November 11, 2020 | | JFAS | Contact Us

News From ACFAS

Another New Video Release!
The free patient education animation video library is growing already! Just released—the Post-Surgical Care Instructions (with crutch use) video. Head to the ACFAS Marketing Toolbox now to view and download to share in your practice.

As the second in our animated patient education video series, this video is geared toward patients who have recently had surgery with instructions on how to use crutches as well as tips on pain medication usage, keeping incision sites dry and elevating to eliminate inflammation. The crutch-use portion of the video visually shows people how to use crutches post-surgery and how to get around safely while walking, getting upstairs and getting up from sitting when using crutches.

Share the newest informational videos with your patients during their next visit to elaborate more on the common instructions you give during an appointment as well as on your website or on your social media channels for patients to reference.

Access the newest patient resource now! Visit to download this video as well as the first in the series on diabetic foot care.
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2021 Dues Payment Reminder
If you haven’t renewed your ACFAS membership for 2021 Fellow and Associate members, now’s the time. Visit to pay online. You can also pay by mail or fax with the reminder we sent out earlier this month. All payments are due by December 31, 2020.

Check out to see the value of your ACFAS membership at work during this unprecedented year, as clinics were moved online, new COVID-specific resources for telehealth and practice management were created, and more.
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ACFAS Rounds Up the Latest Research
Get cozy and catch up on the latest research in foot and ankle surgery right from your home—Scientific Literature Reviews (SLRs) for November are now available.

Get the latest set of short, digestible summaries of research from non-podiatric journals on the latest developments in foot and ankle surgery. This month’s topics include Tibial Nerve Dysfunction Associated with Operatively Treated Talar Neck Fractures, Chilblains in Children in the Setting of the COVID-19 Pandemic, Factors Related to Self-Care Behaviors Among Patients with Diabetic Foot Ulcers and more.

Don’t miss out on more research for November. Visit to view these articles and all archived SLRs.
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Foot and Ankle Surgery

A Modified Transfibular Technique of Ankle Arthrodesis Using Partial Fibular Resection and Onlay Bone Graft
The authors present a modified transfibular technique using partial fibular resection and onlay bone graft for tibiotalar fusion. This study aimed to evaluate whether the ankle joint is well fused with neutral alignment and functionally improved at the final follow-up. For this study, 27 consecutive patients who underwent tibiotalar fusion were retrospectively included. A modified transfibular lateral approach was performed, in which the distal anterior half fibula was resected and fixed as an onlay graft to achieve fusion between the tibia, fibula, talus and fibular onlay graft simultaneously. Radiographic outcomes were assessed using computed tomography at four months after operation and serial follow-up radiographs. Four months after operation, complete union was achieved in 13 patients, near-complete union in eight patients and partial union in the remaining six patients. All the patients achieved complete union and maintained neutral ankle alignment. The functional outcome showed a significant increase between the preoperative and postoperative periods.

From the article of the same title
PLOS ONE (10/22/20) Lee, dong Yeon; Kyung, Min Gyu; Cho, Yun Jae; et al.
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Effect of the First Tarsometatarsal (Modified Lapidus) Arthrodesis on Hindfoot Alignment
The study aimed to demonstrate the effect of first tarsometatarsal (modified Lapidus) arthrodesis on hindfoot alignment. Authors reviewed the radiographs of 39 patients (40 feet) who underwent hallux valgus reconstruction and isolated first tarsometatarsal arthrodesis. Statistically significant differences were found between pre-operative and post-operative measurements for talar declination, lateral talocalcaneal angle, lateral Meary's angle, medial cuneiform height, medial cuneiform to fifth metatarsal distance, anteroposterior (AP) talocalcaneal angle and percentage of talar head uncovering. These results suggest that first tarsometatarsal arthrodesis can affect hindfoot alignment on AP and lateral radiographs.

From the article of the same title
Journal of Foot & Ankle Surgery (10/17/20) Johnson, Travis M.; Hentges, Matthew J.
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Minimally Invasive Plate Osteosynthesis Versus Open Reduction and Internal Fixation in the Treatment of Distal Fibula Danis-Weber Types
Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) in the treatment of different long bone fractures, but evidence of MIPO in distal fibual fractures remains scarce. The study compared the clinical and radiological outcomes of the minimally invasive techniques applied to the distal fibula with open reduction and internal fixation. A series of patients who underwent surgery using either ORIF or MIPO for the treatment of distal fibula fractures were analyzed. Patients were assessed for postoperative pain using a visual analog scale for pain and classified into four groups. The overall complication rate showed to be lower in the MIPO group compared to the ORIF group. Though not statistically significant, specific surgery-related complications such as skin necrosis, nonunion, infections, wound healing disorders and postoperative pain, were more frequent in the ORIF group. The tibiofibular overlap demonstrated to be significantly lower in the ORIF group.

