apply the principles of internal and external fixation to foot and ankle surgery—including major rearfoot and ankle arthrodesis techniques
  • Identify the problems, complications, and intraoperative difficulties that can result from internal and external fixation
  • Implement principles and techniques in a wide variety of complex foot and ankle fractures, multiple revisional and reconstructive surgical techniques of the lower extremity—including specialty plating and external fixation techniques
  • Avoid complications and improve outcomes through preoperative planning
  • Apply psycho-motor skills developed in extensive practical lab exercises
Learn more about this program and apply today at
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New! ACFAS Regional Learning Series
ACFAS is coming to a city near you with our new Regional Learning Series—Common Pathologies: How to Resolve and Maximize Function by Restoring Structure.

Our newest program combines case presentations, lightning lectures and hands-on labs to give you a better understanding of contributing factors associated with foot and ankle surgery complications and help in applying new skills to maximize function and restore structure.

Our first stop is Charlotte, NC, September 24-25, register now! Visit to see all future cities and dates, full agendas or for more information.
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Free Webinar Series – Residency, Fellowship and Career
Want the best-kept secrets to reaching the next step in your career path from your peers who have experiences to share? Mark your calendar for the following complimentary non-CME webinar series:

Let's Play Roulette: How to Aim and Get the Residency of Your Choice
Monday, July 19, 8pm CT (9pm ET; 7pm MT; 6pm PT)
The College’s residency panel is back by popular demand, but with a twist – this year, our residency directors will be joined by two chief residents to offer first-hand advice and answer your questions regarding landing the residency of your dreams.

CV Review and Interviewing in a Zoom World
Tuesday, July 27, 8pm CT (9pm ET; 7pm MT; 6pm PT)
Searching for a job in current times is a strange experience that takes an unusual skill set to navigate successfully. Attend this webinar and prepare yourself for the process – learn about creation of specific cover letters and resumes; how to find those elusive jobs; and strategies for interview preparation in a virtual environment.

The Fellowship Experience: Is Advanced Training Right for You?
Thursday, August 26, 8pm CT (9pm ET; 7pm MT; 6pm PT)
Are you curious about the fellowship experience? Hear advice from recently graduated and current fellows to determine if a fellowship is right for you. This session will cover how to make an informed decision on fellowship; how to be a competitive applicant; how to choose the right program; how to maximize your fellowship experience; and the unexpected benefits of participating in a fellowship.

Visit to view the whole series including detailed abstracts, panelists, bios and links to register.
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ACFAS Regions Support Local Young Researchers
In an effort to support the next generation of foot and ankle surgical researchers, the ACFAS Regions supported local residents and post graduate fellow poster presenters at the 2021 Annual Scientific Conference in Las Vegas, May 18-21.

A list of local award winners can be found at, along with a link to their poster projects. Poster presenters received a $250 stipend and manuscript presenters received $500 to offset their research expenses and travel to the conference.

ACFAS Region officers are happy to encourage young research efforts around the country, and look forward to continued support of resident and post graduate fellow research projects at the 2022 Annual Scientific Conference in Austin.
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Foot and Ankle Surgery

Association of Visual Appearance on Outcomes After Hallux Valgus Surgery
A study sought to assess how cosmetic improvement affected patient satisfaction and functional scores in hallux valgus (HV) surgery. The researchers captured preoperative foot photos of 105 patients who had received chevron osteotomy for HV between 2016 and 2018. Patients were divided into two cohorts. Twenty-four months post-surgery, the photos were shown to the 52 patients in group one but not to the 53 patients in group two. The cohorts were then compared with the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) and the 36-Item Short Form Health Survey (SF-36) scores. Both groups received radiological assessment with preoperative and postoperative HV angles and intermetatarsal angles. No difference was noticed between the cohorts in terms of radiologic parameters either pre- or postoperatively or AOFAS Hallux MTP-IP scores postoperatively. However, in group one the VAS was lower, and both the SF-36 physical functioning and SF-36 mental health scores were higher.

