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News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Technology and Device Trends

News From ACFAS

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Foot and Ankle Surgery

High Heels Reshape Leg Muscles, Create Pain When Not Worn

Habitual high-heel wearing can lead to changes in the calf muscle and tendons, according to a study published in July 16 in the Journal of Experimental Biology. The high-heel habit can cause fibers in the calf muscle to shorten and the Achilles tendon to stiffen and become thicker. While this does not pose problems when the heel is propped up, it can lead to discomfort when standing or walking around flat-footed because the muscle and tendon are stretched beyond their normal range of movement.

From the article of the same title
Live Science (07/15/10) Rettner, Rachael

Local Injections of Anesthetics for Ankle Sprains Do Not Suppress Muscle Activity

The use of local lidocaine injection in athletes to reduce pain from an anterior talofibular and/or calcaneofibular ligament sprain and facilitate return to play does not suppress muscle activity, according to research unveiled at the 2010 Annual Meeting of the American Orthopaedic Society for Sports Medicine. For the study, 14 recreationally active men performed a series of continuous lateral jumps on a custom-built device. The jumps were performed under five injected conditions that were made around, but not into, the anterior talofibular and calcaneofibular ligaments—1 ml saline, 1 ml lidocaine, 3 ml saline, 3 ml lidocaine, or no injection. Muscle activation patterns of the peroneus longus (PL), peroneus brevis (PB), and tibialis anterior (TA) were collected during the lateral jumps to assess peak amplitude, time to peak amplitude, peak amplitude at initial contact, and integrated muscle activity. Separate one-way repeated measures Analysis of Variance tests were used to analyze the dependent variables between injected conditions for each muscle. The results demonstrated no significant difference in firing patterns for any of the conditions studied. There was also no suppressed muscle activity differences between a 1 ml and 3 ml lidocaine injection, indicating the maximum can be used for pain control without reducing the dynamic restraining capabilities of the PL, PB and TA.

From the article of the same title
Ortho Supersite (07/16/10)

New Surgery Improves Outcomes for Severe Flat Foot Deformity

According to research presented at the annual meeting of the American Orthopaedic Foot and Ankle Society, reconstruction of the stage IV flatfoot deformity with the deltoid ligament repair, using the auto/allogenic peroneus longus tendon, resulted in good outcomes. In five patients, the average Foot and Ankle Orthopedic Survey scores were 61.4 for symptoms, 1.5 for stiffness, 78.3 for pain, 87.9 for function/daily living, 71.7 for function/sports/recreational activities, and 42.1 for quality of life. X-rays showed improvement in the foot and ankle alignment and the effects were long-lasting.

From the article of the same title
EurekAlert (07/08/10)

Practice Management

Orthopaedic Practice Looks to Step up Business With Walk-in Clinic

A large Chicago-area orthopedic group practice is opening a suburban walk-in clinic to attract more patients. The clinic will open next month to handle orthopedic injuries. The 90-physician practice says it’s the first such clinic in the Chicago area. Though it’s rare for a specialty practice to operate an immediate-care clinic, walk-in clinics of any type are rare, according to Melody Winter-Jabeck, administrator of Illinois Bone & Joint Institute. She said patients typically are forced to visit hospital emergency rooms for relatively minor injuries. “We see an unmet need, and obviously it’s a way for us to capture some marketshare.”

From "Bone & Joint Institute Looks to Step Up Business With North Shore Walk-in Clinic"
Crain's Chicago Business (07/22/10) Colias, Mike
Web Link - May Require Free Registration | Return to Headlines

Doctor's Notes: You Can Read Them, but Should You?

Researchers led by a team at Beth Israel Deaconess Medical Center in Massachusetts have launched a pilot program called the OpenNotes Initiative that will allow about 25,000 patients in Massachusetts, Pennsylvania, and Washington to read their doctors' notes on a secure Internet portal. The patients and doctors will then fill out questionnaires about whether the project helped or hurt. Some experts say allowing patients to read the doctors' notes will help them better understand their condition and improve communication and shared decision-making between the doctor and patient, but skeptics worry that the notes may confuse or upset patients.

From the article of the same title
Los Angeles Times (07/19/10) Roan, Shari

Mystery Patients Help Uncover Medical Errors

A study led by researchers at six Chicago-area medical centers is the largest on record to use "mystery patients" to investigate how physicians operate in practice. One hundred eleven doctors participated between 2007 and 2009. The physicians knew only that they were part of a study about medical decision-making. Actors playing patients each presented a well-rehearsed case and made an audiotape of their interactions with physicians. For each case, there were four carefully scripted variations that introduced a so-called contextual complication involving the patient's personal circumstances, a biomedical complication involving the patient's physical condition, simultaneous contextual and biomedical complications or no complications.

Researchers used the audio recordings and medical records to calculate how often physicians picked up on red flags signifying possible complications and consequently adjusted their plan of care. The failure to do both counted as an error. In contextually complicated encounters, error-free care was provided only 22 percent of the time. In biomedically complicated encounters, the error-free rate was 38 percent.

The study was published July 19 in the Annals of Internal Medicine.

