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This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Medicine, Drugs and Devices

News From ACFAS

ACFAS Gives Thanks for Its Committee Volunteers

At this time of year, ACFAS gives thanks for those talented, dedicated members who have devoted their time and expertise in service on the College’s committees.

You, too, can help shape the advancement of the profession, the future of the College and, ultimately, the care of patients by volunteering for 2011–12 committees. For information on becoming a committee volunteer, please visit the ACFAS website. The deadline for applications is Dec. 15, 2010.
Congress to Talk Turkey on Medicare “Doc Fix”

The House and Senate will be back in session Nov. 29–Dec. 17 to consider yet another fix to the Medicare reimbursement payment formula. Last week the Senate approved a bill that would extend the current formula that gives a 2.2 percent increase.

The approximately $1 billion cost of the legislation is paid for through savings from a payment reduction for physical and occupational therapy services, by providing payment of the full cost for the most expensive treatment and reducing by 20 percent the cost of all other treatments. Watch for opposition from occupational and physical therapists to this part of the fix.
Visit the New, the ACFAS online career center, is now updated and improved, with resources for the entire career lifecycle of today’s foot and ankle surgeon. Job seekers can take advantage of:
  • Faster, more accurate searches
  • New tools to refine or broaden your search for the exact positions and locations you seek
  • More job categories to help you find an exact match
  • More efficient navigation
  • More relevant career resource articles
If you already have registered for a free account on, your login credentials and profile have not changed. But, you should stop by the new site to optimize your resume and job alerts with the new job categories and tools.

And, employers will find economical options to post ads that will reach out to physicians, nurses and allied health professionals across the country. Get your search started by visiting today!

Foot and Ankle Surgery

Plantar Loading After Chevron Osteotomy Combined With Postoperative Physical Therapy

Researchers set out to determine if a postoperative rehabilitation program helped to improve weightbearing of the first ray after chevron osteotomy for correction of hallux valgus deformity. Twenty-nine patients with mild to moderate hallux valgus deformity who underwent a chevron osteotomy were included in the study. The patients received a multimodal postoperative rehabilitation program including mobilization, manual therapy, strengthening exercises and gait training.

In the great toe, the mean maximum force increased from 72.2 N preoperatively to 106.8 N one year after surgery. The mean contact area increased from 7.6 cm2 preoperatively to 8.9 cm2 one year after surgery, and the mean force-time integral increased from 20.8 N*sec to 30.5 N*sec. For the first metatarsal head region, the mean maximum force increased from 122.5 N preoperatively to 144.7 N one year after surgery and the mean force-time integral increased from 42.3 N*sec preoperatively to 52.6 N*sec one year postoperatively. The mean AOFAS score increased from 61 points preoperatively to 94 points at final followup. The average hallux valgus angle decreased from 31 degrees to 9 degrees and the average first intermetatarsal angle decreased from 14 degrees to 6 degrees.

From the article of the same title
Foot & Ankle International (11/10) Vol. 31, No. 11, Schuh, Reinhard; Adams, Samuel; Hofstaetter, Stefan Gerhard
Web Link - May Require Paid Subscription | Return to Headlines

Reflux in Foot Veins Is Associated With Venous Toe and Forefoot Ulceration

Researchers set out to determine the prevalence of foot vein incompetence in a group of patients with chronic venous insufficiency and to assess the association of this with venous ulceration located on the forefoot. Twenty consecutive patients (21 limbs) with active or healed venous ulceration were prospectively studied with duplex ultrasound of the superficial and plantar foot veins. Four extremities had venous ulceration involving the forefoot.

Reflux was found in 32 percent of pedal vein segments in CEAP C5, C6 legs, with ulceration involving only the gaiter area. Pedal reflux was present in 65 percent of foot vein segments when forefoot ulceration was present. Student t-test for the difference in the mean number of incompetent foot vein segments was significant.

The researchers concluded that venous ulceration can affect the forefoot and toe areas and is associated with reflux in the pedal vein segments.

