August 25, 2021 | | JFAS | FASTRAC | Contact Us

News From ACFAS

Don’t Miss Next Surgical Management of the Active Patient
Register now for the interactive, two-day Surgical Management of the Active Patient course, November 6-7.

Led by a faculty of skilled arthroscopy surgeons, this course gives you the opportunity to learn and practice established and cutting-edge techniques in surgery for the foot and ankle as well as the latest techniques in management of the active patient. Highlights include Achilles tendon pathology, 1st MPJ pathology, jones fracture management and more!

Learn more and register for this course at
Share Facebook  LinkedIn  Twitter  | Web Link
ACFAS 2021 Featured in Podiatry Today Supplement
Get an insight into some of the sessions from this year's Annual Scientific Conference in Las Vegas featured in Podiatry Today's August Supplement.

This supplement showcases the engaging posters presented at ACFAS 2021 as well as different tracks from Trauma on Trial, which presented various approaches to challenging trauma cases, to Going All In on Perioperative Management, which shared emerging insights into pain management, cardiology, vascular surgery, infectious diseases and radiology. Read the entire supplement, visit the Podiatry Today’s website.
Share Facebook  LinkedIn  Twitter  | Web Link
Hey, New Grads: PGY-1 Membership Is Free!
It's easy to join! Dues for PGY-1 residents are waived thanks to your local ACFAS Regions’ support. Your new ACFAS membership will help you get a head start on your post graduate training with the help of the many resources available to ACFAS members: Don't miss out on this valuable membership—download an application today!
Share Facebook  LinkedIn  Twitter  | Web Link
We're Growing -- Socially!
We've expanded our social media efforts to now include ACFAS Pinterest PinsPinterest to further reach consumers on the important work you do. Pinterest is a great way for us to showcase some of the endless educational resources we have on, especially our infographics on various foot and ankle conditions and our new animated videos, which help patients better understand common conditions and procedures.

Follow our page on and share it with your patients and friends to help raise awareness of the profession and how foot and ankle surgeons are an important part of the healthcare spectrum.
Share Facebook  LinkedIn  Twitter  | Web Link

Foot and Ankle Surgery

A New Classification of Talocalcaneal Coalitions Based on Computed Tomography for Operative Planning
A study sought to design a new classification system based on the articular subtalar joint facets involved to cover all talocalcaneal coalitions and guide operative planning based on computed tomography (CT). A total of 106 patients (108 feet) were enrolled, who had been diagnosed with talocalcaneal coalition using a CT scan. The coalition was classified as either inferiorly overgrown talus or superiorly overgrown calcaneus (I); both talus and calcaneus overgrew (II); coalition with an accessory ossicle (III) or complete osseous coalition (IV). Each type was further divided into either involving anterior facets (A), involving the middle facets (M) and involving the posterior facets (P). Generally eight feet were classified as type I, 75 as type II, seven as type III and 18 as type IV. Twenty-nine coalitions involved the posterior facets only (subtype-P), 74 coalitions involved both the middle and posterior facet and five coalitions simultaneously involved the anterior, middle and posterior facets (subtype-AMP). Type II-MP coalition occurred most frequently. The value of weighted Kappa for the main type was 0.93 while the value for the subtype was 0.78.

From the article of the same title
BMC Musculoskeletal Disorders (08/11/21) Vol. 22, No. 678 Wang, Anhong; Shi, Weili; Gao, Lixiang; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Acute Limb Ischemia Among Patients with COVID-19 Infection
Researchers systematically searched PubMed, Embase, Scopus and the Cochrane Library for online literature up to January 2021 reporting cases with SARS-CoV-2 infection and acute limb ischemia. A total of 34 studies published in 2020 covering 540 patients, of whom 199 patients were eligible for analysis, were evaluated. Average patient age was 61.6 years and 78.4 percent of patients were male. Incidence of comorbidities was low, with arterial hypertension comprising 49 percent of cases, diabetes mellitus 29 percent, dyslipidemia 20.5 percent, chronic obstructive pulmonary disease 8.5 percent, coronary disease 8.3 percent and chronic renal disease 7.6 percent. Medical treatment was selected as first-line treatment for 41.8 percent of cases. Pooled mortality rate totaled 31.4 percent and pooled amputation rate reached 23.2 percent. Pooled clinical improvement rate among 28 studies reached 66.6 percent, while pooled reoperation rate among 29 studies reached 10.5 percent. Medical treatment corresponded with a higher death risk compared to any intervention, although amputation risk did not differ between the two strategies.

