News From ACFAS

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Help advance the profession by volunteering to serve on a 2021 ACFAS committee, Clinical Consensus Statement panel or as a scientific literature reviewer where you’ll have an active role in helping to provide members the information we all need to stay up-to-date and shape the future of our profession.

To apply, visit acfas.org/volunteer to help lead the organization and profession into the future! The application deadline is October 31, 2020. Take the next step to sharpen your arthroscopy skills with the Advanced Arthroscopy and Cartilage Restoration course. Don’t wait to register, space is limited.

November 7-8 (Saturday/Sunday)
Orthopaedic Learning Center (OLC) | Chicago, IL
Fees: ACFAS Member $2295 | Non-ACFAS Members $2600
Maximum 16 Continuing Education Contact Hours
View Agenda | Register

Learn the latest techniques and more on cartilage restoration from leading surgeons. Arthroscopic lateral ankle ligament repair, classic OATS resurfacing and particulate cartilage resurfacing techniques, en bloc resection and replacement techniques, subtalar joint arthroscopy and arthroscopic STJ fusion technique.

Attendees must have previously taken ACFAS’ Arthroscopy of the Foot and Ankle course. If you attended a basic arthroscopy course not through ACFAS, fax certificate and agenda from the program attended.

Don’t wait, this will sell out! Visit acfas.org/education to register now. What were you doing in 1981? These 21 DPMs were just starting their careers and took the fateful step to join the American College of Foot and Ankle Surgeons–after becoming a part ACFAS, they’ve stayed loyal for over 40 years. Congratulations to these dedicated members! In appreciation, they are receiving automatic Life Membership status with ACFAS.

For 2021, the ACFAS Board of Directors honors:

• Philip F. Adler, DPM, FACFAS, Jacksonville, FL
• Walter A. Alm, DPM, FACFAS, Elgin, IL
• Steven A. Burns, DPM, FACFAS, Scottsdale, AZ
• Barry L. Efron, DPM, FACFAS, Orange Park, FL
• Edward A. Fazekas, DPM, FACFAS, Lakeland, FL
• William H. Fitzpatrick, DPM, FACFAS, Albuquerque, NM
• Peter Marshall Harvey, DPM, AACFAS, Wichita Falls, TX
• Richard S. Jaffe, DPM, FACFAS, Jerusalem, Israel
• Howard D. Kane, DPM, FACFAS, Westland, MI
• Paul Kinberg, DPM, FACFAS, Dallas, TX
• David A. Laver, DPM, FACFAS, Fremont, CA
• Ronald S. Lepow, DPM, FACFAS Houston, TX
• William S. Lynde, DPM, FACFAS, Newtown, PA
• Stephen N. Marshall, DPM, AACFAS, Camillus, NY
• Martin M. Pressman, DPM, FACFAS, Milford, CT
• Guy R. Pupp, DPM, FACFAS, Dearborn, MI
• Robert J. Snyder, DPM, FACFAS, Tamarac, FL
• Howard M. Sokoloff, DPM, FACFAS, Danville, CA
• Edward S. Stein, DPM, FACFAS, St. Peters, MO
• Allan G. Weiss, DPM, FACFAS, Orange, CA
• Michael K. Wilson, DPM, FACFAS, Oklahoma City, OK

Foot and Ankle Surgery

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The study investigated whether the subtendons of the Achilles tendon can be verified in vivo on magnetic resonance imaging (MRI) in the midportion of the tendon; it also examined the relation of the plantaris tendon to the Achilles tendon. In a retrospective study of 200 MRI of ankle joints, the subtendon from the lateral head of the gastrocnemius muscle was identified in 65 percent of cases and was located in the anterior part of the Achilles tendon. The subtendon from the soleus muscle was recognized in 12 percent, comprising the anterior part of the tendon, and the subtendon from the medial head of the gastrocnemius muscle was identified in 6 percent. The central soleus tendon was identified in 85 percent of cases. There was a weak correlation between the presence of the central soleus tendon and the possibility of identifying the subtendon from the soleus muscle. The plantaris tendon was directly related to the insertion of the Achilles tendon in 42.5 percent.


The study investigated the optimal fixation method for arthrodesis of the first tarsometatarsal joint (TMT1) by examining the medical records of 49 patients that underwent 53 TMT1 arthrodeses. Median average visual analog scale scores decreased from 6.8 to 2.7, while first intermetatarsal angles were reduced from 17.39 degrees to 7.16 degrees, standing lateral first metatarsal angles improved from 21.66 degrees to 23.94 degrees and tibial sesamoid positions were planarized from 6.02 degrees to 2.79 degrees. Plantar plating allowed immediate weightbearing with transition to normal shoe gear at six weeks. Complications occurred in six feet. Plantar locking plates combined with a dorsal compression screw presented a favorable tension-side implant location that closed the fusion site under load. This facilitated substantial reductions in complications, pathologic angles and pain in the treatment of HAV.


The study investigated the variables that predict response to foot orthoses and corticosteroid injection as interventions for plantar heel pain. Baseline variables from a randomised trial in which participants received either foot orthoses or corticosteroid injection were used to predict change in the Foot Health Status Questionnaire foot pain and foot function subscales and first-step pain measured using a visual analogue scale. Regression models were generated for different dependent variables, for each intervention, and at different timepoints. For foot orthoses at week four, greater ankle dorsiflexion with the knee extended predicted reduction in foot pain, and lower fear-avoidance beliefs and feelings predicted improvement in foot function. At week 12, lower BMI predicted reduction in foot pain, improvement in foot function and reduction in first-step pain. For corticosteroid injection at week four, there were no significant predictors for change in foot pain or foot function. At week 12, less weightbearing hours predicted reduction in foot pain and lower baseline foot pain predicted improvement in foot function.