From the article of the same title
Foot & Ankle International (06/30/2021) Bahar, Hakan; Yildiz, Kadir Ilker
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Augmented Microfracture Technique Versus Microfracture in Talar Cartilage Restoration: A Systematic Review and Meta-Analysis
A meta-scale analysis compared effectiveness and safety between the microfracture (MFx) and augmented microfracture (MFx+) procedures for articular cartilage defects of the talus (OLTs). The PubMed and EMBASE databases were searched from January 1950 to October 2020 with only randomized controlled trials, quasi-randomized controlled trials and observational studies applying MFx and MFx+ techniques to treat talar cartilage defects included. Ten trials with 492 patients were covered, with significant difference observed in final American Orthopaedic Foot and Ankle Society score (AOFAS), AOFAS change, visual analog scale (VAS) change score, Magnetic Resonance Observation of Cartilage Repair Tissue score, complication and revision between the MFx and MFx+ cohorts. Neither group had a significant difference for final VAS pain score and Tegner scale. The outcomes suggest augmented microfracture is better than microfracture alone in the treatment of talar OLTs and should be considered as a treatment for OLTs of talus.

From the article of the same title
Journal of Foot & Ankle Surgery (06/29/21) Wen, Hong-Jie; Zhu, Shou-Yan; Tan, Hong-Bo; et al.
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Local Random Pattern Flap Coverage for Implant Exposure Following Open Reduction Internal Fixation via Extensile Lateral Approach to the Calcaneus
Research detailed a new simple local random pattern flap to cover the implant exposure following the open reduction and internal fixation (ORIF) for displaced intra-articular fracture of the calcaneus. Twelve patients with implant exposure after ORIF for this condition underwent the procedure from March 2017 to March 2020. Defect sizes ranged from 2×2 square centimeters to 5×2 square centimeters, with a local random pattern flap designed according to defect size. The average follow-up duration was 6.3 months, within a range of four to 13 months. All 12 flaps healed without incident and all patients were able to wear shoes, with no debulking procedures necessitated.

From the article of the same title
BMC Musculoskeletal Disorders (06/21/21) Vol. 22, No. 567 Liu, Yingjie; Cai, Peihua; Cheng, Liang; et al.
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Practice Management

Going the Extra Mile to Make Patients Feel Welcome
Healthcare providers have a responsibility to create a friendly environment for all patients, especially those that are overweight or obese. One error physicians commit when treating such patients is telling them to lose weight, but not offering guidance. Providers should instead work with patients on a comprehensive obesity treatment that includes intensive lifestyle intervention, structured nutritional assistance, physical activity prescription and medical management. Steps to ensure that patients feel welcome in the office include having courteous and knowledgeable front desk staff and making sure patients should feel encouraged before, during and after appointments. Offices can be made more inviting by weighing patients in a private setting on a scale that can accommodate higher body mass index patients; having furniture that allows patients of all sizes to sit comfortably; and using equipment and supplies designed for larger patients. Recommended technologies include a body composition scale, take-home reports to charts patients' weight-loss progress and a Health Insurance Portability and Accountability Act-compliant portal for virtual or phone appointments.

From the article of the same title
Medical Economics (06/30/21) Lazarus, Ethan
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OSHA Issues Compliance Directive for Enforcing Emergency Temporary Standard to Protect Healthcare Workers From Coronavirus
The US Department of Labor's Occupational Safety and Health Administration has issued a compliance directive designed to ensure uniform inspection and enforcement procedures for its Emergency Temporary Standard to protect healthcare workers from occupational exposures to COVID-19. The new directive provides OSHA compliance safety and health officers with guidance and procedures on how to enforce the standard's requirements for written COVID-19 plans, personal protective equipment, aerosol-generating procedures, physical distancing, cleaning and disinfecting, employee health screening and medical management, vaccination, training, antiretaliation, recordkeeping and reporting to OSHA, among other things. The ETS became effective June 21, 2021. Employers must comply with most provisions by July 6, 2021, and with training, ventilation and barrier provisions by July 21, 2021.

From the article of the same title
OSHA News Release (06/30/21)
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Six Key Components of a Digital Marketing Strategy to Drive Physician Referrals
Physicians should consider six elements of a digital physician referral marketing strategy, starting with creating compelling content. This involves thoughtful identification of the target audience and determining common questions physicians typically have, like those considering ease of referral, expertise, insurance and cost, patient outcomes and testimonials, procedures and services and the process for referral. The second step is to review local listings, making sure all contact details are correct and that listings are optimized with patient endorsements and other information. The third step is social advertising, which should refer back to the physician's defined audience of common referrers, narrowed down for audience and geographic preference; also valuable are videos or image-laden social media ads that showcase the organization's awards, distinctions, outcomes and expertise.

