News From ACFAS

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Last Friday, December 6, ACFAS eligible voting members received an email with a unique link to the 2020 Board of Directors Election website to vote for Board of Director candidates and proposed Bylaw Amendments from the College’s independent election firm (acfas.ballot@intelliscaninc.net). If you are a Fellow, Associate, Emeritus or Life Member, please take a few minutes to cast your vote for your elected leadership and proposed bylaw amendments. Your vote is important to advancing our profession and surgical specialty.

If you have not yet voted, two more reminder emails will be sent to you before the election closes on Sunday, December 22, 2019. If you do not have a valid email on file with the College or your email system blocked the test email from our election company, watch your US mail for voting instructions. An outcome of the July Board meeting, ACFAS developed new mission and vision statements to better represent the College’s core values and focus. The update came after much discussion and consideration among board members to better define the College’s statements and ensure they accurately pinpoint what ACFAS represents.

President Christopher Reeves, DPM, MS, FACFAS agrees the updated statements more closely align with the College’s values and purpose. “The new mission, vision and value statements are more engaging and meaningful for members and the patients we serve. These statements are a snapshot into who we are and what we do, so it’s important they reflect the organizational ideals and capture the work we do each and every day.” If you are looking for a new job or plan to expand your practice’s staff, be sure to bring your CV to ACFAS 2020 in San Antonio and come to the ACFAS Job Fair, sponsored by ACFAS Benefits Partner PodiatryCareers.org. Located in the Exhibit Hall, the ACFAS Job Fair will give you the opportunity to post your CV and open positions and to arrange onsite interviews by contacting employers with jobs posted onPodiatryCareers.org’s onsite boards.

While you’re at the conference, schedule one-on-one time with a professional CV reviewer. The reviewer will offer appointments for the first two days of the conference during Exhibit Hall hours to advise you on how to stand out from the crowd, so stop by early to get an appointment. ACFAS members receive reduced rates on online job postings and can display their available positions on the Job Fair bulletin boards at no cost.

If you cannot make it to San Antonio this year, note that all positions and CVs received on PodiatryCareers.org before the conference will be posted at the job fair. The Winter issue of FootNotes is here and that means another way to promote your practice and educate patients! Get the latest issue in the ACFAS Marketing Toolbox at acfas.org/marketing. Post the issue to your website, hand out copies to patients and promote through your social media channels.

This issue’s articles include tips for healthy Holiday feet, preventing injuries in boots and keeping feet safe at the gym. There’s an open space on the second page allowing you to customize the issue and add your practice contact information so patients can easily reach you.

Visit the Marketing Toolbox at acfas.org/marketing for other free resources to help you promote your practice and educate your patients. Resources are always being added to the Toolbox so check it regularly and follow our social media channels for updates.

Foot and Ankle Surgery

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As total ankle arthroplasty becomes more popular as a treatment for end-stage ankle arthritis, the incidence of total ankle prosthetic infections will also increase. Treating these infections depends on symptom duration and whether the infection is acute or chronic in presentation. Chronic infections are often treated by removing implants and placing a static cement spacer. The authors describe a technique for creating an articulating antibiotic cement spacer through an anterior approach in a patient with an infected total ankle arthroplasty. The articulating antibiotic cement spacer allows high doses of local antibiotics, decreases soft tissue contractures and allows continued motion of the joint.


Open dorsal closing wedge calcaneal osteotomy or Zadek Osteotomy (ZO) has good clinical results for treating insertional achilles tendinopathy (IAT), but it comes with a high rate of postoperative complications. The study aims to describe percutaneous ZO for the treatment of the IAT and to evaluate its impact on the clinical and functional postoperative outcomes. Twenty-six consecutive patients with unilateral IAT refractory to nonoperative measures were treated with percutaneous ZO. The percutaneous ZO showed a significant improvement (p < 0.0001) in preoperative to postoperative Visual Analogue Scale and Foot Function Index Score.

Two postoperative complications (8 percent) were observed: one case of symptomatic non-union and one case of hardware pain, both in healthy patients. The overall rate of satisfaction after surgery was (92 percent), and relief of pain was achieved after an average period of 12 weeks. The authors conclude that ZO is a safe and effective procedure for the treatment of IAT and note that when compared to the open surgical approach, the percutaneous ZO may decrease recovery time and postoperative complications.


The study presents and evaluates a new surgical technique, supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization, for the treatment of varus ankle osteoarthritis with an excessive talar tilt angle (TTA). Seventeen patients with 17 cases of varus ankle arthritis with excessive TTAs underwent surgical treatment using the new technique. The American Orthopaedic Foot and Ankle Society clinical ankle-hindfoot scale score improved significantly from 45.8 ± 2.1 before surgery to 84.8 ± 1.8 after surgery, while the visual analogue scale score decreased from 4.9 ± 0.4 to 1.1 ± 0.2.

The medial distal tibial angle, TTA and hindfoot moment arm values changed from 80.9° ± 0.4° to 90.1° ± 0.4°, 11.7° ± 0.6° to 1.4° ± 0.3° and 12.6mm ± 0.8mm to 4.2mm ± 0.6mm, respectively. The staging of 11 cases (65 percent) improved.

Practice Management

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Amazon announced that it is launching a service called Amazon Transcribe Medical, which transcribes doctor-patient interactions and plugs the text straight into the medical record. The new service is linked to another tool called Amazon Comprehend Medical, which was launched last year to allow developers to process unstructured medical text. The new service puts Amazon in competition with cloud rivals Microsoft and Google as they battle on voice-to-text transcription technology.


