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This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Technology and Device Trends

News From ACFAS

ACFAS Assists AAOS CPG on Tendon Ruptures

Two ACFAS Fellows recently served as peer reviewers of a new American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline (CPG) on “The Diagnosis and Treatment of Achilles Tendon Rupture.” Michael S. Lee, DPM, FACFAS, and Glenn M. Weinraub, DPM, FACFAS, were two of 12 podiatric and orthopaedic surgeons who served as peer reviewers. A separate panel wrote the draft guideline over the past year.

“I was impressed with the AAOS process and the thoughtful responses they provided to my comments and questions. It was a pleasure to participate in this endeavor and ACFAS will reciprocate where appropriate in its own future CPGs,” says ACFAS President-Elect Michael S. Lee, DPM, FACFAS.

Next in the guideline’s development is a public comment period and eventual approval by the AAOS Board of Directors.
Las Vegas Room Rate Reduced

You may already have received the 2010 Annual Scientific Conference program booklet, including registration and hotel reservation information.

But, the Mandalay Bay Resort has just reduced the ACFAS room rate to only $189—down from $199 printed in the booklet.

All reservations made before January 21, 2010, will receive the lowest rate offered. Visit the conference home page for complete program information.
Colorado Sunset Review A Step Forward for Foot and Ankle Surgeons

The Colorado Department of Regulatory Agencies (DRA) has completed a “sunset review” of the Colorado Podiatry Practice Act, with positive results. They recommended that:
  • the state legislature reauthorize the Colorado Podiatry Board for nine years.
  • the definition of the practice of podiatry be amended to state that it includes “treatment of the soft tissue below the mid-calf.”
  • the requirement of certification by the American Board of Podiatric Surgery be repealed for podiatrists who complete a three-year residence.
Specifically, DRA acknowledged that “podiatrists who participate in a three-year residence receive considerable training in ankle surgery and upon completing the residency are qualified to perform ankle surgery.”

Special thanks to ACFAS leadership in Colorado who provided critical input into the process, including Daniel J. Hatch, DPM, and G. Marc Conner, DPM.

Click here to get the entire report in PDF.
20 New Articles in JFAS This Month

Your November/December issue of the Journal of Foot & Ankle Surgery is on its way to you, but you can read all 20 articles, including original research, literature reviews, case reports, and "Tips, Quips and Pearls," online now.

Log on today to read about these topics and more:
  • Persistent dropfoot after calf muscle lengthening
  • Managing clawing of lesser toes in pes cavus
  • Percutaneous RF nerve ablation for plantar fasciitis
  • 1st MPJ arthrodesis using a single screw
Your JFAS subscription is a benefit of your membership in ACFAS. Make sure it's mailed to your preferred address by updating your membership profile.
ACFAS Dues Reminders Hitting the Mail

ACFAS membership is at an all-time high, and there must be a reason!

Dues reminders for 2010 membership will hit your mailbox in the next two weeks. Renewals are due by December 31, 2009, but you can get a jump start by paying online now at the ACFAS website. You will need to log in with your member ID and password to access your account.

College membership allows you to rub shoulders with the best and the brightest foot and ankle surgeons in the world. Access the ACFAS Member Center for a full listing of benefits available to you as a member. Dues can be paid online now, or by mail or fax once your reminder arrives at your home or office.

Now, more than ever, ACFAS is your professional partner — renew a.s.a.p. for 2010!

Foot and Ankle Surgery

Can a Spoonful of Sugar Help Prevent PONV?

The administration of dextrose, a form of glucose, to patients immediately after surgery decreases the risk of post-operative nausea and vomiting (PONV), according to a study presented at the American Society of Anesthesiologists' annual meeting. All 56 patients in the study underwent procedures under general anesthesia, and all were given an antiemetic. The half that received dextrose immediately after their surgeries had a significantly lower risk of PONV and were discharged from the post anesthesia care unit more quickly than the other half, who received a placebo.

