News From ACFAS

---

Profiles and position statements for the five candidates recommended by the Nominating Committee to fill three vacancies on the ACFAS Board of Directors are now available at acfas.org/nominations:

• Shane Hollawell, DPM, FACFAS
• Alan A. MacGill, DPM, FACFAS
• Jason A. Piraino, DPM, MS, FACFAS
• Brett D. Sachs, DPM, FACFAS
• Amber M. Shane, DPM, MS, FACFAS

Online voting will be open December 10-27. Eligible voters will receive an email with a unique link to the election website when the election opens. Watch your email and ACFAS publications for more information on how to vote. As if you need another reason to join us in Austin for ACFAS 2022, here are some highlights of things to look forward to you won’t want to miss!

• New! Two International Symposia: This year, ACFAS will have not one, but two sessions at the conference where you’ll be able to hear the latest research and practices from speakers from around the globe! Join us on Thursday, February 24, for the International HAV Symposium, and then later that same day, come back and attend the International Sports Medicine Symposium!
• Decision Making Process in Flatfoot Reconstruction: Surgeons pick his or her own cases and offer an honest divulgence of a poor case outcome based on surgical decision making and plan, followed by excellent outcome and discussion.
• New! Operating Theater – Surgical Demonstration Session: Moderated by Ryan B. Rigby, DPM, FACFAS, attendees will be able to observe firsthand surgical procedures being performed by the experts. During this engaging session, you’ll get pearls and techniques for various surgical procedures.
• MIS Is Not Just About Smaller Incisions: This session will discuss current techniques and effective execution of MIS surgery with the history and literature surrounding minimally invasive foot surgery.
• Minimally Invasive Surgery Hands-On Cadaver Workshop: MIS bunion surgery is evolving as well as other osseous procedures. This course is an introduction to the instrumentation, technique, fixation and how to reproducibly succeed. During the lab we will practice using the burr, perform akin with fixation, bunion with both methods of fixation, and calcaneal osteotomy with fixation.

Visit acfas.org/Austin for more information on this year’s meeting and to secure your spot now! Calling all ACFAS runners! Come to Austin a few days early of the ACFAS Annual Scientific Conference to be part of the ACFAS Team at the Austin Marathon!

ACFAS is a sponsor of the Austin Marathon with a booth at the health expo and is putting together a team of members to run the marathon to help promote you and the profession. The event takes place on Sunday, February 20. Each runner on our team will get an ACFAS athletic shirt to wear during the race to show who you are as a foot and ankle surgeon.

To participate, sign up at the Austin Marathon website and choose ACFAS under the “Team Name” pull down menu. You can also choose to run either the full, half or 5k event that day.

Packet pickup will start the afternoon of Friday, February 18 and run through Saturday, February 19 at the ACFAS booth in the Palmer Event Center.

For more information, contact ACFAS Team Captain Michelle Kennedy or team organizer Melissa Matusek. Go ACFAS! Next up in the student-led webinar series—Conducting a Prospective Study on December 15 at 8pm CT.

Join the California School of Podiatric Medicine Student Club with presentations by Paul Kim, DPM, MS, FACFAS (Research) and Matthew Doyle, DPM, AACFAS (Case Study).

Each month’s lecture features three 20-minute segments on various topics of the research process each led by an ACFAS Student Club President, a member from the ACFAS Regions and a member of the ACFAS Research Committee.

Visit acfas.org to learn more about the lecture series or to register today.

Foot and Ankle Surgery

---

A study sought to determine the functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails at a major trauma center. Twenty patients (seven males and 13 females) older than 60 and with multiple co-morbidities underwent intramedullary nailing with a tibiotalocalcaneal nail. Thirteen patients returned to their pre-operative mobility state, and the average Charlson Co-morbidity Index (CCI) was 5.05. Patients with a low CCI are more likely to resume pre-operative mobility status. All patients realized radiographical union, taking between 92.5 days and 144.6 days on average. The mean post-operative American Orthopaedic Foot and Ankle Society and Olerud-Molander scores were 53.0 and 50.9, respectively. Four cases of superficial infection and four cases of broken or loose distal locking screws were observed, and no deep infections, periprosthetic fractures, nail breakages or non-unions ensued.


A study was conducted to probe changes in bone mineral density (BMD) and body composition in 22 people 12 weeks after hospitalization for diabetes-related foot ulceration (DFU). Dual X-ray absorptiometry measured total body, lumbar spine, hip and forearm BMD and total lean and fat mass during and 12 weeks after hospitalization. Significant losses in total hip BMD of the ipsilateral limb, total hip BMD of the contralateral limb, femoral neck BMD of the ipsilateral limb and femoral neck BMD of the contralateral limb were noted after 12 weeks. Lumbar spine and forearm BMD remained the same. HbA1c declined from 75 mmol/mol to 64 mmol/mol, while changes to lean and fat mass were insignificant. Total hip and femoral neck BMD fell bilaterally 12 weeks post-hospitalization for DFU. Future research is needed to verify the persistence and clinical implications of these losses.


