News From ACFAS

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The Board of Directors elected its officers for 2022–2023 pursuant to the College’s bylaws. Terms will commence at the ACFAS 2022 Scientific Conference February 24-27 in Austin, TX.

• 2022-23 President: Michael Cornelison, DPM, FACFAS
• 2022-23 Immediate Past President: Thanh Dinh, DPM, FACFAS
• 2022-23 President-Elect: Eric Barp, DPM, FACFAS
• 2022-23 Secretary-Treasurer: George Tye Liu, DPM, FACFAS

High-quality poster presentations are an important part of the Annual Scientific Conference, and time is running out to submit your latest discoveries and late-breaking research to be considered for display at ACFAS 2022, February 24-27 in Austin.

Poster abstracts must be submitted to ACFAS by September 15 to be eligible for review. PDFs of eligible posters are due November 10.

Visit acfas.org/PosterSubmission to view guidelines/criteria and submit your poster today! The College's new student-led webinar series focuses on an overview of the process of podiatric research to provide a starting point for students and new researchers to better understand podiatric scientific pursuits.

The nine-part series, hosted once per month, will consist of three 20-minute segments on various topics of the research process. The 20-minute segments are led by an ACFAS Student Club President, a member from the ACFAS Regions and a member of the ACFAS Research Committee.

Join us Tuesday, September 21, 8pm CT, for the kick-off session on formulating a research topic. Visit acfas.org for more information.

Foot and Ankle Surgery

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The vascular surgery COVID-19 coronavirus disease 2019 collaborative (VASCC) study sought to identify the influential characteristics of a population with severe peripheral artery disease and/or chronic limb threatening ischemia during the COVID-19 pandemic, whose outcomes could have been impacted by postponement of scheduled procedures. The study involved 165 patients in the United States, whose average length of delay to surgery was 59.3 ± 50.4 days. Sixty-six patients had a baseline wound ischemia foot infection (WIfI) grade and stage available. Wound grades of one and three were equally prevalent, an ischemia grade of three was most prevalent. The most prevalent foot infection grade was zero; WIfI clinical stage three was the most prevalent. Severe claudication was the most frequent surgical indication, followed by minor tissue loss, rest pain and major tissue loss. Six patients needed intervention for a threatened bypass and three needed critical in-stent stenosis. Eight delayed patients in the intermin group required conversion of planned, elective surgery to emergent surgery. The indications for emergency surgery were progressive tissue loss for five patients, critical in-stent restenosis for two and threatened bypass for one. The primary major adverse post-emergency surgery event was major limb amputation for four of the eight patients, while 10 of the 165 limbs have required a major limb amputation and seven a minor amputation at the last follow-up.


A study was conducted to compare the clinical and radiographic results of the interdigital approach versus the medial transarticular approach for lateral release plus scarf osteotomy in 77 feet with moderate to severe hallux valgus. Thirty-six feet underwent interdigital procedures while 41 underwent medial transarticular procedures. The American Orthopaedic Foot and Ankle Society score rose from 60 to 93 in the transarticular group and from 59 to 95 in the interdigital group. The hallux valgus angle improved from 35.7 ± 6.5 degrees to 15.5 ± 7.6 degrees in the transarticular cohort and from 36.0 ± 6.8 degrees to 12.9 ± 13.0 degrees in the interdigital cohort. In the transarticular group the intermetatarsal angle improved from 16.5 ± 2.5 degrees to 6.5 ± 2.7 degrees and from 17.2 ± 2.5 degrees to 7.3 ± 4.3 degrees in the interdigital group. None of the clinical or radiographic parameters exhibited any significant differences between the treatment cohorts. The transarticular approach can be deemed safe and effective and leave only one scar rather than two.


A multi-center review of 117 consecutive limbs that underwent partial fifth ray amputations was held to assess incidence of reulceration. The researchers theorized an association between location of resection and reulceration. Seventy-one patients had repeat ulceration following a partial fifth ray amputation. The median follow up time was 19 months. No statistical difference based on location of amputation was observed with regards to reulceration, further amputation, transmetatarsal amputation or below knee amputation. Statistical significance was seen in the follow up time between study sites, fifth ray amputation reoperation rate between study sites and re-ulceration rates between study sites. The results indicated that partial fifth ray amputations can be a good initial salvage operation to clear infection and extend bipedal ambulatory status.

Practice Management

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With the LGBTQ+ population growing, healthcare providers have a responsibility to create LGBTQ+ friendly practices. One step in this direction is for practitioners to demonstrate support for the LGBTQ+ community by wearing something with a rainbow on it or have something in the office with a rainbow on it. Another step is showing cultural competency by allowing use of preferred names and pronouns. Practices should also leverage more resources so they can treat conditions unique to LGBTQ+ patients, like depression and greater tobacco use among lesbian women. Whenever possible, practices should include brochures in the office that promote diversity. Hiring diverse staff who are trained to accommodate LGBTQ+ customers is vital as well.