From the article of the same title
Journal of Vascular Surgery (11/08/10) van Bemmelen, Paul S.; Spivack, Daniel; Kelly, Patrick
Web Link - May Require Paid Subscription | Return to Headlines

Vascular Abnormalities Correlate with Decreased Soft Tissue Volumes in Idiopathic Clubfoot

Lower extremity vascular anomalies have been described for patients with clubfoot but few imaging studies have investigated effects on soft tissues such as fat and muscle. Researchers describe a new noninvasive imaging protocol to identify vascular and soft tissue abnormalities in the lower limbs of patients with clubfoot and determine whether these abnormalities are present in patients who had recurrent clubfoot. Three-dimensional noncontrast-enhanced MR angiography was used to identify vascular, bone, and soft tissue abnormalities in patients with clubfoot.

Four patients with isolated unilateral clubfoot had arterial anomalies in the clubfoot limb. All patients had less muscle volume in the affected limb, and nine of 11 patients had less subcutaneous fat. Vascular anomalies and decreased fat and muscle volumes were present in all three patients with recurrent clubfoot.

The researchers concluded that a high frequency of vascular and soft tissue anomalies in the affected limbs of patients with unilateral clubfoot that may correlate with response to treatment. This approach has the potential to enhance the understanding of the anatomy of clubfoot.

From the article of the same title
Clinical Orthopaedics and Related Research (11/01/10) Merrill, Laura J.; Gurnett, Christina A.; Siegel, Marilyn; et al.
Web Link - May Require Paid Subscription | Return to Headlines

Practice Management

'Blue Button' Technology Pushed to Give Patients Instant Access to Medical Records

The Dept. of Veterans Affairs and CMS have implemented virtual "blue-button" icons on their patient portal websites that, when clicked, give patients the real-time ability to download their own health information. The concept is gaining steam in the private sector as well. According to results from an October survey conducted by Connecting for Health, 70 percent of the public and 65 percent of doctors agree with the blue-button concept.

Some are pushing for widespread adoption of the blue button as physicians face "meaningful use" requirements that give patients the right to receive their medical records electronically upon request. The blue button would be a convenient way for physicians to satisfy this requirement, but most physicians are not yet ready to add it to their websites. For one thing, physicians' electronic medical record systems probably do not have the capability to provide a blue-button link between their EMRs and their websites.

From the article of the same title
American Medical News (11/01/10) Dolan, Pamela Lewis

Doctors: Web Ratings Flawed

More than 30 different online services now rate doctors, but critics say that most sites have too few reviews per doctor to offer statistically significant information. But this may soon change, as Zagat joins the fray in Illinois. Blue Cross and Blue Shield of Illinois is teaming up with Zagat Survey for an online tool that allows members to rate their physicians in four categories: trust, communication, availability, and office environment. Doctors' scores are displayed on the site only if they have reached 10 reviews.

From the article of the same title
Chicago Tribune (11/15/10) Deardorff, Julie

Health Policy and Reimbursement

Commission Proposes to Replace SGR

Draft recommendations submitted by the bipartisan National Commission on Fiscal Responsibility and Reform include a proposal to eliminate the SGR but still lower physician pay incrementally over the next decade. Another proposal would direct CMS to establish a new payment system designed to reduce costs and improve quality beginning in 2015.

Additionally, the plan calls for tort reform to cap non-economic and punitive medical malpractice damages and the expansion of the Independent Payment Advisory Board (IPAB). Under the plan, IPAB would have the authority to impose federal cuts in hospital pay for patients covered by Medicare and Medicaid; raise the IPAB's savings target to 1.5% instead of 0.5% in 2015; impose payment reductions even when Medicare spending does not exceed price index growth rate; and eliminate the trigger that could de-activate IPAB by 2019.

From "SGR Fix Gets Cool Industry Reception"
HealthLeaders Media (11/18/10) Elliott, Jeff

CMS Innovation Center to Improve Care, Payment Efficiency

CMS has established a new center to drive ideas on how to improve patient care while streamlining payment systems. The center, mandated under the healthcare reform bill, will serve as a testing ground for new practices. The initial work of the center will include improving care for patients in hospitals, clinics, physicians' offices, and nursing homes, and developing ways to make care safer and more patient-centered, efficient, effective, timely and equitable. The center will also focus on developing new models that will make it easier for healthcare professionals to coordinate care for a patient to improve his/her health outcome.

