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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

Free CME Resources at ACFAS e-Learning

Need a little more CME for your licensure? ACFAS members are eligible to earn free continuing education contact hours for selected materials at ACFAS e-Learning.

Visit day or night to browse CME options and the entire library of reliable information on the diagnosis and treatment of foot and ankle conditions.
New Performance Measures for Care of PAD Patients

The P.A.D. Coalition reports that the American College of Cardiology/American Heart Association Task Force on Performance Measures has released new measures for the medical care of adults with peripheral artery disease (PAD). The measures are intended to help improve PAD patients’ overall well-being and quality of life, and reduce cardiovascular events and deaths.

The coalition provides an excellent summary of the performance measures’ primary goals and recommended tactics in its online newsletter. The full performance measures are available online at the Journal of the American College of Cardiology.

ACFAS is a member of the P.A.D. Coalition and supports improvement in the management of this and other chronic conditions that frequently manifest in the feet and ankles. To learn more about the coalition, visit its website.
ACFAS Wants to Stay in Touch!

Have you recently changed your work, home or e-mail address, or phone or fax number? Does your practice have a website? Do you want to change your “preferred address” for receiving the Journal of Foot & Ankle Surgery and other ACFAS mailings? We want to stay in touch with you!

Your contact information is listed in the College’s online membership directory so your colleagues can find you.

You can also be listed in the “Find an ACFAS Physician” search tool on the consumer website, After completing your professional profile with website, hours, and up to three locations, be sure to scroll down to “ACFAS Website Listing” and check “Yes” for “Consumer Physician Search.”

Keep yourself available to your peers, potential patients and the College! Update your contact information now at
Get the Scoop with JFAS Articles in Press

“Articles in Press” at the Journal of Foot & Ankle Surgery's online home page offers new articles as soon as their proofs have been approved. Check in for the latest studies on treatment of foot and ankle conditions, and contributing factors such as trauma or underlying health problems.

It’s quick and easy with your free member access:
  • Go to
  • Click on “Read current and past issues online” (member login required)
  • When you reach the JFAS home page, click on “Articles in Press” in the left menu.
Visit JFAS online to get tomorrow’s news today!

Help Shape the Future

You can help shape the advancement of the profession, the future of the College and, ultimately, the care of patients by volunteering for 2011–12 ACFAS committees. For information on becoming a committee volunteer, please visit The deadline for applications is Dec. 15, 2010.

Foot and Ankle Surgery

Ankle Fractures: Impact of Swelling on Timing of Surgery, Length of Hospital Stay and the Economic Burden

A delay in operating on ankle fractures is often due to swelling, but delays beyond 24 hours from injury is associated with lengthening of hospital stay and added costs. Researchers analyzed the relationship between the delay in surgical intervention of ankle fractures from presentation due to ankle swelling and the length of hospital stay and postoperative complications. A retrospective study of 145 consecutive patients treated for ankle fractures over a period of 12 months between January and December 2008 was undertaken.

In total, 117 patients (80 percent) were operated on within 24 hours of presentation (early group). Twenty-eight patients’ surgery was delayed beyond 24 hours (delayed group). Of the early group, the mean inpatient stay was 3.79 days, whereas in the delayed group the mean stay was 8.57 days. Of the delayed group, 57 percent of the cases had swelling as the cause of a postponed operation; other causes included lack of theatre time and lack of fitness for surgery. In the early group, 5 patients (4.27 percent) had wound infections and one patient had a chest infection (0.85 percent). Four patients (14.28 percent) from the delayed group developed wound infections, all of which were from ankle swelling.

Based on these findings, the researchers recommend that policies be put in place to provide early operative intervention for patients with fractured ankles prior to the development of swelling as this would result in improved patient outcome and significant financial savings.

From the article of the same title
Injury Extra (12/01/10) Vol. 41, No. 12, P. 133 Sukeik, M.; Qaffaf, M.; Ferrier, G.

Greater Peak Rearfoot Eversion Predicts Foot Orthoses Efficacy in Individuals With Patellofemoral Pain Syndrome

Researchers evaluated the ability of baseline foot kinematics associated with pronation to predict marked improvement 12 weeks following foot orthoses prescription in individuals with patellofemoral pain syndrome (PFPS). Twenty-six individuals with PFPS were issued a prefabricated foot orthoses, and patient-reported level of improvement was documented at 12 weeks. Potential predictors of marked improvement at 12 weeks were measured during walking at baseline and included forefoot dorsiflexion and abduction, and rearfoot eversion.

Of the 25 participants who completed the study, seven (28 percent) reported marked improvement with the foot orthoses after 12 weeks. Discriminant function analysis revealed a greater peak rearfoot eversion to be the only significant independent predictor of marked improvement.

