News From ACFAS

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You have until September 15 to submit an application for the ACFAS Board of Directors. The ACFAS Nominating Committee seeks experienced members to participate in the upcoming election to serve on the College’s Board of Directors. If you are an ACFAS Fellow, believe you are qualified and would like to help lead the profession, submit your nomination application by September 15, 2021.

Visit acfas.org/nominations for the nomination information and application, including complete details on the recommended criteria for election candidates. Note the application submission process will now be completed using an online application process. Don’t miss our all-new Surgical Management of the Active Patient course coming up November 6-7.

Led by a faculty of skilled arthroscopy surgeons, this two-day, interactive 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 acfas.org/skills. Become a coding pro with another ACFAS coding course—Coding Fundamentals!

Coding Fundamentals is an all-new comprehensive workshop covering the fundamentals of coding and billing for foot and ankle surgeons. The program explains the foundation of the coding and billing process from expert colleagues and is a course for those new to coding or for those who want to brush up on their coding knowledge. The course can be taken before the ACFAS Coding and Billing for the Foot and Ankle Surgeon course and will be offered at ACFAS 2022 in Austin as a preconference program and prior to any future full ACFAS Coding and Billing for the Foot and Ankle Surgeon courses.

For the ACFAS 2022 preconference program, residents will also have the opportunity to take this course as a part of a full day of learning geared toward Residents. Residents can pair this course with Residents’ Day at a discounted rate. Register for Residents’ Day in the morning and learn the foundation of coding and billing in the afternoon with Coding Fundamentals.

Full course information and registration for the ACFAS 2022 Coding Fundamentals preconference course will be available soon at acfas.org/Austin.

Foot and Ankle Surgery

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New research sought to investigate the initial effect of the "telescopic rod" in a combined surgical technique for treating congenital pseudarthrosis of the tibia (CPT) in children. Fifteen patients with Crawford type IV CPT were treated using a combined surgical technique and the telescopic rod from January 2017 to May 2018. The combined surgical technique using the telescopic rod included excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov's fixator, tibia-fibular cross union and wrapping autogenic iliac bone graft. Primary union was achieved in all patients with an average follow-up time of 37.3 months. The mean primary union time was 4.5 months and nine cases showed limb length discrepancy with an average limb length of 1.1 centimeters. Ankle valgus, proximal tibial valgus, telescopic rod displacement and epiphyseal plate tethering occurred in one, three, six and two cases respectively, with no refractures observed during the follow-up periods.


A study explored the effect of low-intensity pulsed ultrasound (LIPUS) following intramedullary screw fixation for proximal fifth metatarsal stress fractures. Patients who underwent intramedullary screw fixation for proximal fifth metatarsal stress fractures were evaluated retrospectively. LIPUS treatment was initiated within three weeks of surgery in all cases, and of the 101 feet analyzed, 57 were assigned to the LIPUS treatment group and 44 were assigned to the non-LIPUS treatment group. The average to restart running and return to sports was 6.8 and 13.7 weeks in the LIPUS treatment group and 6.2 and 13.2 weeks in the non-LIPUS treatment cohort, respectively. No significant differences in these parameters were observed between groups, and the mean time to radiographic bone union was not significantly different between the LIPUS treatment group (11.9 weeks) and the non-LIPUS treatment group (12 weeks). The rate of postoperative nonunion in the LIPUS treatment group was 0 percent, versus 4.5 percent in the non-LIPUS treatment group. These findings discourage recommending LIPUS to shorten the time to bone union.


A retrospective evaluation of the influence of age on clinical outcomes of surgical correction of hallux valgus was conducted. Patients who underwent corrective surgery for hallux valgus at an academic hospital were stratified as either = 70 years old (Group one) or < 70 years old (Group two). There were 106 patients in total, with 53 patients in each group. Clinical outcomes, quality of life and satisfaction questionnaires were collected preoperatively and at six months and 24 months postoperatively. There were no differences between patient groups in preoperative biodata and clinical parameters, but elderly patients had significantly poorer Physical Component Summary scores postoperatively at both six and 24 months and significantly poorer American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale at 24 months. No difference was noted between the two groups in patient satisfaction rates at 24 months postoperatively.

Practice Management

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Continued dispensing of prescription drugs that are no longer appropriate for a patient has emerged as a widespread safety issue. Much of the problem, write Saira Shervani, MD, and William Madden, PharmD, of University of Chicago Medicine, is due to the failure of some electronic health records (EHRs) and pharmacy systems to implement electronic medication discontinuation along with electronic prescriptions. Because of the disconnect between different vendors and users, there is an absence of complete interoperability between the systems that results in some patients continuing to receive and take high-risk medications—including warfarin and insulin—that are dispensed in error. In response, the authors emphasize the importance of raising awareness among clinicians and encouraging them to help patients better understand their medicine regimens. As another short-term solution, they suggest that medication discontinuation in the EHR could trigger a reminder to actually call the pharmacy. However, Shervani and Madden assert, "A long-term technological solution will require implementation of e-discontinuation in EHR and pharmacy systems, allowing e-discontinuation orders to be routed to the same pharmacy that received the initial e-prescription."


