News From ACFAS

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To help encourage patients to not skip their appointments during the pandemic, ACFAS is launching the “New Normal” campaign as a continuation of our Welcome Back national public relations campaign This campaign highlights the safety precautions foot and ankle surgeons are taking to keep their offices safe for patients.

The video campaign includes two videos showing the old and new normal we’re facing amid the ongoing pandemic. The “Old Normal” video shows that while we’re making these adjustments to keep everyone safe, the one thing that hasn’t changed is the caliber of care patients are still receiving from the foot and ankle surgeons they know and trust. The “New Normal” videos show footage of different doctor’s offices and the safety protocols in place to keep everyone safe, socially distant and to continue providing the top-notch care that patients are used to.

These videos will be circulating on Facebook letting patients know that foot and ankle surgeons are still here for them, open and operating as usual. Most importantly, the videos will also encourage patients who may have been putting off care to make those appointments to keep their feet and ankles healthy. Webinar Wednesday is back with our Trauma Case-Based Webinar Series. First up in this four-part series is Monday Morning Trauma, case-based presentations focusing on fifth met base fractures, lateral malleolar fractures and acute Achilles ruptures including techniques for repairs and complications.

Wednesday, December 9
Monday Morning Trauma
8pm CT | CME: 1 Credit
Fees: Member $20 | Non-Member $30

You can keep building your bundle by picking any three available (live or recorded) webinars for the price of two. Visit acfas.org/OnDemand and register today and walk away with practical case-based skills to help you better treat your patients.

Foot and Ankle Surgery

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The aim of this study was to compare the strength and reaction time of the quadriceps, hamstring, and gastrocnemius (GCM) muscles and foot pressure between patients with plantar fasciitis (PF) and normal controls. A total of 21 PF patients and 21 normal controls were enrolled. Muscle strength was measured by the peak torque per body weight. The strength of the quadriceps was significantly lower in the affected ankles of the PF group than in the control group. The acceleration time (AT) of the quadriceps and hamstring muscles was significantly increased in the affected ankles of the PF group than in the control group, while the AT of the GCM muscle was significantly decreased and correlated negatively with quadriceps muscle strength and AT. Forefoot and hindfoot pressure were significantly greater, with the valgus/varus index showing hindfoot valgus, in the affected ankles in the PF group compared to the control group.


Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of CBCT and measurements of plantar loading could improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading. Sixteen patients with diabetes were enrolled in the study. CBCT foot scans were taken and 3D bone models were obtained by image segmentation. Pressure patterns were also acquired, from which absolute and normalized pressure-time integral were calculated at hallux and at first, central and fifth metatarsals (LOAD variables). Lateral and 3D angles showed the highest percentage of significant correlations with LOAD. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes. LOAD at the hallux increased with plantarflexion at the 3rd phalanx.


This study evaluated clinical outcomes with 13 patients who underwent osteochondral fresh allograft transfer of the first metatarsal to treat early stages of hallux limitus. Intraoperative evaluation of osteochondral defects of the first metatarsal demonstrated a mean diameter size of 8.2 millimeters. Ten patients had a concomitant cheilectomy procedure performed. The mean American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal score, which was determined postoperatively, was 71.2 of 100. Four patients with overall scores below 60 reported moderate daily pain at the first metatarsophalangeal joint. Mean AOFAS pain score was 26.9 of 40, mean AOFAS function score was 30.8 of 45, and mean AOFAS alignment score was 13.4 of 15. An overall improvement in preoperative symptoms and patient satisfaction was documented; authors therefore find that osteochondral fresh allograft transfer can be considered a reasonable option in treating defects found at the first metatarsal head.

Practice Management

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Personalized email marketing can be an effective, cost-efficient strategy to improve patient outcomes and grow a healthcare business. Practices should always be sure to comply with HIPAA rules around marketing to patients. In short, covered entities can market to patients, but written or electronic prior authorization is required in some cases. There are various ways to encourage patients or potential patients to opt-in to receive marketing emails from you. When people are opting in, practices should be clear about what the emails will include. Messages and their content should be tailored to the correct audience. A pithy subject line can help make the email stand out to patients. Emails should provide a clear, useful message and get to the point quickly, without spelling or grammatical errors.