From the article of the same title
Chicago Tribune (07/18/10) Graham, Judith

Health Policy and Reimbursement

A Tougher Conflict Policy at Harvard Medical School

Professors at Harvard Medical School will no longer be able to take industry money to speak for drug or medical device companies or accept gifts, travel, or meals under a new conflict-of-interest policy announced Wednesday. The school has also taken steps to separate, but not ban, industry financing and industry exhibits from Harvard’s postgraduate education classes and reduce by 50 percent, to $10,000, the limit on how much a faculty member can be paid by a company whose product or invention is under study by the faculty member. The American Medical Student Association praised the new policy. “We hope to see other medical centers follow this example,” said John Brockman, the association's president. The new rules take effect Jan. 1, 2011.

From the article of the same title
New York Times (07/22/10) Wilson, Duff

Fewer Medicare Patients for Specialists Due to Consult Code Cuts

Approximately 20 percent of specialists has eliminated or cut back on accepting new Medicare patients, largely due to the federal government's elimination of pay for specialty consultations, according to a survey by the American Medical Association and 17 professional specialist societies. As of Jan. 1, 2010, CMS eliminated the special series of five CPT codes that allowed specialist physicians to bill for consultations, performed at the request of a practitioner who wants a specialist's opinion regarding his or her patient. Before Jan. 1, those codes allowed doctors to bill between $20 and $50 more than what they would bill under an ordinary office visit.

From the article of the same title
HealthLeaders Media (07/19/10) Clark, Cheryl

HHS Seeking Suggestions for Online Inventory of Comparative Effectiveness Research

The Department of Health and Human Services is seeking suggestions on what to include in a national database of comparative effectiveness research that will be available to the public online. The 2009 stimulus act set aside $1.1 billion for comparative effectiveness research. HHS envisions a site that is searchable, simple to update, and makes it easy to gauge gaps in available research, according to a notice published in the Federal Register. The site also will supply users with information on how to conduct comparative effectiveness research and how to translate findings into language that is understandable to policymakers and healthcare decision-makers. The deadline for comments is Aug. 9.

From the article of the same title
Kaiser Health News (07/20/10)

Technology and Device Trends

Deltoid Ligament Reconstruction: A Novel Technique with Biomechanical Analysis

Deltoid ligament insufficiency has been shown to decrease tibiotalar contact area and increase peak pressures within the lateral ankle mortise, creating an arthritic ankle joint if left unresolved. Researchers describe a new technique that reconstructs both main limbs of the deltoid ligament in anatomic orientation while providing secure graft fixation. Six pairs of cadaveric lower extremities were utilized. Matched right and left lower limbs (one pair) were allocated either to a deltoid reconstruction group or an intact deltoid group. The anterior tibial tendon was chosen as the graft for ligament reconstruction and was harvested from the ipsilateral specimen. Tunnels were created in the distal tibia at the deltoid origin, the talus (deep), and calcaneus (superficial) deltoid insertions. The graft ends were passed through the talus and calcaneus respectively. The residual graft loop was then routed through the tibial tunnel and secured proximally with a cancellous screw post and spiked washer. The reconstruction technique under low torque was able to restore eversion and external rotation stability to the talus, which was statistically similar to the intact deltoid ligament. The researchers concluded that the procedure may be incorporated into total ankle arthroplasty, triple arthrodesis, and sports injuries to re-establish lost medial stability.

From the article of the same title
Foot & Ankle International (07/10) Vol. 31, No. 7, Haddad, Steven L. ; Dedhia, Sunil ; Ren, Yupeng ; et al.

Effect of Hinged Ankle-Foot Orthoses on Standing Balance Control in Children with Bilateral Spastic Cerebral Palsy

Researchers sought to identify the characteristics of static standing balance and its postural control mechanisms during quiet side-by-side standing and the changes in these measures while wearing hinged ankle-foot orthoses (AFOs) in children with bilateral spastic cerebral palsy (CP). Twenty-one children with bilateral spastic CP and 22 typically developing (TD) children were recruited. Pressure data were recorded while subjects with or without AFOs stood on dual force platforms and net body center of pressure (CoP) coordinates were calculated from this data. Net body CoP was traced for measuring mediolateral (ML) and anteroposterior (AP) displacement and path length per second. ML and AP displacement and path length per second of the CoP trajectory were higher in children with CP compared to TD children. There were no significant improvements in these parameters while wearing hinged AFOs. Compared to TD children, children with CP used less ankle strategy though more hip and transverse rotation strategies for postural control during quiet standing. While wearing hinged AFOs, the contribution of ankle strategy was significantly increased for ML balance control in children with CP.

From the article of the same title
Yonsei Medical Journal (07/15/10) Rha, Dong-wook; Kim, Dong Jin; Park, Eun Sook

New Discovery in Nerve Regrowth

New research in the Journal of Neuroscience describes a way to enhance nerve regeneration in the peripheral nervous system, potentially leading to new treatments for nerve damage caused by diabetes or serious injuries. The study team examined a pathway that helps nerves to grow and survive, which contains a molecular brake, called PTEN, that normally helps prevent excessive cell growth. The researchers found that PTEN prevents peripheral nerves from regenerating after nerve injury, but when the investigators blocked PTEN, nerve outgrowth dramatically increased. Researcher Kimberly Christie said, "We were amazed to see such a dramatic effect over such a short time period. No one knew that nerves in the peripheral system could regenerate in this way, nerves that can be damaged if someone has diabetes for example."

From the article of the same title
Science Centric (07/13/10)

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July 28, 2010