November 22, 2017 | | JFAS | Contact Us

In honor of Thanksgiving, ACFAS Headquarters will be closed Nov. 23–24. Happy Thanksgiving!

News From ACFAS

ACFAS Board Nominees Announced
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 electronic election:
  • Eric A. Barp, DPM, FACFAS
  • George T. Liu, DPM, FACFAS
  • Roya M. Mirmiran, DPM, FACFAS
  • Eric G. Walter, DPM, FACFAS
Two three-year terms will be filled by election. Candidate profiles and position statements will be posted at on December 15. Eligible voters may cast one or two votes on their ballot. Regular member classes eligible to vote are Fellows, Associates, Emeritus and Life Members. Individuals who intend to nominate by petition must notify ACFAS by November 30, and petitions are due no later than December 23.

Online voting will be conducted January 7–22, 2018. All eligible voters will receive an email with special ID information and a link to the election website in advance. After logging in, members will first see the candidate biographies and position statements, followed by the actual ballot. Eligible voters without an email address will receive paper instructions on how to log in to the election website and vote. There will be no paper ballots.

The 2017 Nominating Committee included ACFAS Fellows Sean T. Grambart, DPM, Chair; Georgeanne M. Botek, DPM; Tony D.H. Kim, DPM; Javier M. La Fontaine, DPM; Alan A. MacGill, DPM; Laurence G. Rubin, DPM; and Monica H. Schweinberger, DPM.
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Volunteer with ACFAS
Help advance the profession, patient care and the future of the College by volunteering to serve on an ACFAS committee, a Clinical Consensus Statement panel or as a reviewer of Scientific Literature.

The volunteer application deadline is December 12, 2017. Visit for more information.
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Star of the Show: ACFAS 2018 Exhibit Hall
Take center stage with us in the ACFAS 2018 Exhibit Hall, March 22–25 in Nashville. This is the place to:
  • Explore the latest industry products and services and meet new vendors
  • Search open job positions and available candidates at the Job Fair
  • Listen to hourly sessions on hot topics in the HUB
  • Have lunch with your colleagues and friends
  • Chat with poster authors about their research
  • Enter daily prize drawings
  • Update your professional headshot for free in Booth No. 148
Also stop by the Exhibit Hall each day to scan your badge so you can earn CME credit for the sessions you attend. Visit to register now for ACFAS 2018 and make sure you’re part of the Exhibit Hall action!
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Hear New Perspectives on Patient Care at ACFAS 2018
Sixteen speakers specializing in pain management, orthopaedics, radiology and other disciplines will join the ACFAS 2018 session lineup to share their insights for treating some of the most complex cases. See the practice of foot and ankle surgery from different angles and learn new techniques that lead to the best outcomes for your patients.

Download the ACFAS 2018 program from to view the complete session schedule and to decide which sessions you would like to attend. ACFAS 2018 will take place March 22–25 at the Gaylord Opryland Hotel in Nashville.
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Foot and Ankle Surgery

Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players
Researchers at Waseda University in Tokyo conducted a study to compare the static foot alignment and distribution of foot pressure of athletes with and without a history of fifth metatarsal stress fractures. Study participants comprised 335 collegiate male soccer players, of whom 29 with a history of fifth metatarsal stress fractures were in the fracture group and 306 were in the control group. Researchers measured the foot length, arch height, weightbearing leg-heel alignment, nonweightbearing leg-heel alignment, forefoot angle relative to the rearfoot, forefoot angle relative to the horizontal axis and foot pressure. The nonweightbearing leg-heel alignment was significantly smaller and the forefoot angle relative to the rearfoot was significantly greater in the fracture foot group than in the control foot group. With regard to plantar pressure, there were no significant differences among the groups. Midfield players had significantly higher rates of fifth metatarsal stress fracture in their histories, whereas defenders had significantly lower rates. There were no significant differences in the frequency of fifth metatarsal stress fractures according to the type of foot (kicking foot vs. pivoting foot) or the severity of ankle sprain. Playing the midfield position and having an everted rearfoot and inverted forefoot alignment were associated with fifth metatarsal stress fractures. This information may be helpful for preventing fifth metatarsal stress fracture recurrence. More detailed load evaluations and a prospective study are needed in the future, the researchers concluded.

From the article of the same title
Sports Medicine - Open (12/01/2017) Matsuda, Sho; Fukubayashi, Toru; Hirose, Norikazu
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Minimally Invasive Distal Metatarsal Diaphyseal Osteotomy for Chronic Plantar Diabetic Foot Ulcers
A prospective study was conducted to evaluate the safety and effectiveness of minimally invasive distal metatarsal diaphyseal osteotomies (DMDOs) for treating a consecutive series of patients living with diabetes and chronic plantar diabetic foot ulcers (CPDFUs) and to assess their clinical-functional and radiographic outcomes. A consecutive series of patients affected by diabetes mellitus with CPDFUs, not responsive to previous nonoperative management, underwent DMDO. The CPDFUs were evaluated using the University of Texas Diabetic Wound Classification System (UTDWC). Demographic parameters, Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, healing times and complications were recorded. Maestro et al criteria and bone callus formation were analyzed radiologically. Statistical analysis was carried out, and 30 consecutive enrolled patients with a mean age of 66.7 (range, 53–75) years presented 35 CPDFUs with a mean diameter of 16.3 mm and a mean duration of 10.3 months. The most frequent grade of the UTDWC was IIIB (42.9 percent). All ulcers recovered with a mean healing time of 7.9 ± 4.0 (range, 4-17) weeks. AOFAS scores improved significantly from 55.3 to 81.4 points (P < .001). At a mean follow-up of 25.3 months (range, 18-71), no cases of ulcer recurrence were recorded, while a major complication or a wound infection required longer healing time. The researchers concluded that minimally invasive DMDO was a safe and effective method in promoting CPDFU healing, regardless of the grade of severity, by the reduction of the high plantar pressure under the metatarsal heads. This technique improved functional and radiographic outcomes with few complications.