From the article of the same title
Journal of Vascular Surgery (08/11/21) Galyfos, George; Sianou, Argiri; Frountzas, Maximos; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Split Anterior Tibial Tendon Transfer to Dorsal Lateral Foot for Cavovarus Deformities with Neuropathic Ulcerations: A Case Series
A case series iluustrates split anterior tibial tendon transfer as a surgical reconstruction of cavovarus pedal deformity. The split anterior tibial tendon in-phase transfer to the dorsal lateral foot method restores eversion and dorsiflexory pull for offsetting peroneal attenuation. The procedure can be performed primarily or staged, in order to realize infection temporization prior to the transfer. Fourteen patients underwent the procedure, 57.14 percent of which had preoperative ulcerations and 42.86 percent of which had preoperative hyperkeratotic pre-ulcerative lesions. The preoperative ulcerations persisted for an average of 67.89 weeks, with an average area of 6.09 ± 7.44 cm square. The ulcerations healed in three-quarters of the patients at 19.67 weeks, with new ulceration occurrence in 7.14 percent at a 7.14 percent rate of ulceration recurrence. None of the patients had to undego minor or major amputation. The tendon transfer aims to decrease midfoot plantar pressures on the lateral foot and enable resolution of pre-existing ulcerations and rebalancing the foot and ankle.

From the article of the same title
Journal of Foot & Ankle Surgery (08/14/21) Cates, Nicole; Bunka, Taylor J.; Kavanagh, Amber M.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Management

AHA Urges Greater Attention to Peripheral Artery Disease
A new scientific statement issued by the American Heart Association (AHA) warns that peripheral artery disease (PAD) in the legs is inadequately diagnosed and treated. AHA recommends screening for PAD using a first-line diagnostic test called the ankle-brachial index (ABI) for adults aged 65 years and older and those aged 50-64 years with risk factors. Michael H. Criqui, MD, MPH, at the University of California, San Diego who chaired the initiative, says: "What has increasingly been recognized is that if an individual has blocked arteries in the legs, they're also very likely to have blocked arteries in the heart and the brain." He adds, "The first step is recognizing PAD and getting patients on the correct medications or other therapy." The scientific statement is published online in Circulation. The authors cited probable reasons for underappreciation of lower extremity PAD, including limited availability of the ABI test in clinics, the notion that a lower extremity vascular disease is not fatal and the belief that a diagnosis of PAD would not necessarily alter clinical practice. The authors also noted that several studies indicate many PAD patients do not receive evidence-based therapies. The statement concludes that "orchestrated efforts" among healthcare providers, researchers, expert organizations and healthcare organizations are necessary to raise awareness and understanding of the prevalence of PAD and improve its diagnosis and treatment.

From the article of the same title
Medscape (08/13/21)
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Free Registration

How Email AI Can Help Your Practice Thrive
Email is a technology ripe for artificial intelligence (AI) innovation that could work to the advantage of healthcare providers, with benefits ranging from securing inboxes from hackers to receiving transcribed voicemails directly to their inboxes. Predictive, AI-based email security is proving to be highly effective against most advanced business email compromise scams, phishing attacks and other evolving email threats. Providers can avail themselves of optimal protection by applying the Zero Trust security model to machine learning (ML) email AI tools. In terms of email security, ML is transitioning the dominant defense model to a proactive strategy that recognizes and even predicts novel threats as quickly as they emerge. Meanwhile, visual voicemail taps AI to automatically transcribe a voicemail into text, making it unnecessary for physicians to listen to incoming messages and risk violating the Health Insurance Portability and Accountability Act should someone overhear a voicemail containing protected health information.

From the article of the same title
Physicians Practice (08/17/21) Greevy, Hoala
Share Facebook  LinkedIn  Twitter  | Web Link

Use Technology to Avoid Surprises From the No Surprises Act
The No Surprises Act going into effect next year restricts out-of-network facilities and providers from balance billing, particularly when the patient cannot choose an in-network provider such as being transported by ambulance to the nearest facility. Though balance billing frequently occurs in emergency situations, it can also happen when a patient visits an in-network facility for a procedure or service and gets treated by an out-of-network provider. Physicians performing services at hospitals, outpatient departments, critical access hospitals or ambulatory surgical centers will have to comply with the legislation. This includes providing patients with notice, receiving written permission to bill for out-of-network services and generating "good faith estimates" so patients can manage expected costs. Providers must also offer price estimator tools, confirm that patients will stay in-network when receiving follow-up services and guarantee transparent billing processes.

Estimator tools can furnish individualized cost estimates to engender trust between patient and provider, patient satisfaction and long-term patient collections. Facilities must also know which providers should be used in a patient's care cycle and automated verification processes should be implemented within revenue cycle workflows to perform the proper network checks before making referrals or scheduling appointments.

From the article of the same title
Medical Economics (08/16/21) Beard, Kathryn S.
Share Facebook  LinkedIn  Twitter  | Web Link

Health Policy and Reimbursement

New York, DC to Require Healthcare Workers to Be Vaccinated
As the Delta COVID variant continues to spread nationwide, the state of New York and Washington, DC, announced on Monday COVID-19 vaccine mandates for health care workers. Gov. Andrew M. Cuomo of New York said the state is asking health care workers to "lead the battle between the variant and the vaccine." In Washington, DC, meanwhile, Health Director LaQuandra Nesbitt explained the mandate was "necessary for us to ensure that we're creating safe environments in our health care facilities." The states of California and Washington have previously announced similar moves. A recent Quinnipiac University poll found that six in 10 Americans back vaccine mandates for health care workers, with 35 percent opposing such a requirement.