Independent physicians can make their practices more sustainable and prosperous in the current health industry climate by forming a new super group or joining an existing one. Another option is to adopt a private equity investment/management services organization (MSO) model. A third choice involves forming an MSO as an asset protection/estate planning tool. Practices can also align themselves with a hospital, health system, affiliate and employment. Clinical integrated networks and accountable care organizations can be another route to sustainability, while organic growth could give the practice more negotiating sway with payors and/or make the practice more appealing for a merger, acquisition or other affiliation. Finally, a concierge practice model could increase satisfaction for both physician and patient.


Practices that train staff for their specific jobs must make sure to include other nonspecific areas in their training, or risk overlooking important aspects. One area is time management, whose benefits for employers include greater efficiency and productivity. Workplace safety issues are also valuable, and employers that avoid safety incidents can keep employees on the job more consistently and avoid issues involving insurance and workers' compensation. Environmentalism training can improve a practice's image as a custodian of its community and environment, while practice-required patient service training can help make the importance of that value apparent practice-wide. Ethics training could cover items with concrete legal or regulatory implications, like antibribery laws, as well as topics like practicing honesty and transparency with colleagues, superiors and subordinates. Both employees and patients generally appreciate working for and with organizations and teams they view as ethical.


New research from care navigation and coordination company Quantum Health indicates that 79 percent of 1,001 surveyed consumers who received healthcare services in the past two years faced an average three challenges when doing so. Difficulties included administrative issues and understanding the care they received, and understanding coverage levels, applying all available benefits, finding providers and understanding insurance claims or billing questions were areas they struggled with. Moreover, 90 percent of respondents with complex or ongoing clinical needs faced additional challenges related to tasks like securing approval of prior authorizations; understanding test results or diagnosis and treatment options and devising a plan of care for more complex health issues. Meanwhile, 57 percent of respondents suffered a resulting negative impact like significant declines in mental well-being or physical health, or disruption of a prescribed treatment plan. The healthcare challenges were even more impactful for people with chronic conditions.

Health Policy and Reimbursement

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The US government directed hospitals to begin publishing a complete list of the prices they negotiate with private insurers in 2021. Though many hospitals have refused, data from compliant hospitals reveals that they are charging patients wildly different fees for basic services and that major insurers are negotiating shockingly unfair rates for customers. Concealing this information has allowed hospitals to tell patients that they are receiving "steep" discounts, while still charging many times what a public program like Medicare is willing to cover. This is of increasing concern to patients, who often enroll in high-deductible plans that force them to pay thousands of dollars in costs before coverage kicks in. In the long term these high prices trickle down as higher premiums, which across the country are climbing every year. Analysis indicates that small health plans with seemingly little clout are sometimes out-negotiating the five dominant US insurers, while a single insurer can have a half-dozen different prices within the same facility, based on which plan was picked during open enrollment and whether it was bought as an individual or through work. However, patients considering two plans — choosing a higher monthly cost or a bigger deductible — do not realize that they may also be picking a much worse price when they later require care.


The US House of Representatives approved a $3.5 trillion budget plan that includes expanded healthcare coverage for older Americans. Medicare would provide coverage for dental, vision and hearing under the plan, while enrollment age would be lowered, probably to 60 from 65. The proposals are part of Democrats' agenda to fortify the social safety net, and Medicare proponents are optimistic that coverage of the extra benefits will be instituted. "This would be a very big deal for the Medicare program and Medicare beneficiaries," said David Lipschutz, associate director and senior policy attorney for | the Center for Medicare Advocacy. "If Congress adds [those] benefits, it would fill some major gaps in coverage that the program has had since its inception." Lipschutz notes that Medicare's current extra care provisions are not comprehensive, but if expanded benefits were mandated under original Medicare, they would be standardized in an Advantage Plan. "We'd hope this would enrich benefits for all beneficiaries," he said.

Medicine, Drugs and Devices

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The US Chamber of Commerce and the Pharmaceutical Care Management Association have sued the US Department of Health and Human Services and other federal agencies to block a federal rule requiring insurers and employers to disclose the prices they pay for healthcare services and drugs. Under the rule, health plans, including those offered by self-insured employers, must publicize the rates they pay to hospitals and other healthcare providers, starting next year. Economists say the impact of disclosure will likely vary, depending on the situation and those involved in negotiating prices. Researchers have suggested that the range of prices will narrow since hospitals and other providers that learn they are receiving the lowest rates will likely push to elevate them, while insurers that find they are paying the most will likely pursue bigger discounts so their fees are more comparable to their competitors'. The plaintiffs argue certain provisions of the price transparency rule exceed federal authority and could increase healthcare costs. They claim the computer-readable files are not directed at consumers, while the mandates are onerous for employers and the net drug price measure was improperly proposed before completion.


Overweight adults in the United States should be screened for diabetes and prediabetes starting at age 35, the US Preventive Services Task Force recommended Tuesday. The task force had previously recommended screening begin at age 40. The last update to its diabetes recommendations was in 2015. The change in the screening recommendations comes partly from research showing that diabetes incidence increases at 35 years of age compared with younger ages, the panel said. It also took into consideration research showing that earlier medical treatment for newly diagnosed diabetes could be helpful in lowering the risk of health complications and premature death.