From the article of the same title
Foot & Ankle International (11/17) Biz, Carlo; Gastaldo, Stefano; Dalmau-Pastor, Miki; et al.
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The Accessory Tendon of Extensor Hallucis Longus Muscle and Its Correlation to Hallux Valgus Deformity: A Cadaveric Study
A study was conducted to probe the incidence and morphology of accessory extensor hallucis longus (EHL) tendons in cadavers and to analyze any possible correlation to the occurrence and severity of hallux valgus (HV) deformity. The researchers looked for any possible correlation between the presence of accessory tendon (AT) and the cadavers' age and the HV deformity in 98 female adult cadaveric feet. The HV and intermetatarsal (IMA) angles were quantified and assessed for association with the relative angle between the primary EHL tendon and AT along with the AT's length. AT was present in 26.5 percent and HV deformity existed in 36.7 percent of all feet. A high prevalence of HV deformity was observed in feet with AT, but the HV angle and IMA were similar in feet with and without AT. No significant correlations were seen between AT morphological characteristics and the cadavers' age or the HV angle and IMA.

From the article of the same title
Surgical and Radiologic Anatomy (12/01/17) Vol. 39, No. 12, P. 1343 Natsis, K.; Konstantinidis, G.A.; Symeonidis, P.D.; et al.
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Practice Management

New Tool Could Let Patients Contribute to Doctors' Notes
A study from researchers at the University of California, Los Angeles sought to determine the impacts of allowing patients to directly contribute to doctors' notes. The study involved the OurNotes platform, which lets patients and doctors create notes. Interviews with 29 doctors, patient advocates, nurses and computer experts found mixed feelings over the topic. Participants believed the platform could have positive benefits, but there were concerns it could limit time doctors need to perform their duties. In addition, participants also believed patients would not likely add to their notes during their free time or outside of an appointment. Nevertheless, OurNotes is still being tested by researchers. Results of the study were published in the Annals of Internal Medicine.

From the article of the same title
Reuters (11/13/17) Rapaport, Lisa
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Preventing Burnout's Worst Case Scenario by Embracing Emotions
High-performing individuals, such as physicians, often avoid being open about mental health issues out of anxiety regarding potential job loss or because the job has become a core part of their identity, which makes depression stemming from burnout an especially trying ordeal. Kip Wenger of Team Health in Philadelphia says healthcare systems must encourage physicians to be open about such issues without fearing job loss and must make them aware of their vulnerability to depression. The American Foundation for Suicide Prevention estimates approximately 300 to 400 physicians take their own lives each year in the United States, and burnout is a significant risk factor. Among the preventive strategies experts recommend for physicians is prioritizing self-care by eating well and getting sufficient sleep. Also important is finding allies within the working environment who can form part of a support network for the physician. They can be colleagues who are also friends, a mentor within the system or even external support from people in other hospitals or networks.

From the article of the same title
Medical Economics (11/16/17) Rosenfeld, Jordan
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Trump Health Agency Challenges Consensus on Reducing Costs
For several decades, a consensus has grown that reining in the United States' $3.2 trillion annual medical bill begins with changing the way doctors are paid: Instead of compensating them for every appointment, service and procedure, they should be paid based on the quality of their care. The Obama administration used the authority of the Affordable Care Act to aggressively advance this idea, but many doctors chafed at the scope and speed of its experiments to change the way Medicare pays for everything from primary care to cancer treatment.

From the article of the same title
New York Times (11/12/17) Goodnough, Abby; Zernike, Kate
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Health Policy and Reimbursement

Fewer Return Visits to the Hospital but Higher Rates of Death, Study Finds
A new study published in JAMA Cardiology shows an Affordable Care Act (ACA) penalty for hospitals with high numbers of visitors with heart failure who returned for treatment not long after they were released led to fewer rehospitalizations, but also higher rates of death among that demographic. The researchers say the results of the study "support the possibility that the [penalty] has had the unintended consequence of increased mortality in [subjects] hospitalized with heart failure." The team examined data for 115,245 Medicare beneficiaries hospitalized for heart failure at 416 hospitals between 2006 and 2014. One in five persons with heart failure returned to the hospital within 30 days before the ACA passed. That fell to 18.4 percent after the penalties were instituted. Mortality rates rose from 7.2 percent before the ACA to 8.6 percent after the penalties or about 5,400 more deaths annually for Medicare beneficiaries not in managed care plans. Study coauthor Gregg Fonarow with the University of California, Los Angeles cardiology unit says he wants the U.S. Centers for Medicare and Medicaid Services to suspend and review the heart failure penalty program. New York University Professor Leora Horwitz disagrees, arguing the study may indicate an increase in the overall U.S. mortality rate for heart failure in recent years, possibly because hospitals increasingly admit only the sickest people who are at a higher risk of death.