From the article of the same title
Reuters (11/16/10) Stephenson, Emily

Drug Firms Say They'll Take Closer Look at the Docs They Pay

Several of the largest pharmaceutical companies in the United States say they plan to tighten screening of physicians who promote their drugs. Eli Lilly, for example, said that next year, for the first time, it would hire an outside firm to search for state disciplinary actions against its hired speakers and advisers. AstraZeneca is "evaluating new ways to retrieve state disciplinary actions that would allow us to act on that information in a timely manner," according to spokesman Tony Jewell. Pfizer said in a statement that it is doing the same.

From the article of the same title
ProPublica (11/18/2010) Ornstein, Charles; Weber, Tracy; Kusnetz, Nicholas

Medicine, Drugs and Devices

Effect of High-Voltage Pulsed Current on Recovery After Grades I and II Lateral Ankle Sprains

High-voltage pulsed current (HVPC) is known to curb edema formation in laboratory animals and is commonly applied for ankle sprains, but the clinical effects remain undocumented. Researchers set out to determine whether, as an adjunct to routine acute and subacute care, subsensory HVPC applied nearly continuously for the first 72 hours after lateral ankle sprains affected time lost to injury. Fifty intercollegiate and professional athletes were involved in the study. Near-continuous live or placebo HVPC for 72 hour postinjury in addition to routine acute and subacute care was applied. Time lost to injury was measured from time of injury until the athlete was declared fit to play.

Overall, time lost to injury was not different between treated and control groups. However, grade of injury was a significant factor. Time lost to injury after grade I lateral ankle sprains was greater for athletes receiving live HVPC than for those receiving placebo, but no differences were found between groups for grade II sprains.

The researchers concluded that application of subsensory HVPC had no clinically meaningful effect on return to play after lateral ankle sprain.

From the article of the same title
Journal of Sport Rehabilitation (11/01/10) Vol. 19, No. 4, P. 399 Mendel, Frank C.; Dolan, Michael G.; Fish, Dale R.; et al.

No Effects of PRP on Ultrasonographic Tendon Structure and Neovascularisation in Chronic Midportion Achilles Tendinopathy

Researchers assessed whether a platelet-rich plasma (PRP) injection leads to an enhanced tendon structure and neovascularisation, measured with ultrasonographic techniques, in chronic midportion Achilles tendinopathy. Fifty-four patients with chronic midportion Achilles tendinopathy were included in the study. Patients were randomized to eccentric exercise therapy with either a PRP injection or a saline injection (placebo group). Tendon structure was evaluated by ultrasonographic tissue characterization. Color Doppler ultrasonography was used to measure the degree of neovascularisation. Follow-up was at six, 12, and 24 weeks.

A significant improvement in echo-types I+II was found after 24 weeks within both the PRP group (n=27) and the placebo group (n=27), but there was no significant between-group difference. After 6 weeks, the neovascularisation score increased within the PRP group and the placebo group, but there was no significant between-group difference in change in neovascularisation score at any point in time.

The researchers concluded that injecting PRP for the treatment of chronic midportion Achilles tendinopathy does not contribute to an increased tendon structure or alter the degree of neovascularisation compared with placebo.

From the article of the same title
British Journal of Sports Medicine (11/03/10) de Vos, R. J.; Weir, A.; Tol, J. L.; et al.

Nonprofit Launches Electronic Health Records Safety Tracker

iHealth Alliance, a nonprofit organization made up of medical professional and malpractice insurance executives, has launched a website to track safety issues related to the use and implementation of electronic health records (EHRs). Insurance companies and the FDA plan to use data collected on the system, called EHRevent, to develop educational literature regarding patient safety and EHRs.

From the article of the same title
Mass Device (11/15/2010)
Web Link - Publication Homepage: Link to Full Text Unavailable | Return to Headlines

Propoxyphene Withdrawn From U.S. Market

The FDA has asked that propoxyphene, sold under the brand names Darvon and Darvocet by Xanodyne Pharmaceuticals, be removed from the U.S. market due to new clinical data showing that the drug puts patients at risk for potentially serious or even fatal heart rhythm abnormalities . The decision will also affect generic manufacturers and the makers of propoxyphene-containing products.

The FDA is advising healthcare professionals stop prescribing the drug. Patients who are currently taking the drug are advised not to abruptly halt their medication but rather contact their physician as soon as possible to discuss switching to an alternative therapy.

A phased withdrawal of propoxyphene is already underway in Europe. The European Medicines Agency made that decision in June 2009.

From the article of the same title
Medscape (11/19/10) Gandey, Allison

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November 23, 2010