News From ACFAS

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This Saturday, October 31, is the deadline to volunteer to serve as an ACFAS committee member, Clinical Consensus Statement panelist or scientific literature reviewer. Don’t miss your chance to help the College and shape the future of our profession in 2021.

If you would like to volunteer, visit acfas.org/volunteer to apply. After careful review of applicants to serve on the ACFAS Board of Directors, the Nominating Committee recommends these four Fellows for two positions in the upcoming election:

• George T. Liu, DPM, FACFAS - Incumbent
• Shane M. Hollawell, DPM, FACFAS
• Andrew J. Meyr, DPM, FACFAS
• Gregory P. Still, DPM, FACFAS

Two, three-year terms will be filled by election. Candidate profiles and position statements will be posted at acfas.org/nominations on November 25. Online voting will be conducted December 11-28, 2020. All eligible voters will receive an email with a unique link to the election website in advance.

The 2021-2021 Nominating Committee included ACFAS Fellows: Christopher L. Reeves, DPM, MS, FACFAS, Chair; Eric G. Walter, DPM, FACFAS; Adam M. Budny, DPM, FACFAS; Brandi M. Johnson, DPM, FACFAS; Scott C. Nelson, DPM, FACFAS; Roland S. Ramdass, DPM, FACFAS; Ronald G. Ray, DPM, FACFAS Sharpen those arthroscopy skills next weekend with the Advanced Arthroscopy and Cartilage Restoration course.

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.

Space is limited, so don’t wait to register. Visit acfas.org/education to save your spot now.

Foot and Ankle Surgery

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The study evaluated the reliability and clinical relevance of Auto-generated three-dimensional (3D) measurements based on weightbearing cone-beam computed tomography (CT) scan technology in patients with posttraumatic end-stage ankle osteoarthritis. Seventy-two patients treated at one institution for posttraumatic end-stage ankle osteoarthritis, with available weightbearing conventional radiographs and a cone-beam CT scan, were analyzed. The accuracy of 3D measurements performed on osteoarthritic ankles was similar to 3D measurements performed on healthy individuals. Thirty-three of the 72 included patients evidenced an inframalleolar compensation of a supramalleolar/intra-articular ankle deformity, whereas 24 of those 72 patients showed no compensation or a further increase of a supramalleolar/intra-articular ankle deformity.


Long-segment disease involving the insertional region of the Achilles tendon can be a significant challenge. The authors used an Achilles tendon-bone block allograft in combination with a flexor hallucis longus tendon transfer for long-segment Achilles tendon deficits involving the insertion. A retrospective review was performed on a group of 14 patients who underwent this procedure to assess complication rates. Postoperatively, all patients exhibited grade five muscle strength with manual muscle testing, and 12 of the 14 patients were able to perform a single limb heel rise. This case series reviews the surgical technique as well as the patient demographics and complication rates. This procedure has been reliable for those patients with long-segment Achilles tendon deficits involving the insertion who desire to resume a high demand occupation or active lifestyle. The complication rate is relatively low.


The study investigated the kinematic, kinetic and electromyography (EMG) differences between shod and barefoot walking at comfortable (CW) and fast (FW) speeds in individuals with chronic ankle instability (CAI). Twenty-one individuals with CAI walked on a five-meter walkway shod and barefoot at CW and FW speeds. A force plate was used to record the ground reaction forces, a three-dimensional motion analysis system to record the lower limb kinematics and a surface EMG system to collect the gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles activity. The dependent variables were ankle and knee angles and moments and normalized muscle activity. Individuals with CAI exhibited more ankle dorsiflexion angle, knee extension and tibialis anterior muscle activation during the beginning of the stance phase during shod compared to barefoot walking. In addition, the biomechanical effects of shoes are similar during walking at FW and CW.

Practice Management

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Patients recovering from COVID-19 across the country are testing the degree to which telemedicine can replace in-person doctors' appointments and help them recover safely at home. Telehealth, once a fledgling segment of US healthcare, has been widely adopted during the pandemic. A series of regulatory moves, including one that says remote visits can be reimbursed by insurers at the same rate as in-person visits, opened the door to broader adoption. Patients concerned about COVID-19-like symptoms in the early days of the pandemic flooded telehealth providers with questions. Hospitals and many medical offices used remote care to stay in touch with patients and keep all but the sickest out of emergency departments (EDs). Red flags typically elicit a call from a virtual physician who is on call to help patients decide whether to remain at home or report to an ED. Hospital administrators say telehealth has helped to triage patients, monitor them after discharge and lower readmission rates. Still, access to reliable remote care depends on access to a device and internet connectivity. Language differences and issues of trust in the medical system can also obstruct adoption.