From the article of the same title
Washington Post (08/16/21) Suliman, Adela; Nichols, Kendra; Shammas, Brittany; et al.
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

US Will Require Nursing Communities Get Staff Vaccinated or Lose Federal Funds
President Biden announced that all US nursing communities must require their staff to be vaccinated against COVID-19 or risk having their Medicare and Medicaid funding withheld, reports CNN. He said he is directing the Department of Health and Human Services to draft new regulations making their vaccinations mandatory for Medicare and Medicaid participation. "If you visit, live or work at a nursing [community], you should not be at a high risk of contracting COVID from unvaccinated employees," Biden declared. "While I'm mindful that my authority at the federal government is limited, I'm going to continue to look for ways to keep people safe and increase vaccination rates." However, the American Health Care Association and National Center for Assisted Living said imposing a mandate only on nursing communities could trigger a "disastrous workforce challenge," and | instead proposed that all healthcare workers in all settings should comply with the directive. "Defunding the care providers who continue to fight on the front lines would be a tragic misstep," added LeadingAge CEO Katie Smith Sloan. "Without Medicaid and Medicare funding, nursing [communities] cannot provide the quality care that our nation's most vulnerable older adults need."

From the article of the same title
CNN (08/18/21) Diamond, Jeremy; Luhby, Tami
Share Facebook  LinkedIn  Twitter  | Web Link

Medicine, Drugs and Devices

FDA Warns BlackBerry Vulnerability May Hit Drug Manufacturing, Medical Devices
The US Food and Drug Administration (FDA) said a vulnerability in a BlackBerry operating system may create risks for some medical devices and pharmaceutical manufacturing equipment. FDA released disclosures about the vulnerability, called "BadAlloc," from the U.S. Cybersecurity and Infrastructure Security Agency (CISA) and BlackBerry. The documents provide information on how to patch the risky code. BlackBerry said that an integer overflow vulnerability affecting several older versions of its QNX operating system, which is broadly used in medical and manufacturing equipment, "could potentially allow a successful attacker to perform a denial of service or execute arbitrary code." The company said it is unaware of any real-world exploitations of the vulnerability. FDA said organizations affected by BadAlloc should notify the agency of any products, equipment or systems that use the vulnerable real-time operating systems (RTOS) and inform it of any potential complications. The agency said, "Manufacturers are assessing which equipment or systems may be affected by the BlackBerry QNX cybersecurity vulnerability, evaluating the risk and developing mitigations, including deploying patches from BlackBerry." The BadAlloc vulnerability was previously disclosed by CISA after being identified by researchers at Microsoft in April. It affects software in various RTOS, including versions of Amazon's FreeRTOS, Apache Nuttx OS and ARM's Mbed OS.

From the article of the same title
Regulatory Focus (08/17/2021) Mezher, Michael
Share Facebook  LinkedIn  Twitter  | Web Link

Ingestible Robot Delivers Insulin to Your Body Without External Needles
Italian scientists have designed PILLSID, a robot that could eventually dispatch insulin to diabetes patients without requiring external injections. PILLSID consists of an wirelessly charged internal insulin dispenser implanted in the patient's abdomen and an ingestible magnetic capsule. The patient swallows the capsule, which travels through the digestive system to the dispenser. The dispenser magnetically rotates the capsule and pumps it full of insulin via a retractable needle,. The patient excretes the capsule once it is empty. When tested with diabetic pigs, PILLSID could successfully manage their insulin levels for several hours.

From the article of the same title
Engadget (08/18/21) Bonifacic, Igor
Share Facebook  LinkedIn  Twitter  | Web Link

Lawmakers Press Insulin Manufacturers for Lower Prices
Two members of the US House Energy and Commerce Committee increased pressure on insulin manufacturers to reduce the cost of the drug. The lawmakers asked Eli Lilly, Novo Nordisk and Sanofi—which control 99 percent of the world's insulin—to describe the steps they have taken to improve insulin prices over the past 2.5 years. "The Committee is troubled that despite your company's expressions of shared concern, insulin prices in the United States remain unacceptably high," wrote full committee Chairman Frank Pallone Jr. (D-NJ) and oversight subcommittee Chairwoman Diana DeGette (D-CO) in letters. "This is particularly frustrating considering Americans continue to bear a disproportionately high financial burden for their insulin compared to diabetes patients in other countries." Pallone and DeGette also asked the companies about what they have done to increase accessibility and reduce costs and how the COVID-19 pandemic affected their products "in any way." The companies' responses are due by September 17.

From the article of the same title
The Hill (08/19/21) Coleman, Justine
Share Facebook  LinkedIn  Twitter  | Web Link


This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, FACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

Contact Us

For more information on ACFAS and This Week @ ACFAS, contact:

American College of
Foot and Ankle Surgeons
8725 W. Higgins Rd.
Suite 555
Chicago, IL 60631
P: (773) 693-9300
F: (773) 693-9304
E: ThisWeek

Visit Us: Friend us on Facebook Follow us on Twitter Link us in on LinkedIn

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.

Some publication websites may require user registration or subscription before access is granted to the links following the articles. If an article is unavailable online, a link is provided to that publication's homepage.

Copyright © 2021 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe, click here.

News summaries © copyright 2021 SmithBucklin