Practice Management

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Under the HIPAA Security Rule, healthcare organizations have to retain electronic communications data for a minimum of six years. Email archiving is an effective way to accomplish this. Email archiving solutions generally upload emails to the provider’s servers, where the emails are indexed to allow the archive to be searched. The emails are encrypted which reduces the potential for “man-in-the-middle” attacks where data is intercepted in transit. Service providers impose tight controls over who can access archived emails to view patient data, fulfill an audit request made by the US Department of Health and Human Services or provide email content for legal purposes. The benefits of email archiving include easy storage management, business continuity, data theft prevention and accelerated audit response. Email archiving also offers automated email retention in one centralized place, which can help ensure the consistent disposal of personal health information.


Physicians considering whether to acquire another practice should enter the process with a strategic growth plan that reflects their goals and experience. Physician-owners need to know what strategic outcomes they want from acquisitions and consider the implications to both the buyer and the practices that may want to sell. Once they have articulated a foundation for their plan, physicians will need to define the parameters of the practice they want to acquire. Some areas to think about initially include practice size, location, price range and patient catchment area.


COVID-19 has prompted some physicians to retire before they had planned and others to close their practices. A recent survey of 3,000 US physicians by Physicians Foundation reported 4 percent said they wouldn’t return to work due to concerns for their personal health, while more than a quarter (28 percent) admitted having “serious concerns” about catching COVID-19. The physician survey also found that 8 percent had permanently closed their offices, 43 percent reduced their staff and 72 percent suffered an income loss because of the pandemic. Gary Price, president of the Physicians Foundation, said changes in medical practice in recent years "put great stress on [physicians] even before the pandemic." A second survey from the Physicians Foundation found that 30 percent felt “hopeless” as a result of the pandemic, 18 percent had sought mental healthcare and 18 percent had increased their use of medications, alcohol or illicit drugs.

Health Policy and Reimbursement

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Cigna has joined Anthem and UnitedHealthcare in restricting coverage for most advanced imaging, including MRIs and CT scans, when performed in a hospital-based department or facility, except under special circumstances. Cigna said the policy intends to steer patients away from expensive hospitals, and its implementation during a pandemic, when hospitals are facing lower-than-normal patient volumes and losing money, is notable.


New studies from federal as well as private researchers suggest that the loss of health insurance was less dramatic than predicted during the pandemic, partly because many low-income workers were in jobs that already did not provide health insurance while many employers opted to leave furloughed and temporarily laid-off workers on the company insurance plan. Others who lost health benefits sought coverage through a spouse's or parent's job, Medicaid, or plans offered on the state-based Affordable Care Act (ACA) marketplaces. However, the studies also indicate that even with the new options and expanded safety net created by the ACA, by the end of summer a record number of people were poised to become newly uninsured. Health policy experts and insurers say these losses could deepen in the months ahead and into 2021, if the economy doesn't improve and Congress offers no further assistance.


With COVID cases rising across the United States, seniors are reluctant to seek help in person. Consequently, more Medicare open enrollees are expected to go online for assistance. Humana said it will offer socially distanced, in-person appointments with agents, "based on the guidance of local health officials," while UnitedHealth Group is transitioning enrollment to an online format. "We hold a lot of community meetings across the country during open enrollment ... (but) we're expecting to do many more of those in a virtual setting," said UnitedHealthcare Medicare and Retirement plans CEO Tim Noel. Online health insurance brokerages are anticipating a boom in demand for phone consultations when Medicare open enrollment begins soon. They have been expanding their staff over the summer, moving agents from call centers to home-based systems and revamping their websites.

Medicine, Drugs and Devices

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With supplies of any coronavirus vaccine likely to be in short supply initially, a special US committee explained how it believes distribution should be prioritized. Front-line healthcare workers and first responders should be first in line, panel members suggested, followed by people with underlying conditions that elevate their risk of severe COVID-19 disease. The experts, who represent the National Academies of Sciences, Engineering and Medicine, said the next wave of doses should go to teachers, childcare providers, transit workers and other high-risk groups. Young adults, children and university and hotel employees would be among the demographics vaccinated in the next phase.


The National Poll on Healthy Aging found most older Americans take two or more prescription medications, yet only a small number have had a pharmacist review potential drug interactions. Michigan Medicine polled 2,048 Americans ages 50 to 80 and estimated that two-thirds take two or more prescription drugs and about 20 percent take five or more. Medication reviews are covered for qualifying Medicare Part D beneficiaries, but patients have been historically unlikely to participate. The survey indicated 85 percent of Medicare Part D enrollees who had not had a medication review were unaware that they could be eligible for one. Moreover, just 29 percent of respondents who take five or more prescription drugs have had a medication review with their pharmacist. "These results show the importance of continuing efforts by physicians, pharmacists, other healthcare providers, insurers and policymakers to help older adults understand the importance of medication reviews," said survey co-author Antoinette Coe.


Insulin caps have lost much of their potential during the COVID-19 pandemic, increasing the value of underground exchanges serving patients who cannot afford the medication, listed at $125–$450 per vial. With Colorado at the forefront, cap initiatives were implemented last year in several states seeking to ease the copay burden on patients. However, jobs—along with the associated income and medical insurance—fell victim to the health crisis, rendering the cap plans largely ineffective. Meanwhile, traffic embargoes have prevented patients seeking lower-cost supplies to cross the border. Instead, patients have turned to underground networks where other diabetics share, at no cost, any surplus insulin they have.