News From ACFAS

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December 31 is the deadline for renewing your membership for Fellow and Associate members. As we’ve gone through this unprecedented year together, the support system your membership provides has emerged as one of its greatest benefits. You can renew online or via mail or fax. Please reach out to the Membership Department at membership@acfas.org or visit the Member Center at acfas.org if you have any questions about your membership benefits. Naohiro Shibuya, DPM, MS, FACFAS has been named the Deputy Editor of The Journal of Foot & Ankle Surgery. Dr. Shibuya brings more than 10 years of experience as a research section editor and will work alongside current JFAS Editor, D. Scot Malay, DPM, MSCE, FACFAS in all areas of journal management including article intake and review processes.

Journal submissions have continued to grow steadily over the years making this additional role crucial for its continued success. This extra management support, along with a new managing editor through J & J Editorial, will help to strengthen and streamline the submission process and accommodate the growing volume of submissions ensuring its spot as the authority in foot and ankle research. Another chance to explore the A to Zs of research is coming your way this month. Next up for ACFAS Virtual Journal Club is Acute Achilles Tendon Ruptures.

Join the CORE Institute Foot and Ankle Advanced Reconstruction Fellowship on Thursday, December 17 at 7pm CT for Acute Achilles Tendon Ruptures presented by Jessica Arenson, DPM and Jordan Crafton, DPM, AACFAS.

Don’t miss this installment, register today at acfas.org. For more information on the Virtual Journal Club and to see the lineup for 2021 visit acfas.org/JournalClub. Ready to do some holiday shopping? Don’t forget to add an ACFAS Logo Store visit to your shopping list. ACFAS makes it easy to show your pride in your professional accomplishments and the College with merchandise from the ACFAS Logo Store, your one-stop shop for ACFAS gear.

Shop 24/7 online through acfas.org for shirts, jackets, pullovers and scrubs in a wide range of colors and sizes. Also check out drinkware, pens and other items perfect for even the pickiest person on your shopping list. Visit the ACFAS Logo Store and create a new account to check out all the available products.

Visit acfas.org/LogoStore to get started on your holiday shopping today!

Foot and Ankle Surgery

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Although arthroscopic lateral ligament repair (ALLR) with suture anchors for chronic lateral ankle instability has become widely accepted, some complications have been reported as well. The study reports a novel technique and good clinical results of ALLR using a knotless suture anchor. Authors examined 30 patients with a mean age of 30.0 years who underwent ALLR. The Japanese Society for Surgery of the Foot ankle-hindfoot scale showed a significant improvement from preoperatively to follow-up. The Self-Administered Foot Evaluation Questionnaire was significantly improved in all subscales (pain and pain-related, physical function and daily living, social function, shoe-related and general health and well-being). Complications included residual joint pain due to remaining osteophytes in one case, scar pain of the accessory anterolateral portal in two cases and positive Tinel sign indicative of superficial peroneal nerve irritation at the anterolateral portal in one case.


The study surveyed members of 21 local and international scientific societies focused on fook and ankle or sports medicine surgery about how they manage osteochondral lesions of the talus (OLT). Answers with a prevalence greater than 75 percent of respondents were considered a "main tendency", whereas where prevalence exceeded 50 percent of respondents they were considered a "tendency". A total of 1804 surgeons from 79 countries returned the survey. Symptoms reported to be most suspicious for OLT were pain on weight-bearing (WB) and after activity, deep localization of the pain and any history of trauma.

Eighty-nine percent of surgeons routinely obtain an MRI, 72 percent routinely get WB radiographs and 50 percent perform a CT scan. When treated surgically, OLTs are combined with ligament repair or reconstruction by 79 percent; 67 percent report simultaneous excision of soft-tissue or bony impingements. For lesions less than 10-15 millimeters in diameter, bone marrow stimulation (BMS) represents the first choice of treatment for 78 percent of surgeons.


The study evaluated clinical outcomes of 28 patients with intractable lateral malleolar bursitis who were treated with the inoperative saline load test to find communication between the bursal sac, the ankle joint and the quilting sutures after bursectomy to reduce the dead space. When there was capsular opening detected with the saline load test, it was closed with sutures or augmented with periosteum. The lateral malleolus was examined for bursitis recurrence on the final follow-up. Patient medical records were reviewed for postoperative wound dehiscence, skin necrosis, infections and nerve symptoms. The saline load test was positive in 11 cases, while the mean foot function index improved from 25.94 to 11.73. Fourteen patients were very satisfied with the results, nine were satisfied, two rated their satisfaction as fair and one was dissatisfied. No cases required skin graft or flap surgery.