The researchers concluded that the findings provide preliminary evidence that greater peak rearfoot eversion is predictive of marked improvement 12 weeks following prefabricated foot orthoses prescription in individuals with PFPS. Therefore, foot orthoses may be most effective in the subgroup of people with PFPS and increased dynamic foot pronation.

From the article of the same title
British Journal of Sports Medicine (11/16/10) Barton, C. J.; Menz, H. B.; Levinger, P.; et al.

Soft Tissue Reconstruction of the Foot Using the Distally Based Island Pedicle Flap after Resection of Malignant Melanoma

Researchers used a distally based island flap for soft tissue reconstruction of the foot in limb salvage surgery for malignant melanoma patients. A distally based sural flap was used for 10 cases for the hindfoot reconstruction, and a lateral supramalleolar flap was used for three cases for the lateral arch reconstruction of the mid- and forefoot after wide excision of malignant melanomas. The length of the flap varied from 7.5 cm to 12 cm and the width varied from 6.5 cm to 12 cm.

Superficial necrosis developed in four flaps, but was successfully treated by debridement and suture or a skin graft. All 13 flaps survived completely and they provided good contour and stable and durable coverage for normal weight bearing.

The researchers concluded that distally based sural flap is useful for reconstructing the hindfoot, and the lateral supramalleolar flap is good for reconstructing the lateral arch of the mid- and forefoot after resection of malignant melanoma of the foot.

From the article of the same title
Clinics in Orthopedic Surgery (12/01/10) Vol. 2, No. 4, P. 244 Kang, Hyun Guy; Kim, June Hyuk; Cho, Hwan Seong; et al.

Practice Management

Hospitals Embrace Incentives for Efficient Healthcare

Hospitals and doctors around the nation are beginning to create new entities that aim to provide more efficient healthcare, spurred by incentives included in the healthcare reform bill. In Arizona, for example, Tucson Medical Center is forming a company that the hospital will own jointly with local physicians' practices. The joint venture will aim to sign contracts with insurers and Medicare to earn financial rewards if it saves healthcare dollars. Supporters say data-tracking tools such as electronic health records should help such ventures, called accountable care organizations, accomplish their goals.

From "Embracing Incentives for Efficient Health Care"
Wall Street Journal (11/28/10) Mathews, Anna Wilde
Web Link - May Require Paid Subscription | Return to Headlines

How Physicians Can Reduce Patient Wait Times

Physician practices are preparing for a looming increase in patients with a team approach to care delivery that is designed to cut down wait times and optimize physician face time. Wait times for an appointment to see a physician or specialist are already hitting record numbers, according to a survey by Merritt Hawkins & Associates. For orthopedic surgery, the survey found an average wait time of 16.8 days. "Specialty practices in the future will be asked to be much more coordinated and streamlined with whoever else is the primary care physician of the patient," says Roland Goertz, MD, president of American Academy of Family Physicians. "The whole system, to be efficient, is going to have to change."

Goertz predicts the following four changes will take place to accommodate the patient influx:

1. The adoption of modern tools such as electronic health records (EHR)
2. Use of creative and innovative scheduling models
3. Designing the hours of the practice to better accommodate patient need
4. Focusing more attention on quality measurements such as patient demographics

From the article of the same title
HealthLeaders Media (12/01/10) Webster, Anna

Rethink Social Media Policies in Light of NLRB Complaint, Lawyers Say

If a practice employee posts something negative about you or your practice on Facebook, your first thought might be to dismiss that employee. But after a recent complaint was filed by the National Labor Relations Board (NLRB) against a company that did just that, lawyers are advising their clients not to be so quick to fire the employee, particularly if the social media post is about improving workplace conditions. Attorneys are advising practices to re-examine their social media policies as a result of the complaint or write a policy to make sure they are protected.

From the article of the same title
American Medical News (11/29/10) Dolan, Pamela Lewis

Health Policy and Reimbursement

10 Percent of Family Docs Mull Shuttering Over Medicare Cuts

Nearly 13 percent of 516 physicians responding to an online survey of American Academy of Family Physicians (AAFP) members who have an ownership stake in their medical practices said they would consider no longer seeing patients if Congress failed to override looming Medicare pay cuts. The survey asked family physicians in September about the impact of a pending 23 percent Medicare pay cut that will deepen to 25 percent in the coming months.

The survey found that among family physicians who maintain their practices, 62 percent said they may be forced to stop accepting new Medicare patients, and 73 percent said they would have to limit the number of Medicare appointments because of the reimbursement cuts. "If you ran a business and knew that up to 30 percent of your customers were going to reduce your payment by 25 percent or more, what would your business do?" said Roland Goertz, president of AAFP.

