News From ACFAS

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Today is the last day 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 the end of today, 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. Have you recently moved or gotten a new phone number? Make sure you are maximizing all the College has to offer by updating your ACFAS member profile. By keeping your contact information up to date you have access to the ability to gain new patients from FootHealthFacts.org, connect with your colleagues through the ACFAS Member Directory, get the latest edition of The Journal of Foot & Ankle Surgery (JFAS) and the latest news from ACFAS on the profession and the College.

How do I make sure my information is accurate? Log into your account at acfas.org to access your profile to:

• Check and update your work and personal email addresses, fax number and your work, home or cell numbers.
• Opt in to include yourself in the “Find an ACFAS Physician” search tool on FootHealthFacts.org and in the ACFAS Membership Directory.
• Confirm your preferred mailing address for JFAS and ACFAS Update.

Whenever you have a change of address or information, you can always log in and update your profile. If you have any questions, reach out to the Membership Department.
Join us tomorrow, Thursday, September 16, for the next ACFAS Virtual Journal Club at 7pm CT. This installment is hosted by the Foot & Ankle Institute Fellowship in Indianapolis and presented by Jered M. Stowers, DPM. To see articles being discussed tomorrow and to register, visit acfas.org/Journal Club. The College’s annual Residency Directors Forum is back, in person, for ACFAS 2022 in Austin! Co-sponsored by the Council of Teaching Hospitals (COTH), this year’s forum is set for Wednesday, February 23 from 1-5:30pm.

Topics will include various topics to assist resident educators in optimizing their resident review and oversight such as milestones, resident remediation and resident burnout. The day will continue with tips to teach the teachers, like why good documentation is important and a primer on Sim Labs and virtual education options. The day will end with a session on program mergers and acquisitions and updates from an A to Z list of resident education stakeholder organizations.

The Forum is complimentary for all residency directors, faculty and program coordinators (up to two representatives from each program), fellowship directors and school Deans. Registration will open soon so check your email for more details.

Foot and Ankle Surgery

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A study aimed to classify the articular cartilage of the syndesmosis, which is valuable for minimizing the risk of iatrogenic damage during surgical correction. The researchers dissected 20 cadaveric ankles to identify the cartilage of the syndesmosis. Distinct articular cartilage extending above the plafondon on the tibial side was spotted in 19 of 20 specimens (95 percent), and the tibial cartilage extended an average 6 ± 3 (range, two to 13) millimeters above the plafond. Six of 20 (30 percent) specimens on the fibular side exhibited cartilage proximal to the talar facet, which extended a mean of 24 ± 4 (range, 20-31) millimeters above the tip of the fibula. The superior extent of the syndesmotic recess was a mean of 10 ± 3 (range, five to 17) millimeters in height. The syndesmosis cartilage across all specimens did not extend more than 13 millimeters proximal to the tibial plafond, and the syndesmotic recess did not extend more than 17 millimeters proximal to the tibial plafond. The authors concluded that syndesmosis fixation placed more than 13 millimeters proximal to the tibial plafond would have safely skipped the articular cartilage in all specimens and the synovial-lined syndesmotic recess in the majority.


Research was held to assess and compare the talar rotation prior to and following lateral ankle lateral stabilization surgery in patients with mechanical ankle instability (MAI). The researchers theorized that abnormal internal talus rotation in MAI patients would decline post-surgically, with no significant difference in internal talus rotation between the ligament repair and reconstruction cohorts. A retrospective review of 56 MAI patients who underwent ankle lateral stabilization surgery following arthroscopic evaluation (repair, 36 cases; reconstruction, 20 cases) was conducted. The internal rotation of the talus decreased significantly following ankle lateral stabilization surgery in patients with MAI versus before surgery, but no statistically significant difference between the ligament repair and reconstruction groups was evident before or after the procedure.


A study sought to summarize and assess the effectiveness of current treatment strategies for the presentation of multiple Morton's neuromas in adjacent intermetatarsal spaces of the same foot. A systematic review of articles on this procedure ultimately yielded seven articles for the study. The most frequently reported treatment protocol was simultaneous neuroma excision using a single incision, while two studies each detailed simultaneous excision with two separate incisions and delayed excision, respectively. No strong evidence was found favoring delayed excision or multiple incisions, and further high-quality work is necessary to make more definitive conclusions, which should include non-operative treatment and other protocols.