Practice Management

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The Trump administration released its final revision to regulations on physician self-referral, known as the Stark Law. Taking into consideration stakeholder comments, the US Centers for Medicare and Medicaid Services (CMS) said, "The final rule provides additional guidance on several key requirements that must often be met in order for physicians and healthcare providers to comply with the Stark Law. For example, compensation provided to a physician by another healthcare provider generally must be at fair market value."

The final rule eases a few of the elements in the proposed rule, notes Randi Seigel, a partner at Manatt Health, a professional services firm in New York City. "For instance, originally they'd proposed to exclude labs and durable medical equipment makers and pharmaceutical manufacturers from being eligible to be a value-based entity participant, but they walked that back in the final rule and are not making those types of entities categorically excluded from participating in a value-based arrangement," she explains. CMS also created a new exception that would allow certain payments to be protected from violating the Stark Law if they were below an aggregate annual amount. "CMS originally proposed $3,500" for the annual limit, "but they actually responded to industry comments and increased that amount to $5,000," she says.


As the holiday season nears, asset-protection attorney Ike Devji highlights some issues that physicians and other clients should keep front of mind. Even during the pandemic, many medical offices will continue the annual holiday party tradition. Besides the usual liabilities, planners now must consider the risks of COVID-19 exposure. An alternative, Devji suggests, is to reward staff with gift exchanges, PTO or cash bonuses and other compensation or perks instead.

Because year-end is also an opportune time for healthcare organizations to swap out office equipment for devices more suited to remote work, telemedicine and video conferences, it is also critical to minimize the risk of data breach during the transition. According to Devji, that means retaining strong cyber liability policies and tracking which equipment was replaced and how it was disposed. Practice owners also may want to "de-risk" by shifting excess capital from their practices to their personal savings, Devji writes. He also recommends reevaluating personal legal planning and liability insurance coverage in light of lockdowns, personal safety risks faced by healthcare workers on the front line of the COVID-19 crisis and other current circumstances.

Health Policy and Reimbursement

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The US Centers for Disease Control and Prevention (CDC) may soon abbreviate the length of time it recommends that a person self-quarantine after potential exposure to COVID-19, in an effort to promote more compliance. CDC's Henry Walke said agency officials are finalizing recommendations for a new quarantine period that will likely last between seven and 10 days and include a test to ensure a person is COVID-19-negative. Although the risk of overlooking some infections exists, Walke suggested it may be worth the potential trade-off, as "hopefully, people would be better able to adhere to quarantine if it was, for example, seven to 10 days."

Health authorities have advised a two-week quarantine, plus other precautions like wearing masks and keeping a distance. However, some public-health experts say 14 days can be excessive, citing findings on how long someone is infectious in conjunction with the latest virus-testing strategies. The new recommendation could boost demand for testing at a time when capacity is already stretched, potentially complicating some people's ability to quarantine for a shorter period.

Medicine, Drugs and Devices

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Drugmakers have sued to prevent the Trump administration from permitting states to import certain prescription medications, in the first of what will likely be many legal challenges by the healthcare sector to the incumbent president's 11th-hour attempts to realize policy goals before the transition in January. The plaintiffs include Pharmaceutical Research and Manufacturers of America, the Partnership for Safe Medicines and the Council for Affordable Health Coverage. They claimed that the US Health and Human Services (HHS) Secretary is not authorized to preemptively certify that states' importation programs would lack safety risks and would save money before actually seeing the programs.

HHS acknowledged in rulemaking documents that it could not estimate cost savings because of its inability to predict the scope of states' plans. In a New England Journal of Medicine article, Washington University School of Law Professor Rachel Sachs and University of Michigan Professor Nicholas Bagley said "HHS may not have the legal authority to certify to Congress that entirely hypothetical state plans will save money and not pose health risks until the agency has had an opportunity to evaluate them."


The US Food and Drug Administration (FDA) has unveiled an Orphan Drug Designation Portal to support the development of treatments for patients with rare diseases. The portal seeks to bolster the information technology process within the agency's Office of Orphan Products Development. The portal will allow the electronic submission of new orphan drug designation requests. In addition, shifting from a paper-based to a cloud-based submission portal offers enhanced, direct communication between drug developers and FDA regarding each submission. The portal system will help sponsors provide feedback and ensure questions are answered.

The Office of Orphan Products Development has also launched a new internal orphan drug designation workflow management tool. This tool will streamline the tasks needed for assessing an orphan drug designation submission and automates certain review and processing functions. The agency will continue to work on these technological enhancements to support FDA's mission to advance the evaluation and development of safe and effective treatments for rare disease patients and families.