From the article of the same title
HealthLeaders Media (11/29/10) Commins, John

California's Largest Health Plans Are Fined Nearly $5 Million

California's seven largest health plans have been fined a total of nearly $5 million for failing to properly pay medical claims submitted by thousands of doctors and hospitals over the last three years. Regulators said the companies also would pay "tens of millions of dollars" in restitution to medical providers whose claims were underpaid or incorrectly rejected.

From the article of the same title
Los Angeles Times (11/30/10) Helfand, Duke

Senate Widens Its Probe of Bare-Bones Health Plans

What began as a Senate investigation into McDonald's Corp.'s insurance policy for store employees is being widened into a sweeping probe of "mini-med" policies that could involve major carriers such as Cigna and Aetna. Congressional investigators are scrutinizing the two carriers and gathering insurance policy data on employers of all sizes, according to a Senate aide. The aide says Senate Democrats plan to demonstrate in a Dec. 1 hearing how some employers are offering workers health-insurance policies with low caps on yearly benefit payouts that leave employees paying for care. Mini-med plans cover approximately 1.4 million Americans, and new strictures in the health overhaul approved in March are expected to phase out such plans as of 2014, when low-salaried workers will qualify for tax credits to help them purchase insurance.

From the article of the same title
Wall Street Journal (11/30/10) Adamy, Janet

Medicine, Drugs and Devices

DOD Awards $2.24 Million Grant to Study Keratin Gel in Peripheral Nerve Regeneration

Orthopaedic researchers at Wake Forest University Baptist Medical Center have received a $2.24 million four-year grant from the U. S. Department of Defense to study the use of keratin gel in the regeneration of damaged peripheral nerves in the feet, hands, and arms. Invented at the center's Institute for Regenerative Medicine, keratin gel is a biomaterial derived from human hair. In pre-clinical testing at the Medical Center, keratin gel was shown to promote the growth of severed nerves by increasing the number of axons, the structures in the peripheral nervous system that carry signals to and from the spinal cord.

From the article of the same title
News-Medical.Net (12/02/2010)

Guidelines Call for Increase in Vitamin D

New guidelines for vitamin D issued by the Institute of Medicine call for increasing the recommended dietary allowance (RDA) of vitamin D to 600 international units (IU) for everyone aged 1 to 70, and raising it to 800 IU for adults older than 70 to optimize bone health. The new guidelines also call for a recommended dietary allowance of 700 milligrams of calcium per day for children ages 1 through 3, 1,000 milligrams daily for almost all children ages 4 through 8, 1,300 milligrams of calcium per day for adolescents ages 9 through 18, and 1,000 milligrams for all adults aged 19 through 50 and men until age 71. Women starting at age 51 and men and women age 71 and older need 1,200 milligrams of calcium per day, according to the guidelines.

From the article of the same title
WebMD (11/30/10) Mann, Denise

Surgical Treatment of Syndesmotic Diastasis: Emphasis on Effect of Syndesmotic Screw on Ankle Function

Researchers treated 52 adult patients with syndesmotic diastasis (SD) with closed anatomical reduction and stable fixation by a trans-syndesmotic cancellous screw. A short leg splint was prescribed for a six week postoperative period. Treatment outcomes of syndesmotic screw removal at various time points were studied and compared (group 1 at six weeks, group 2 at three months, and group 3 at an average of nine months).

Recurrence of SD occurred in 15.8 percent of patients in group 1, 15 percent in group 2, and 0 percent in group 3. Breakage of the syndesmotic screw occurred in three patients within three months (group 2, 15.0 percent) and in two patients beyond three months (group 3, each at six and 12 months, 15.4 percent). None of the group 1 patients experienced screw breakage. Forty-three patients (82.7 percent) were classified as having satisfactory outcomes. Ankle function did not significantly differ among the three groups, with or without syndesmotic screw breakage and with or without SD recurrence.

The researchers conclude that restriction of daily activity for at least three months is required to prevent recurrence. Removal of the syndesmotic screw at six weeks may prevent its breakage but increases the risk of recurrence. Over an average follow-up of 19 months, SD recurrence does not lead to deterioration in ankle function.

From the article of the same title
International Orthopaedics (11/11/10) Hsu, Yi-Ton; Wu, Chi-Chuan; Lee, Wei-Cheun; et al.
Web Link - May Require Paid Subscription | Return to Headlines

Ultrasound Gets More Portable

Two years ago, Washington University in St. Louis computer engineers developed a prototype that brought a new level of mobility and connectivity to ultrasound imaging by connecting an ultrasound probe to a smart phone. Now, a startup company called Mobisante is waiting for approval from the FDA to sell the device. Such mobile ultrasound technology would be useful for emergency responders, who could scan an injured person to detect internal bleeding or trauma and send an image to a hospital so physicians could get ready for the patient.

From the article of the same title
Technology Review (11/29/10) Swanson, Sandra

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December 8, 2010