A retrospective multicenter cohort study compared pain and functional outcomes between patients in which the Böhler angle (BA) was preserved in surgery for displaced intra-articular calcaneal fracture and those in whom it was lost during follow-up. Surgeons at 10 facilities surgically treated 271 cases of calcaneal fractures from 2014 to 2018, divided into Group L (lost reduction of fracture) and Group P (preserved reduction of fracture). Ultimately 38 patients were assigned to each cohort. No difference in total American Orthopedic Foot and Ankle Society (AOFAS) was observed between the two groups, but the pain component of AOFAS score at six months and 12 months was worse in group L than in group P. The amount of BA loss also correlated with postoperative pain, while logistic regression analysis demonstrated that patients who were female and BA before surgery independently predicted loss of reduction. The reduction and preservation of BA within its normal range should lessen operative pain.

Practice Management

---

With office holiday parties returning this year, physician practice owners and leaders need to manage a number of risks. For those opting to host live events, expectations of safe conduct and requirements for attendance must be clarified beforehand, including issues such as vaccination status, masking for staff and their guests and uniform safety protocol enforcement. Skipping guests should be one consideration, which will help reduce crowd size, minimize disagreement over safety rules and keep the focus on the team, their achievements and relationships. Practices should also consider the pandemic safety policies of the venue they use, while those hosting should pay attention to things like safe food and beverage handling that avoids buffets, passed appetizers and other "shared-touch" items. Furthermore, the size, layout and ventilation of any venue used for the event must be evaluated.


The US Centers for Disease Control and Prevention has updated four parts of the Epidemiology and Control of Selected Infections section of the Guideline for Infection Control in Healthcare Personnel. This guideline is intended for use by leaders and staff of Occupational Health Services (OHS) and to guide OHS in the management of exposed or infected healthcare personnel (HCP) who may be contagious to others in the workplace. The updated recommendations in these sections include the latest evidence-based guidance to continue to protect HCP as they serve their patients. Specifically, the updates focus on postexposure management, including postexposure prophylaxis (PEP), for exposed HCP and work restrictions for exposed or infected HCP. The updated sections provide current guidance on the management of exposed or potentially infectious HCP; expanded information regarding defining occupational exposures in healthcare settings

Health Policy and Reimbursement

---

US District Judge Matthew Schelp in St. Louis has blocked a Biden administration COVID-19 vaccine requirement in 10 states, ruling that the US Centers for Medicare and Medicaid Services (CMS) likely overreached in mandating that healthcare workers get vaccinated against the coronavirus. He argued that the agency had downplayed the "overwhelming" cost of its mandate and by refusing to submit the rule to public comment had encouraged the vaccine hesitancy the rule is meant to curtail. "Congress did not clearly authorize CMS to enact this politically and economically vast, federalism-altering and boundary-pushing mandate, which Supreme Court precedent requires," Schelp wrote. The states that sued to have the rule blocked include Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire. CMS stated it was reviewing the ruling, warning that unvaccinated healthcare staff jeopardize patient safety.


Some hospitals charge up to 10 times as much as others for standard medical scans, according to research published online in Radiology. Median prices for taking images of the brain, legs, abdomen and chest differed across hospitals by thousands of dollars in some cases, researchers from Johns Hopkins and Michigan State universities reported. “This is very far away from a competitive market,” said Ge Bai, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health and an author of the study.

Medicine, Drugs and Devices

---

A study by the US Centers for Disease Control and Prevention (CDC) published in the American Journal of Infection Control found 30 percent of over 3 million healthcare workers in more than 2,000 US hospitals have not been vaccinated against COVID-19. The researchers assessed vaccine uptake from January 20 to September 15 in 41 percent of hospitals using data reported to the US Department of Health and Human Services' Unified Hospital Data Surveillance System. Seventy percent of 3,357,348 surveyed healthcare personnel (HCP) in 2,086 hospitals were fully vaccinated as of September 15, and vaccine coverage was highest among HCP in children's hospitals, followed by short-term acute-care facilities, long-term acute-care hospitals and critical access centers.


Small and mid-size organizations and outpatient facilities are still hounded by healthcare cyberattacks as larger health systems deploy protective measures. Trends on the Office for Civil Rights (OCR) data breach portal indicate various hacks targeting smaller healthcare organizations that may lack the resources to combat exploits, including a ransomware attack on a Pennsylvania primary care clinic and data exfiltration and encryption at a family of neuromonitoring practices. Pennsylvania-based TriValley Primary Care began alerting patients that their protected health information (PHI) was potentially compromised by an unauthorized individual who accessed the clinic's systems. Analysis could not ascertain when they penetrated the systems or what specific records were accessed or acquired. TriValley recommended that impacted patients take action to protect their information and is offering free credit monitoring and identity theft protection. Meanwhile, neuromonitoring practices network Medsurant Holdings posted an online advisory warning individuals — 45,000 by OCR's count — of a data security incident that also may have affected patient PHI.