Online reviews play a critical role in the success of modern medical practices. Given that health complications can arise or worsen even if providers have done everything right, healthcare practices are especially vulnerable to unfair and misinformed reviews. To combat defamatory reviews, practices should first understand that, in general, a person may be liable for defamation when they post a review that contains demonstrably false assertions of fact (as opposed to opinion) that damage the subject of the review. This means that patients are entitled to post reviews that are statements of opinion and accurate statements of fact, but they cannot make statements such as "I was billed for procedures that were not performed" if those statements are not true. When considering whether or how to address negative online reviews, it is therefore important to determine whether the review qualifies as purported fact.

If the review is not defamatory, consider alternative ways of addressing the review, such as pursuing any takedown procedures provided on the review platform. Practices can also balance out negative reviews by making a sustained effort to increase the number of positive reviews. To prevail in court, you will need to prove that the statements in question are false, which can be done a number of ways, including witness testimony and records. Consider the severity of the harm inflicted when determining whether to pursue legal action. A widespread defamatory review can inflict significant harm, but very minor misstatements may not be worth the time and resources needed to pursue legal action, even if you have a valid claim.


Only 36 percent of the nation's professionally active physicians are women, and females account for less than 40 percent of the physician workforces in 44 states, pointing to enduring systemic barriers to gender equality in medicine. In addition to implicit gender bias, this includes barriers related to pregnancy and parenthood that weigh more heavily on women, ultimately impacting the trajectory of their training and careers. Females pregnant during graduate medical education (GME) are more likely than their male counterparts to revise career plans during and after pregnancy, suffer from loss of research productivity, alter on-call and rotation schedules and complete the program later than originally planned.

Moreover, a 2018 study found that just eight of 15 GME-sponsoring institutions have paid childbearing or family leave provisions for residents, and the American College of Physicians reports a mere 28.9 percent of physician contracts that provide maternity coverage and taking leave. This prompts many women to choose to work part-time, which limits access to leadership opportunities and curtails representation in more time-intensive and competitive specialties. Major medical organizations say the solution is to stop penalizing physicians who work less, provide universal access to paid medical and family leave and expand paid leave to more than six weeks.

Health Policy and Reimbursement

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The number of people signing up for Affordable Care Act (ACA) plans since November 1 this year has narrowed thanks to a big jump in enrollments during the fourth week. During the week, 703,556 people selected plans using Healthcare.gov, compared to 500,437 consumers the year before, helping narrow the enrollment gap year-over-year. Both the number of new and renewing consumers picked up during the fourth week. By comparison, enrollment numbers were down 13 percent from last year during the third week and 20 percent from last year during the second week.

Many insurers have returned to the ACA market or expanded their footprint, with more plans offered and lower premiums or premium increases compared to last year. Since January 2019, individuals are no longer required to have coverage or face a tax penalty, which could factor into an individual's decision whether to buy health insurance.


In a recently-filed lawsuit, several hospital groups argue that the Trump administration exceeded its legal authority in issuing a rule that would require hospitals to reveal negotiated rates for many procedures. The administration issued the rule to allow patients to better shop for deals on a range of services, which the groups say violates their First Amendment rights and would not accomplish the aim of helping consumers avoid surprise bills. The rule is part of the administration's efforts to tackle rising hospital costs, which have significantly outpaced the increase in physician prices. The Trump administration has also proposed a rule requiring insurers to allow patients to get advanced estimates of their out-of-pocket costs before they see a doctor or go to the hospital.


Monthly premiums fell from $288 in 2017 to $162 in 2019 for subsidy-eligible Affordable Care Act enrollees in rural markets, while monthly premiums fell from $275 to $180 for urban enrollees over the same period, according to research published in Health Affairs. Rural enrollees have seen falling rates since late 2017, when President Trump axed cost-sharing reduction (CSR) payments that helped individuals between 100 percent to 250 percent of the federal poverty line enrolling in Silver plans. Insurers responded by "silver-loading," meaning that the CSR costs were incorporated into Silver plan premiums. At the same time, federal subsidies rose significantly, making Bronze and Gold insurance plans more affordable.

Medicine, Drugs and Devices

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The Senate Health, Education, Labor, and Pensions Committee has advanced the nomination of Stephen Hahn to lead the U.S. Food and Drug Administration. Hahn, chief medical executive at the University of Texas MD Anderson Cancer Center, was nominated by President Trump last month to replace Scott Gottlieb, who left the job in April.


Dexcom, a company that makes sensors used by people with diabetes to measure their blood-glucose levels, has been one of the biggest success stories in applying technology to health. Sales of its continuous glucose monitors climbed to $396 million in the third quarter of 2019, up 49 percent from a year ago. However, a key feature of Dexcom's devices recently failed. One of the selling points of the monitors is that they allow people other than the person with diabetes to receive alerts when the patient's blood sugar drops too low. But those alerts, a feature called Dexcom Follow, stopped working. Worse, parents who were using it to help monitor their children with type 1 diabetes did not realize that the system had stopped working.


Patients and their families have frequently complained about the alarms that come with nearly every machine in a modern hospital, which many say sound far more than necessary. Research firm ECRI Institute ranked alarms as one of the top 10 health technological hazards every year since 2007, meaning that alarms are misconfigured or that staffs are too swamped with alarms to notice a patient in distress. The Joint Commission, meanwhile, warned about the “frequent and persistent” problem of alarm safety in a 2013 report and now requires hospitals to create formal processes to tackle alarm system safety. The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85 percent to 99 percent do not require clinical intervention.

In the past 30 years, the number of medical devices that generate alarms has risen from about 10 to nearly 40. Hospitals have turned to “clinical alarm management,” bringing in consultants to figure out how many devices have alarms, which go off most frequently and which are the most important. Some units are trying to lower the number of alarms from monitors by customizing alarm settings and converting some audible alerts to visual displays at nurses' stations.