From the article of the same title
Journal of Orthopaedic Surgery and Research (10/22/20) Marazzi, Cesare; Wittauer, Matthias; Hirschmann, Michael T.; et al.
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Practice Management

A New Hippocratic Oath Asks Doctors To Fight Racial Injustice And Misinformation
First-year medical students at the University of Pittsburgh recently wrote a new version of the Hippocratic oath explicitly recognizing the COVID-19 pandemic and racial injustice. The new oath asks physicians to eliminate their personal biases, combat disinformation to improve health literacy and be an ally to minorities and other underserved groups in society. It also calls on doctors to learn about the social determinants of health "to use my voice as a physician to advocate for a more equitable healthcare system from the local to the global level."

From the article of the same title
NPR (11/04/20) Boden, Sarah
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The Benefit Of COVID-19 Waivers to Stark Law, Anti-Kickback Statute
On October 19, the US Centers for Medicare and Medicaid Services (CMS) highlighted recent actions taken by the federal government to criminally charge healthcare providers nationwide for alleged fraud. CMS and the Office of Inspector General have worked together from the onset of the COVID-19 pandemic to relax regulatory restrictions under fraud and abuse laws to facilitate pandemic response efforts. While the waivers provide regulatory relief in the short run to enable providers to respond to the COVID-19 pandemic, in the long run they may present an opportunity to influence policymaking related to fraud regulations. At the same time, abusive arrangements that seek to take advantage of regulatory flexibilities may threaten the flexibility the waivers provide. The systemic risk of abusive conduct appears particularly high for telehealth services, which have been greatly expanded during COVID-19.

From the article of the same title
Medical Economics (11/03/20) Duffy, Conor; Struzzi, Peter
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Transitioning from Solo Practice to Partnership
Some solo physician practices will eventually choose to bring on another physician partner. Before doing so, sole physicians should first reflect and identify what they need from a partner. They should identify what a partner brings to the table and discuss their vision with the potential partner. Succession and future planning should be discussed, as should each partner's expectations of each other. When evaluating potential partners, it is important to construct objective criteria. It can also be beneficial to use a consultant after the partner joins to ensure communication and business training happens between partners.

From the article of the same title
Physicians Practice (10/28/20) Hernandez, Nick
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Health Policy and Reimbursement

ACA Sign-Ups Begin as Millions More Are Uninsured
Americans who lost health insurance due to the pandemic can now sign up for coverage under the Affordable Care Act (ACA). The US Centers for Medicare and Medicaid Services, which oversees, says premiums are down slightly on average for 2021, and most people will have at least three insurers from which to select plans. Lower-income individuals and even middle class families may qualify for tax credits that can significantly reduce what they pay monthly for premiums. However, US Supreme Court justices are slated to hear a case to strike down the ACA on November 10.

From the article of the same title
Associated Press (10/31/20) Alonso-Zaldivar, Ricardo
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CMS Provides Transparency on Cost and Quality in State Medicaid and CHIP Programs
The US Centers for Medicare and Medicaid Services has released the third annual update to its Medicaid and Children’s Health Insurance Program (CHIP) Scorecard. Since 2018, the Scorecard has highlighted state and federal performance on the administration and health outcomes of the Medicaid and CHIP programs. In addition to providing per capita expenditure data across all states, the 2020 Scorecard includes a variety of new metrics. Further, the national context now provides information on the percentage of Medicaid beneficiaries currently enrolled in Medicare as well as those eligible for dual enrollment. The Scorecard identifies room for improvement in measures such as: emergency department utilization rate for children and adolescents and inpatient hospital admission rates for short-term complications of diabetes in adults.

From the article of the same title
Healthcare Purchasing News (11/20)
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Medicine, Drugs and Devices

A New Item on Your Medical Bill: The 'COVID' Fee
The coronavirus pandemic has made the practice of healthcare more costly as providers must wear protective gear and sanitize equipment more frequently. To address this financial shortfall, some health providers are turning directly to patients, leading to numerous "COVID" and "PPE" fees nationwide, according to bills examined by the New York Times. Some of these fees have drawn the scrutiny of state attorneys general who say charging patients directly can take advantage of vulnerable consumers or violate health insurance contracts and consumer protection laws.

From the article of the same title
New York Times (11/05/20) Kliff, Sarah; Silver-Greenberg, Jessica
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Face Masks Are Again in Short Supply as COVID-19 Cases Surge
A surge in COVID-19 cases has placed renewed strain on the supply of critical protective equipment. While the national supply of protective equipment has improved since the first months of the pandemic, levels at some healthcare facilities remain well below what regulators recommend. Many healthcare facilities continue to ration and reuse masks, even as manufacturers have raised production, and demand continues to outpace production in much of the country. Some new producers said long wait times for certification and for the equipment needed to make masks has scared off prospective manufacturers. Many states and hospitals that couldn't find N95 masks this spring instead purchased KN95 masks, a similar certification used in China, but many of these masks have failed quality checks. The US Food and Drug Administration said last month that it wouldn't approve new KN95 manufacturers for US hospitals, leading to even more demand for certified N95 masks.

From the article of the same title
Wall Street Journal (11/04/20) Hufford, Austen
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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