Practice Management

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Post-traumatic stress disorder (PTSD) has become a common struggle for nurses who have worked in hospitals during the coronavirus pandemic. Before the pandemic, studies found that PTSD among front-line healthcare workers ranged between 10 percent and 50 percent. In addition, the suicide rate among doctors was twice that of the general public. A survey of healthcare workers in Turkey last fall found a PTSD rate of 49.5 percent and an increase in suicidal thoughts. The American Medical Association and other union groups want to see changes that can help nurses and doctors. One proposal is a national rule limiting the number of patients a nurse cares for. Workers also say they should have free access to therapy, medication and other interventions. The working conditions and stress of the job is also pushing more nurses to quit due to burnout. Some nurses say it is important that healthcare workers practice self-preservation when it comes to the job, but a loss of experienced workers is a risk many worry about.


Text messaging patients is an excellent approach for boosting recalls and keeping them healthy, and texting campaigns have grown revenue for patient services and improved care compliance. Simple text message templates, scheduled ahead of time, will also ease management by the practice's staff. Best practices for using text messaging start with determining a benchmark recall figure for the specialty, followed by running a report in the electronic medical record/practice management software on patients that have not been seen in that same period. This list should be exported as a comma-separated values or Excel document to a secure location. The next step is to use a reliable text messaging platform for sending specific tests to this group and to mark the date that the individual responds in a new column. Texting care-related reminders to patients also can be effective for improving care compliance.


The growing use of virtual care creates a need for physicians to understand and safeguard against the risks for litigation. One of the biggest risks concerns virtual examinations. Doctors conducting a telemedicine appointment must rely on a patient's description and reading of symptoms to attempt diagnosis without testing and physical examination, which could more easily lead to misdiagnosis. Security and technology threats also pertain to virtual care, while simple mistakes like a poor Internet connection or an older computer with a low-quality camera lens could result in misdiagnosis or miscommunication. Providers who opt for virtual care can lower their risk by implementing best practices and recommendations from the American Telemedicine Association and working with lawyers who are knowledgeable about medical malpractice defense to formulate policies and procedures for following those guidelines. Providers should also educate patients on proper procedures of virtual visits and the possible risks. When a virtual visit fails to supply enough information, providers should document this deficit and advise an in-person appointment.

Health Policy and Reimbursement

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The US Food and Drug Administration announced a public workshop to discuss the need for mandatory opioid prescriber education as part of a Risk Evaluation and Mitigation Strategy. Topics to be discussed at the meeting, which is scheduled for October 13-14, include the value of a single source for education on the appropriate use of opioids, risks of opioid abuse and misuse and treatment of opioid use disorder to address multiple needs and reduce the burden on prescribers.


The medical publishing community mobilized this week against climate change, as journals around the world circulated an editorial on what they agree is the "greatest threat to global public health." The opinion piece was penned by editors of top journals including The Lancet and the New England Journal of Medicine and ran in more than 200 other sources representing specialties across the health spectrum. The viewpoint put the spotlight on the direct and indirect health effects of rising temperatures and demanded immediate international collaboration in the fight against global warming.

Medicine, Drugs and Devices

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The White House endorsed a proposal to limit prices for prescription drugs, calling for the government to negotiate with drug makers on prices and applying those prices not just to Medicare but to all drug purchasers in the country. The proposal, published as a white paper from the US Department of Health and Human Services, was included a range of recommendations to foster more competition among drugmakers and improve the affordability of drugs for patients enrolled in Medicare.


A study from the US Centers for Disease Control and Prevention (CDC) indicates that drug-resistant infections are rising in hospitals as a result of efforts to treat severely ill COVID-19 patients when the coronavirus pandemic peaked. CDC noted that drug-resistant bacteria escalated as a result of reusing protective equipment, I.V. lines and medical equipment such as ventilators. In recent years, pathogens such as bacteria and fungi have mutated and developed defenses that allow them to resist medications, in particular in older patients and people with compromised immune systems. In extreme cases, no effective treatments remain for such infections.


The pandemic has disrupted annual doctor visits, and digital technology, imaging, gene sequencing and artificial intelligence (AI) will likely further virtualize physicals. Adding more technology to physicals could further distance the doctor-patient relationship, but designers of digital medicine tech see opportunities for improvement. Rochester, MN's Mayo Clinic is sending laboratory kits to patients ahead of physicals, while patients can get blood sampled at local clinics for standard and genetic analyses, then discuss the results with physicians virtually. Mayo eventually expects to collect additional patient data remotely using smartphone and smartwatch applications, wearable sensors and blood pressure cuffs. AI and machine learning are also needed to extract meaningful information from massive datasets gathered by digital tech; the University of California, San Francisco's Geoffrey Tison suggests doctors will eventually provide regular electronic reports to patients on various health metrics based on the data from digital devices.