All employee handbooks should cover a few core subjects. One is the practice's social media policy, including rules about social media use on work time. If the practice is in a state has an at-will employment law, it should also have a statement that the handbook cannot be considered a contract and can be changed at will. The handbook should also cover disciplinary procedures, as well as procedures to deal with harassment. The handbook should additionally detail the benefits offered by the practice and its leave and personal time off policies.

Health Policy and Reimbursement

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US President-elect Joe Biden's proposal to lower the eligibility age for Medicare from 65 to 60 has met resistance from hospitals, which are worried that adding millions of people to Medicare will lead to billions of dollars in lost revenue. Medicare reimbursement rates for patients admitted to hospitals average half of what commercial or employer-sponsored insurance plans pay. "It will be a huge lift [in Congress] as the realities of lower Medicare reimbursement rates will activate some powerful interests against this," according to Josh Archambault with the conservative Foundation for Government Accountability. Biden said the plan will help those who retire early and those who are unemployed or cannot find jobs with health benefits.


Officials announced that Medicare’s Part B monthly premium for outpatient care will go up by $3.90 next year to $148.50. The cost increase will claim about 20 percent of the average retired worker's cost-of-living adjustment of $20 a month next year. The situation could have been worse, as it was feared that emergency actions the government took to help stabilize the healthcare system in the coronavirus pandemic could have triggered large premium increases. That prompted Congress to pass bipartisan legislation that limited the increase for 2021 but would gradually collect the full amount later under a repayment mechanism. Medicare also announced that the Part B deductible next year will be $203, an increase of $5, while the inpatient deductible will be $1,484, an increase of $76.


US Supreme Court Chief Justice John Roberts and Justice Brett Kavanaugh suggested that the high court may cast aside a challenged provision of the Affordable Care Act (ACA) while leaving the rest of it standing. Such a decision would leave in place the central aspects of the legislation. The provision in question, known as the individual mandate, requires most Americans to obtain health insurance or pay a penalty, which the GOP-controlled Congress reduced to $0 in 2017. The Supreme Court upheld the mandate in 2012 under Congress's taxing power, but Texas and other Republican-led states argued that the reduction of the penalty made that justification no longer workable and as a result, the whole ACA must be struck down.

Medicine, Drugs and Devices

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Facial masks protect the general public from COVID-19 as well as the mask wearer, The US Centers for Disease Control and Prevention (CDC) reported. The agency, in its strongest endorsement about the effectiveness of masks thus far, said that "adopting universal masking policies can help avert future lockdowns, especially if combined with other non-pharmaceutical interventions such as social distancing, hand hygiene and adequate ventilation." The agency noted that while there are only observational and epidemiological studies on the "real-world" effectiveness of community masking, seven separate studies have verified the benefit of the practice. CDC said, too, that masks help reduce the risk of inhalation of respiratory droplets by the wearer.


Researchers investigated the influence of treatments for osteoporosis and other non-inflammatory rheumatic conditions, such as osteoarthritis and fibromyalgia, on COVID-19 incidence. They conducted a cross-sectional study of 2,102 patients being treated at the Rheumatology Service of Hospital del Mar. In our cohort, COVID-19 cumulative incidence from March 1 to May 3, 2020, was compared to population estimates for the same city. We used Poisson regression models to determine the adjusted relative risk ratios for COVID-19 associated with different treatments and comorbidities. Denosumab, zoledronate and calcium were negatively associated with COVID-19 incidence. Some analgesics, particularly pregabalin and most of the studied antidepressants, were positively associated with COVID-19 incidence, whereas duloxetine presented a negative association. Oral bisphosphonates, vitamin D, thiazide diuretics, anti-hypertensive drugs and chronic non-steroidal anti-inflammatory drugs had no effect on COVID-19 incidence in the studied population. Their results provide novel evidence to support the maintenance of the main anti-osteoporosis treatments in COVID-19 patients, which may be of particular relevance to elderly patients affected by the SARS-CoV-2 pandemic.