News From ACFAS

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It’s been a challenging year thus far, but we’re looking forward to 2021 for Las Vegas and the 79^th Annual Scientific Conference February 25-28!

Las Vegas is open for business and has moved into phase 4 to safely reopen putting many precautions in place and using technology to protect visitors and employees. As ACFAS continues developing content for this year’s meeting and pre-conference workshops, we are confident ACFAS 2021 will not only be a success but will keep everyone safe and healthy.

Online registration opens in the fall, but we will continue to keep you informed as new developments and updates arise. For more information on ACFAS 2021 and on submitting a manuscript or poster, visit acfas.org/LasVegas. The Arthroscopy Skills Course last weekend in Chicago was a big success on many levels! While it was hardly a “standard course” by pre-COVID-19 means, attendees were given the same high-quality education expected from ACFAS all while also being kept safe with the necessary protective measures and safety precautions amid the ongoing coronavirus situation.

Some of the new safety measures from this weekend’s course included plexiglass barriers on speaker podiums and at check-in, speakers and attendees were required to wear masks throughout the course and safely spaced to allow for social distancing, attendee packets were handed out in clear bags, and meals were packaged individually.

ACFAS is ready for you and we hope to see you soon at more of our educational programs! To learn more about safety precautions in place for upcoming in-person meetings, visit acfas.org/SafetyPrecautions.

Do you have original research for publication? Help lead the way for the profession with innovative research by submitting it to The Journal of Foot & Ankle Surgery! By publishing your research in JFAS, you’re helping to showcase foot and ankle surgeons as the true experts in foot and ankle surgery and putting forward the latest techniques and new developments improving patient outcomes.

Articles can be submitted in a traditional subscription format or through Open Access ensuring your research will be widely seen, reaching millions of readers, non-subscribers, news outlets and health reporters worldwide. All ACFAS members also receive a 50 percent discount on Open Access submissions.

If you’re not sure about publishing, check out the Elsevier’s Researcher Academy for modules to help you prepare for and write research with articles on pre-submission processes, securing funding and more.

Visit jfas.org to access the JFAS Guide for Authors to guide you toward submission. You can review the formatting guidelines and once you’re ready, you can submit your article!

Foot and Ankle Surgery

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The study describes the normative Achilles tendon properties in 65 asymptomatic collegiate athletes using evaluations by ultrasound B mode on two tendon positions (neutral state and active maximum dorsiflexion). The mean Achilles tendon length was found to be 14.9 centimeters, mean transverse dimension of 1.38 centimeters, thickness of 0.49 centimeters and cross-sectional area of 0.61 centimeters in the relaxed state. Males had greater tendon length, tendon width, tendon thickness, tendon cross-sectional area and foot length, as well as larger tendon dimensions and cross-sectional areas. The Achilles tendon parameters had a statistically significant correlation with the height, weight and foot length. The tendon length in the dorsiflexed-stretched position had a statistically significant relationship to foot length, tibia length, calf circumference and range of motion. Differences in the correlation between the Achilles tendon parameters and body habitus was recorded as a function of ankle position.


The study investigated accompanying osteochondral lesions of the talus (OCLTs) in patients with an ankle fracture and evaluate its relationship with clinical outcomes. The study included 56 patients who were treated for ankle fractures between June 2016 and February 2017; 30 patients were treated operatively and 26 nonoperatively. The mean American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate the clinical results in all patients in the second month and second year. The second-month ankle MR images were evaluated for OCLTs in all patients. Accompanying OCLTs were detected in 19 of 56 patients. There was no significant association between OCLT and fracture type or treatment type. The mean AOFAS score significantly decreased in the OCLT group in the second-year control, whereas a significant increase was observed in patients without OCLTs.


A slim and light plantar pressure sensor was newly developed to detect the effect of sex difference on plantar pressure during standing and walking. One-hundred healthy adult volunteers (50 women and 50 men) were recruited. Ten plantar pressure sensors were implanted in a 1 millimeter thick insole, and plantar pressure was measured during three seconds of standing and while walking 10 steps. The maximum loads during standing and walking were analyzed in each sensor, and the results were compared between different areas of the foot in the antero-posterior direction and the medio-lateral direction and between different time points. The movement of the center of pressure (COP) during walking was also evaluated. The movement of COP was constant for both sexes. In all cases, the maximum load was observed on the medial of the foot. Women had a significantly higher peak pressure on the hallux, toes, forefoot and medial aspect of the foot compared to men while standing and walking.

Practice Management

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A coalition of healthcare organizations has released an advertising campaign to encourage people to return to their medical providers as the COVID-19 pandemic continues, a sign of how difficult it has been to allay fears of catching the coronavirus during visits to a doctor or pharmacy. The coalition behind the campaign—which includes Walgreens Boots Alliance, pharmaceutical distributor McKesson Corp. and the Children's Hospital of Philadelphia—asks patients to "stop medical distancing." The group is running ads on television, social media, print and other platforms. The effort underscores how significantly the declines in patient visits for regular checkups and even emergencies are rippling through the US healthcare system.