From the article of the same title
Outpatient Surgery (10/20/09) Tsikitas, Irene

Transosseous Capsuloplasty Improves the Outcomes of Lindgren-Turan Distal Metatarsal Osteotomy in Moderate to Severe Hallux Valgus Deformity

A group of researchers sought to determine whether transosseous capsuloplasty combined with Lindgren-Turan osteotomy would enhance the clinical and radiological outcomes in patients with moderate to severe hallux valgus deformity. The researchers assessed 23 feet operated by Lindgren-Turan osteotomy and 25 feet operated by the same Lindgren-Turan osteotomy/transosseous capsuloplasty for the correction of the hallux valgus, intermetatarsal, and distal metatarsal articular angles, sesamoid reduction, American Orthopaedic Foot and Ankle Society Clinical Rating Scale, and patient satisfaction. The researchers recorded considerable improvement in all radiological parameters for both groups, but the group that received Lindgren-Turan osteotomy/transosseous capsuloplasty exhibited greater postoperative improvements in intermetatarsal and distal metatarsal articular angles. More than half of the patients in that group had complete reduction of medial sesamoid, versus 17.4 percent in the group that only received Lindgren-Turan osteotomy. The researchers conclude that better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren-Turan distal metatarsal osteotomy in combination with transosseous capsuloplasty.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (10/09) Ozkan, Namik Kemal; Guven, Melih; Akman, Budak; et al.

Diabetic Foot Ulcer Burden May Be Modified by High-Dose Atorvastatin: A 6-Month Randomized Controlled Pilot Trial

For patients with diabetes, a high dosage of atorvastatin for six months may have a beneficial effect on foot ulcers, according to a small study. Researchers randomized 13 patients with diabetes and neuropathic foot ulcers to receive either 10 mg or 80 mg of atorvastatin for six months in addition to standard care. There were six patients and six ulcers in the 10 mg group, and seven patients and nine ulcers in the 80 mg group. All six ulcers in the 10 mg group healed, as did six of the nine ulcers in the 80 mg group. However, two of the ulcers in the low-dosage group recurred, and six new ulcers developed. In the high-dosage group, none of the previously healed ulcers recurred, and only one new ulcer developed. "We observed a possible beneficial effect of 6 months’ high-dose atorvastatin on DFUs, which should be tested in appropriately sized prospective studies," the researchers concluded.

From the article of the same title
Journal of Diabetes (09/01/2009) Vol. 1, No. 3, P. 182; Johansen, Odd Erik; Birkeland, Kare Inge; Jorgensen, Anders Palmstrom; et al.

Practice Management

2009 Productivity Survey: How Do You Compare?

Medical Economic's annual survey on physician productivity found that primary care physicians worked the same number of hours in 2007 and 2008,but saw slightly fewer patients. Consultants suggest that transitioning to an electronic medical record and reviewing flow of patients through the office are important steps to ensure an efficient practice. The survey also found that the shift in the job market has created headaches for physicians as they seek to become credentialed by new plans to retain patients.

From the article of the same title
Medical Economics (10/27/09) Weiss, Gail Garfinkel

Patient Surveys Can Help Practices Improve

Health plans increasingly are grading physicians by surveying patients about their experiences, even sending secret-shopper patients into practices. Some practices are reacting by using the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey developed by the Agency for Healthcare Research & Quality and endorsed by the National Quality Forum to boost care. The free survey gives practices a standardized way to measure patient satisfaction with all aspects of their experience.

From the article of the same title
American Medical News (10/08/09) O'Reilly, Kevin B.

House Passes Red Flag Exemption for Small Practices

The House of Representatives has passed a bill that would exempt a healthcare practice with 20 or fewer employees from the FTC's Red Flags Rule requirement. The rule, which will be enforced starting November 1, 2009, requires healthcare entities considered to be "creditors" to implement an identity theft prevention program. The measure will also exempt entities that know all of their customers or clients individually; only perform services in or around the residences of their customers; and have not experienced incidents of identity theft if identity theft is rare for businesses of that type. The bill now moves to the Senate.