Medical practices can improve their management of incoming calls in seven ways, first by simplifying and shortening the greeting and ordering its options in terms of the associated call volume. There should also be fewer rings before rolling to voice mail, and patients should be told when to expect action or a call back. Staff should be trained to manage calls effectively with a focus on courtesy, friendliness, attentiveness and diligence. A portal for electronic patient communication should also be furnished, as should educational materials for patients to reference at their convenience. Finally, practices should provide patients with a summary of their visit, which should keep the number of calls the practice receives from patients requesting clarification to a minimum.


Doctors generally lack the training to get fair terms in salary and contract negotiations with hospital executives, and one way to improve their bargaining position is to view contracts holistically. This perspective covers base salary, bonuses and benefits. The first course of action for doctors is to pull the data on salaries for physicians in their geographic area with the same specialty. Resources like Doximity, Merritt Hawkins and the American Medical Group Association disclose data from physician compensation surveys on an annual basis. Physicians also should ensure they get more than one offer, with at least five to 10 hospitals targeted. Finally, they should strive to counter the first offer they receive.

Health Policy and Reimbursement

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The US Centers for Disease Control and Prevention (CDC) estimated that the number of Americans with some form of health insurance coverage increased by about 1.6 million last year despite the COVID-19 pandemic, mainly due to enrollment growth in government-sponsored health plans. Early CDC data indicates 31.6 million, or 9.7 percent of Americans of all ages, were uninsured in 2020, versus 33.2 million in 2019. Total Americans with public health plan coverage increased by 2.1 million to 123.5 million last year, while the number of privately insured Americans grew by 1.9 million to 200.6 million. Roughly 14 percent of Americans between 18 and 64 were uninsured last year, compared to 14.7 percent the year before. Hispanic adults were most likely to be uninsured, followed by non-Hispanic Black adults, according to the National Center for Health Statistics survey. Americans with a family income of less than 100 percent of the federal poverty level had the highest percentage of coverage from public health plans like those of Medicaid, Medicare or children's health insurance program.


The US Department of Health and Human Services (HHS) intends to launch the new Office of Climate Change and Health Equity, which will deem climate change a public health issue and report to a White House climate task force. The new office is expected to address health risks related to climate change, including those that disproportionately impact poor and minority communities. Sources said the office is expected to protect populations most at risk—including seniors, minorities, rural communities and children—and could eventually result in policies compelling hospitals and other care facilities to lower carbon emissions. Arsenio Mataka has been appointed HHS Senior Adviser for Climate Change and Health Equity, and John Balbus will move to the HHS Office of the Assistant Secretary for Health to help establish the new agency. Risks cited by recent research include fatalities and injuries from extreme events like heat waves, storms and flood or infectious diseases borne in food or water, as well as higher levels of air pollution, which disproportionately affect minority communities.

Medicine, Drugs and Devices

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The US Congressional Budget Office (CBO) has issued a new drug development model that calculates a proposed Medicare drug pricing bill could reduce the number of drugs brought to market by 21 to 59 over the next 30 years. The Elijah E. Cummings Lower Drug Costs Now Act introduced in the House of Representatives would require the Secretary of Health and Human Services to negotiate drug prices for insurers participating in Medicare Part D, cap drug costs at 120 percent of international prices and "prioritize drugs to areas where the impact would be greatest." A CBO working paper published this past February estimated price reductions between 57 percent and 75 percent under the legislation. CBO's model determined that a similar policy would reduce expected returns on drugs by 15 percent to 25 percent, meaning two fewer drugs would debut on the market annually in the first decade of the policy being enacted, with 23 fewer drugs in the second decade and 34 fewer drugs by the third.


A company that manufactures penicillin products has resumed operations in Bristol, TN, after going bankrupt a year ago. Officials, including Gov. Bill Lee and Rep. Diana Harshbarger, commended the turnaround. Jackson Healthcare relaunched operations on August 30 under the name of USAntibiotics. A 360,000-square foot factory will manufacture enough amoxicillin and amoxicillin-clavulanate to stockpile the United States for five years, the company said. Overall, it will produce two billion tablets and 300 million capsules annually. Neopharma of the United Arab Emirates declared bankruptcy last August and shut down its factory, leaving the United States completely dependent on penicillin from China. After the plant's prior closure, Harshbarger lobbied the US Cybersecurity and Infrastructure Security Agency to keep its critical infrastructure designation.


Some people with rheumatoid arthritis (RA) are treated with a monthly infusion of the biologic tocilizumab. However, the drug is now in short supply because of the surge in COVID-19 cases. In June, FDA gave tocilizumab its emergency use authorization to treat hospitalized COVID-19 patients. This monoclonal antibody can help reduce inflammation by blocking a protein called IL-6, which causes RA-related damage. That same protein plays a role in alleviating serious symptoms in people with severe COVID-19. Genentech estimates that demand for the drug increased by more than 400 percent beyond pre-COVID-19 levels in just two weeks. When RA patients go without the medication, even for 1 month, they can experience debilitating flare-ups. Steven Taylor, executive vice president of mission and strategic initiatives for the Arthritis Foundation, says that while there are other drugs available for RA patients, they are not easily interchangeable. Genentech says additional supplies of the drug should be available by August 30, and a subcutaneous injectable form of tocilizumab that has not been authorized to treat COVID-19 is still available for RA patients.