Doctors and other healthcare professionals are heavily represented among the estimated hundreds of thousands of COVID-19 patients who experience persistent symptoms after their acute illness. There's no reliable count of how many medical professionals have contracted COVID, but they were hard-hit in the spring. A July study in the Lancet based on self-reported data found that healthcare workers had at least a threefold increased risk of contracting COVID-19. Some doctors with long-term COVID symptoms are turning to each other for support and advocating for greater awareness and better treatment. In the United Kingdom, a group of doctors who are long COVID patients are penning letters in medical journals and lobbying the government.


It is critical for leaders to prioritize physicians as burnout escalates across the country. By fundamentally transforming workplace culture, leaders can engage employees, build trust and empower growth. Organizations that shape workplace culture around mission and values are well-equipped to attract and retain employees, differentiate themselves from competitors and set clear employee expectations. Leaders must evaluate their existing culture by digging into cross-functional metrics and engaging in dialogue with employees. Employee-review websites such as Glassdoor and Indeed can give employees a platform to share honest feedback about organizations. Leadership must be accessible, authentic and transparent throughout this process. Ongoing measurement and benchmarking are essential to ensuring a healthy workplace culture.

Health Policy and Reimbursement

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Premiums for a typical Affordable Care Act (ACA) health insurance plan fell 2 percent for the 2021 coverage year, according to a report released by the US Centers for Medicare and Medicaid Services. The report noted that the average benchmark plan premium for a typical family of four increased from $794 in 2014, the first year the ACA's main requirements were introduced, to $1,486 in 2021. ACA users can start enrolling in plans for 2021 between November 1 and December 15, with coverage starting on January 1.


Approximately 21 percent of Medicare beneficiaries reported skipping non-COVID-19 care due to the pandemic, according to a new survey from the US Centers for Medicare and Medicaid Services. Dental care (43 percent) was the most common type of forgone care due to the pandemic, followed by regular check-ups (36 percent), treatment for ongoing conditions (36 percent) and diagnostic or medical screening tests (32 percent). Not wanting to risk being at a medical facility was the most common reason for avoiding care.

Medicine, Drugs and Devices

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Artificial intelligence (AI)-assisted surgery has been an area of gradual growth, and it has the potential to aid in all parts of the surgical process. For example, a new surgical resource at UC San Diego Health uses AI to parse reams of video recordings of surgeons performing operations. Video recordings of minimally invasive procedures are uploaded to the cloud for quick analysis, then sent back to surgeons divided into critical steps with a dashboard that compares an operation to previous procedures. The Cleveland Clinic’s epilepsy center uses AI to review MRI scans of the brain and identify where seizures are coming from before surgery. Despite such advances, experts underscore the need for AI surgical systems are trained on high-quality and representative data.


A new report by the Center for Infectious Disease Research and Policy at the University of Minnesota warns that the pandemic could intensify existing medicine shortages this winter, when COVID-19 cases and hospitalizations are expected to rise. Across the United States and Europe, 29 out of 40 drugs that help treat COVID-19 are currently in short supply. Shortages can result when drugmakers stop producing a product, citing unprofitably, or regulatory requirements making a drug too expensive to manufacture in a particular market. The global pharmaceutical supply chain also relies heavily on China for active pharmaceutical ingredients and on manufacturers based in India. Currently, 43 percent—or 67 of 156—of acute care medicines used to treat various illnesses are running low, including antibiotics, blood thinners and sedatives.


After four consecutive years of posting record numbers of abbreviated new drug application (ANDA) approvals, the US Food and Drug Administration (FDA) approved 22 percent fewer generic drugs in the 2020 fiscal year (FY2020) than it did in the previous fiscal year. In FY2020, FDA approved 909 ANDAs, compared with a record 1,171 ANDAs in the previous fiscal year. Complete responses came in at 2,010, down from 2,310 in FY2019. The decline comes after FDA increased its focus on generic drug approvals as part of the drug competition action plan championed by former FDA Commissioner Scott Gottlieb. It is also unclear how big a role the COVID-19 pandemic has played.