Patients are weighing their health concerns and needs as well as their age and any pre-existing conditions in considering whether to leave home to pick up a prescription or visit a doctor, healthcare providers say, and sometimes opt to delay care. Fewer medical appointments have led to reduced demand for some tests and prescription drugs. It has already taken a financial toll on primary care practices, many of which have furloughed or laid off workers. Doctors and insurers fear that conditions left untreated or undiagnosed will require more extreme healthcare interventions later.


While medical practices are understandably focused on financial survival, practice leaders say that keeping up employee morale amid the fear and uncertainty surrounding COVID-19 is equally important. The keys to doing so are ensuring that employees feel safe and valued while building trust through regular communication. That communication takes the form of daily huddles with front-office staff and that the medical director conducts with the practitioners. Leaders also suggest offering perks such as free lunches and gift cards to boost morale.


The article examines COVID-19 infection liability waivers and their effectiveness in managing patient infection lawsuits. A well drafted waiver can be one part of a risk management plan but, like most asset protection strategies, it should not be relied upon as complete protection on its own. Waivers cannot provide a shield against reckless or intentional conduct and are typically only effective against mere “negligence”. In courts, waivers are often construed in favor of the plaintiff and may also specifically be void for public policy in certain settings. As such, waivers should narrowly comply with state law and should be professionally drafted, and practices should be sure to obtain informed consent from patients. Other layers of protection should always include insurance- and fact-specific legal tools, as well as thorough sanitation practices and measures to prevent infection.

Health Policy and Reimbursement

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The US House Committee on Appropriations' Subcommittee on Agriculture, Rural Development, Food and Drug Administration and Related Agencies held a markup session for appropriations for fiscal year 2021. Of the total budget of $23.98 billion, the bill allocates $3.21 billion for the US Food and Drug Administration (FDA), an increase of $40.8 million from the prior fiscal year. FDA funding will total $5.99 billion when user fee revenue is included. The budget increase represents a smaller rise than the 3 percent boost in appropriations the agency received in fiscal year 2020.

Medicine, Drugs and Devices

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Newer point-of-care tests for detecting COVID-19 are being developed, though they might not be available in clinics for months. Some of these tests use plastic tubes that gather saliva, while others place patient samples into chemical mixes that light up if coronavirus genes are detected. Another type of test that is less expensive can could be mass produced identifies coronavirus proteins within minutes. Once scaled up and distributed, these faster COVID-19 tests could be used in hospitals to rapidly screen emergency department patients and in schools and workplaces to monitor the health of children and employees. With additional adjusting, some tests could be developed to work at home as easily as a pregnancy test, providing a positive or negative result. Amesh Adalja, MD, at the Johns Hopkins University Center for Health Security, says such tests will need to become more widely available. "The quicker and easier tests can be done," the more widespread they can be, said Adalja. "That's going to help people get back to some semblance of normalcy."


According to GoodRx, pharmaceutical companies logged more than 800 price increases this year and adjusted the cost of 42 medicines upward by an average of 3.3 percent so far in July. While the size of that increase is not out of line with past years, the number of branded drugs seeing hikes this month was higher than last year. "Business as usual is a problem in a pandemic. These price increases contribute nothing to innovation, but greatly to suffering. These aren't new drugs," said Peter Maybarduk, director of the Global Access to Medicines Program at consumer advocacy group Public Citizen. Drugmakers generally raise prices twice a year, in January and at mid-year, but some delayed or staggered increases amid increased scrutiny from the Trump administration. The administration is looking at ways to reduce high prescription drug costs and could issue an executive order on the matter soon, according to White House Chief of Staff Mark Meadows.


Data released by the US Treasury reveals that many of the healthcare delivery sites in the medical technology industry benefited from the support of the Paycheck Protection Program (PPP). In the diagnostics sector, about 5.6 percent of the nearly 15,500 medical laboratories in the United States received loans exceeding $150,000, as did roughly 16.1 percent of the more than 3,100 businesses classified as diagnostic imaging centers. In addition, some 26.6 percent of the nearly 3,500 freestanding ambulatory surgical and emergency centers received loans greater than $150,000, and 5.8 percent of approximately 33,200 medical and surgical hospitals did as well. Some 770 loans above that threshold were listed for surgical and medical instrument manufacturing businesses, and about 380 were noted in the surgical appliance and supplies manufacturing category. Meanwhile, President Trump signed an extension to the deadline, now Aug. 8, for businesses to apply for PPP funds. About $132 billion can still be accessed from the program, the Small Business Administration reported. Support for smaller labs comes as consolidation in the industry is poised to continue.


Medical workers say that personal protective equipment (PPE) is running low again as the coronavirus resumes its rapid spread and the number of hospitalized patients climbs. Rear Adm. John Polowczyk, who is in charge of coronavirus-related supplies for the White House, told the US Congress last week that more than than one-fourth of the states have less than a 30-day supply. In June, the government started replenishing its PPE stockpile with the goal of building up a two-month supply.

Although all US states have received some protective gear from the US Federal Emergency Management Agency (FEMA), an Associated Press analysis of the agency's own data found that the amounts varied widely when measured by population and the number of confirmed COVID-19 cases. Low-population, mostly rural states received the largest FEMA allocations per confirmed case. Many states say the federal supplies make up a small part of their stockpiles after they spent millions to acquire equipment on their own.