From the article of the same title
Wall Street Journal (10/12/17) Evans, Melanie
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President Announces Health and Human Services Secretary Nominee
President Donald Trump has nominated attorney Alex Azar as secretary of the U.S. Department of Health and Human Services (HHS). Azar is a former George W. Bush administration official who served as deputy secretary of HHS before spending nearly a decade as a top official at Eli Lilly & Co. GOP lawmakers said that Azar would bring significant institutional knowledge to the job, but some consumer groups criticized his pharmaceuticals background, saying he might neglect to focus on lowering drug costs. At HHS, Azar implemented the Bush administration's flagship healthcare effort, the Medicare Part D prescription drug program, and since then, he has called for limited federal involvement in health policy and voiced support for key conservative ideas.

From the article of the same title
Wall Street Journal (11/14/17) P. A2 Armour, Stephanie; Radnofsky, Louise
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Senate Plans to End ACA Mandate in Revised Tax Proposal
GOP senators intend to include the repeal of the Affordable Care Act’s individual mandate in their proposed tax reform bill, which would save more than $300 billion over a decade but result in 13 million fewer Americans being covered by health insurance by the end of that period, according to the Congressional Budget Office (CBO). Average health insurance premiums in the individual market would increase by about 10 percent, but insurance markets would remain stable in almost all parts of the country, CBO found. The move risks renewing the debate over healthcare that Republicans were involved in for much of the year. In a November 14 letter, meanwhile, groups representing doctors, hospitals and insurers warned congressional leaders that eliminating the mandate would "result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans."

From the article of the same title
New York Times (11/15/17) P. A1 Kaplan, Thomas; Tankersley, Jim
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Medicine, Drugs and Devices

FDA Approves First Digital Ingestion Tracking System Med
The U.S. Food and Drug Administration (FDA) has approved the first drug with a digital ingestion tracking system, known as Abilify MyCite. The drug is used to treat schizophrenia, and FDA says the digitally enhanced medication "works by sending a message from the pill's sensor to a wearable patch." Dr. Mitchell Mathis, director of the division of Psychiatry Products in FDA’s Center for Drug Evaluation and Research, says, "Being able to track ingestion of medications prescribed for illness may be useful for some patients. FDA supports the development and use of new technology in prescription drugs and is committed to working with companies to understand how this technology might benefit patients and prescribers."

From the article of the same title
Associated Press (11/14/17)
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Smog May Harm Bones in Older Adults, Study Suggests
A study published in The Lancet Planetary Health suggests exposure to air pollution raises the risk for osteoporosis and broken bones in older adults. The study involved analysis of 9.2 million Medicare enrollees in the Northeast/Mid-Atlantic area of the U.S. who had been hospitalized for fractures from 2003 to 2010. Even a slight elevation in exposure to air pollution particulate matter called PM2.5 was associated with an increase in fractures among older adults. Also examined were eight years of follow-up among 692 middle-aged, low-income adults in a Boston health poll. The researchers determined that people who lived in regions with higher levels of PM2.5 and black carbon exhibited lower levels of a key calcium and bone-related hormone and greater reductions in bone mineral density than those exposed to lower levels of the pollutants.

From the article of the same title
United Press International (11/10/17)
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Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure
Leading U.S. heart experts have issued new guidelines for high blood pressure that mean tens of millions more Americans will develop the condition and will require lifestyle changes and medicines for treating it. The American Heart Association/American College of Cardiology guidelines forecast the number of men under age 45 with a diagnosis of high blood pressure will triple, and the prevalence among women under age 45 will double. The new criteria are based on mounting evidence that blood pressure far lower than had been considered normal greatly cuts the chances of heart attack and stroke, as well as overall mortality risk. Recent studies indicate this is true even among older people for whom intensive treatment was considered too much of a risk. The guidelines will now define high blood pressure as 130/80 millimeters of mercury or higher for anyone with a significant risk of heart attack or stroke; earlier guidelines defined high blood pressure as 140/90. Almost 50 percent of all American adults, and nearly 80 percent of those aged 65 and up, will meet the new criteria and will need to take action to lower their blood pressure. Any person with at least a 10 percent risk of a heart attack or stroke in the next 10 years should strive for blood pressure below 130/80. However, being 65 or older comes with a 10 percent risk of cardiovascular difficulty, and so basically everyone over that age will need to aim for the new target.

From the article of the same title
New York Times (11/13/17) Kolata, Gina
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, FACFAS

Daniel C. Jupiter, PhD

Gregory P. Still, DPM, FACFAS

Jakob C. Thorud, DPM, MS, FACFAS

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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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