From the article of the same title
HealthLeaders Media (10/26/09) Nicastro, Dom

Health Policy and Reimbursement

Public Option Push in Senate Comes with Escape Hatch

Senate Majority Leader Harry Reid is including a “public option” — a government-run health plan — in the health care legislation that will be debated by the full Senate in the next few weeks. His proposal includes an “opt out” provision for states that do not want to include a public option in the proposed health insurance exchanges contained in the legislation. Republicans remain united in opposition of any public option. Reid will need the votes of all 58 Democrats and 2 Independents to pass legislation. Observers note that is unlikely that a final bill will emerge from Congress for President Obama’s signature before Christmas.

From the article of the same title
New York Times (10/27/09) Pear, Robert; Herszehorn, David

Insurers Not Improving Nation's Health Care

The National Committee for Quality Assurance (NCQA) issued its 13th annual “State of Health Care Quality” report, and the results were discouraging. After 12 years of significant progress, the report found that quality of care was stagnant in 2009 for patients in both private and public plans. NCQA gathers data from 979 plans that voluntarily submit quality information. The report found that overuse of imaging for back pain and breast cancer screening increased and that quality of care for a number of health conditions declined. It noted that nearly two-thirds of children prescribed medicine for ADHD did not see a doctor for follow-up care. NCQA officials hope that the results are a “blip” and attribute the decline in performance to the economy and the fee-for-service payment model.

From the article of the same title
CNNMoney (10/16/09) Kavilanz, Parija

Medicare Pricing Gets New Look; RUC Process Revisited

As the Centers for Medicare & Medicaid Services (CMS) prepares for its latest five-year review of possibly misvalued services in the physician fee schedule, the Medicare Payment Advisory Commission (MedPAC) is once again raising its 2006 recommendation that the Health and Human Services secretary establish a separate expert panel to advise on potentially overvalued or undervalued services. Generally, CMS accepts most recommendations from its existing AMA/Specialty Society Relative Value Scale Update Committee, or RUC, but there are some questions about things like the physician work portion of particular value units. Research from CMS suggests that overestimates of physician time may be a problem that applies to a number of services.

From the article of the same title (10/19/09) Silva, Chris

Technology and Device Trends

A Promising New Development for Treatment of Duchenne Muscular Dystrophy

A technique called exon skipping shows great potential to increase muscle strength and prolong life in people with a severe form of Duchenne muscular dystrophy, according to a new study published in the journal Molecular Therapy on Oct. 20. Exon skipping changes the way messenger RNA instructions are read, so that only error-free exons go into the final protein "recipe." The goal is production of a functional protein despite the presence of flawed genetic instructions.

From the article of the same title
Newswise (10/22/09)

Bolt Fixation for Syndesmotic Injuries

Researchers performed a retrospective study of 28 patients who underwent bolt fixation for a syndesmotic injury to the ankle. Overall, the fixation device was found to adequately stabilize the syndesmosis during healing. Radiologically accurate syndesmosis reduction was achieved in 26 patients. The mean AOFAS score was 86 (range: 33–100). The majority of patients were very satisfied with the overall result. The researchers concluded that the fixation is a simple and quick operative procedure providing reliable syndesmotic reduction, adding that the material should not be removed prior to walking. They noted, however, that the only drawback is the greater need for removal in the event of local symptoms.

From the article of the same title
Injury (11/01/09) De Vil, J.; Bonte, F.; Claes, H.; et al.

Botulinum Toxin Improves Reduced Dorsiflexion After Achilles Tendon Surgery

Some patients have ongoing problems with dorsiflexion of the ankle joint following surgery for an Achilles tendon rupture. Researchers here report on their use of botulinum toxin into the gastrocnemius and soleus muscles to improve dorsiflexion. Weakening of the triceps surae by botulinum toxin allowed patients to perform the required exercises and to tolerate casting at night. Thus, all patients were able to tolerate plantigrade foot position nine months after beginning of botulinum toxin treatment. At final follow-up after two years, pain had significantly improved and a mean dorsiflexion of 21° was reached.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (10/13/09) Reuter, Iris; Lorbach, Olaf; Mehnert, Sabine

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October 28, 2009