The fourth step is to display ads to maximum advantage, by building a custom geotarget that includes common or ideal referrers in the area surrounding the hospital or practice. The fifth step is to implement paid search to find referring physicians by generating content and running ads targeted for niche search terms. The sixth and final step involves tracking leads. This entails monitoring not just how many impressions and clicks the content drives, but also how many phone calls, emails or online scheduling requests are received. Physicians also should consider whether prospective referrers eventually make a referral.

From the article of the same title
Physicians Practice (06/30/21) Sauceman, Rachael
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Health Policy and Reimbursement

First Rules to Protect Patients From Unexpected Medical Bills Issued by Agencies
The Biden administration has issued rules to protect Americans from unexpected medical bills after patients go to emergency rooms (ERs) or receive other care they did not realize was out of network. The rules, which go into effect next January, stipulate that, if a health plan includes any emergency services, those services must be covered without requiring prior insurer consent. Regardless of whether the ER or its doctors are in the insurer's network, patients may not be charged more for emergency care or air ambulances than if those services were supplied by in-network providers. The regulations also prohibit higher charges when an anesthesiologist, assistant surgeon or others provide such out-of-network ancillary care, even though the patient's main surgeon is within a health plan's network of allowed medical personnel and facilities. The main author of the new rules is the US Department Health and Human Services, and they are being coordinated with the departments of Labor and Treasury and the Office of Personnel Management, since the protections will apply to federal workers' health benefits.

From the article of the same title
Washington Post (07/01/21) Goldstein, Amy
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Special Affordable Care Act Subsidies Available for Unemployed Americans Starting July 1
The Biden administration says unemployed Americans can sign up for subsidies for 2021 coverage on the federal Affordable Care Act exchange, effective July 1. The benefit, part of the $1.9 trillion rescue package enacted in March, allows anyone who receives or is approved to receive unemployment compensation during the year to obtain health insurance policies for as little as $0 per month in premiums and with low cost-sharing requirements, after federal assistance. The subsidies are linked to the benchmark silver plan, so those who select higher-level policies might have to pay a premium. The same goes for those who live in states that require plans to cover additional benefits that go beyond the law's essential health benefits. An average of three out of five eligible uninsured Americans can access $0 plans after subsidies are factored in, according to the US Department of Health and Human Services.

From the article of the same title
CNN (06/29/21) Luhby, Tami
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Medicine, Drugs and Devices

California Bill Would Require Docs to Disclose Payments from Drug, Device Companies
California State Assembly member Adrin Nazarian (D-Sherman Oaks) has proposed legislation requiring physicians in California to reveal to patients any funds or gifts they receive from drug and medical device companies. Assembly Bill 1278 was recently approved by the assembly and is expected to move to the state's Senate in the coming weeks. An existing federal law, the Physician Self-Referral Law, often called the Stark Law, requires physicians to give written notice if they send a patient to a facility in which they have financial interest.

From the article of the same title
Medscape (06/24/21) Kalter, Lindsay
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Walmart Unveils Low-Price Insulin as More Patients With Diabetes Struggle to Pay for Drug
Walmart will this week start selling a less costly version of insulin that could better fit into the budgets of millions of diabetic Americans who lack health insurance or have difficulty paying for the medication. The pharmacy chain will offer an exclusive private-label version of analog insulin, ReliOn NovoLog, to adults and children with a prescription and extend its availability to its membership-based Sam's Club in mid-July. A vial of the drug will cost about $73, or about $86 for a package of prefilled insulin pens. NovoLog is the latest addition to Walmart's ReliOn brand of diabetes products. Walmart executive Cheryl Pegus said the company worked directly with drugmaker Novo Nordisk to cut costs. She noted that the price difference with branded competitors will run up to $101 per vial or up to $251 per pack of prefilled pens. "This price point, we hope, will improve and hopefully revolutionize the accessibility and affordability of insulin," Pegus said.

From the article of the same title
CNBC (06/29/21) Repko, Melissa
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, FACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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