News From ACFAS

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Here is a recap of major ACFAS achievements in 2017…with a heartfelt thank you to our dedicated members and volunteer leaders who made it all possible!

• The Take a New Look at Foot & Ankle Surgeons public relations campaign—targeted at referring healthcare specialists—ended its second year with 100,000 visits to TakeANewLook.org, 652 one-on-one contacts, more than six million social media ad views and much more—all designed to get you more patient referrals.

• And the Take a New Look campaign received a national Silver Anvil award from the Public Relations Society of America in the “Reputation/Brand Management, Associations” category, along with awards from the Chicago Chapter of the Public Relations Society of America and Publicity Club of Chicago.

• Another “New Look” outcome: A joint clinical consensus statement on the treatment of gout is now underway with the American Association of Nurse Practitioners.

• The 75^th Anniversary Scientific Conference in Las Vegas once again set an all-time conference attendance record. There must be a reason! (Will we see you in Nashville this March?)

• And to celebrate its diamond jubilee, The Evolution of a Profession: The First 75 Years of the American College of Foot and Ankle Surgeons, was published. Want a copy? Just call ACFAS’ headquarters!

• Two new Clinical Consensus Statements were published on Heel Pain and Perioperative Management. Three more will be published in 2018.

• The College published its second e-Book, The Art and Science of Orthobiologics for the Foot and Ankle.

• The Board of Directors redoubled its focus on the need for more research. The 2018 Research Committee will receive new directives to address this issue.

• ACFAS conducted its third Total Ankle Surgical Skills Course as a sell-out in 2017…not to mention sell-outs of six other skills courses and great attendance at a dozen other programs across the nation.

• ACFAS membership peaked at more than 7,500 members for the first time ever!

• ACFAS’ 14 regional Divisions successfully completed the process to transition to nine Regions with equal memberships and resources.

• First-year resident membership in ACFAS surpassed an all-time high of more than 400 PGY-1 members.

• Nine new fellowship programs received status through ACFAS’ Recognized Fellowship Initiative, bringing the total number of programs with status to 44. Postgraduate fellow membership reached more than 50 for the first time.

Early birds, don’t let dollars saved on your ACFAS 2018 registration fee fly the coop! Register before January 8, 2018 at a reduced rate and get the best deal on the year’s biggest conference for foot and ankle surgeons.

Set for March 22–25, 2018 at the Gaylord Opryland Hotel in Nashville, ACFAS 2018 will bring you the superior clinical sessions and workshops you count on each year to refine your surgical skills and better manage your practice. Attendee favorites, including the scientific poster display, HUB theater and Job Fair, will also make encore performances.

Head to acfas.org/nashville to register now and get your New Year off to a running start! The Coalition for Patients’ Rights, of which the College is a member, issued a statement in response to the American Medical Association’s (AMA) adoption of Resolution 214. This resolution calls for the creation of a national strategy to oppose legislative efforts that grant independent practice to nonphysician practitioners through model legislation and state-level campaigns. In the past, AMA has included podiatry as part of its economic protectionism work.

CPR is concerned about the negative impact that Resolution 214 could have on patients’ access to and choice of care. ACFAS will continue to monitor this issue closely and will share updates as they become available. Visit patientsrightscoalition.org to learn more about CPR and its mission.

Foot and Ankle Surgery

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The plantaris tendon (PT) has been thought to contribute to symptoms in some patients with Achilles midportion tendinopathy, with symptoms improving after PT excision. Researchers hypothesized that there is compression and differential movement between the PT and Achilles tendon (AT) during ankle plantarflexion and dorsiflexion. Researchers studied 18 cadaveric ankles that were mounted in a customized testing rig, where the tibia was fixed, but the forefoot could be moved freely. A Steinmann pin was drilled through the calcaneus, enabling a valgus torque to be applied. The soleus, gastrocnemius and plantaris muscles were loaded with 63 N with a weighted pulley system. They discovered that PT tendons with an insertion separate from the AT demonstrated greater differential motion through range when compared with those directly adherent to the AT. They concluded that the PT inserting directly into the calcaneus resulted in significantly greater differential motion as compared with the AT. Tendon compression was elevated in terminal plantarflexion, suggesting that adapting rehabilitation tendon-loading programs to avoid this position may be beneficial.


Researchers evaluated a standardized algorithm to assess and treat impaired limb perfusion prior to surgical fixation of geriatric ankle fractures and to determine the prevalence of peripheral arterial disease (PAD) in geriatric patients presenting with ankle fractures. Eighty-four patients were preoperatively diagnosed and treated according to an algorithm (study group) and were compared with 84 patients diagnosed and treated before the algorithm was introduced. In 14 patients of the study group, clinical noninvasive examination revealed signs of relevant PAD, which was confirmed with computed tomographic angiography in nine patients, all of whom had successful angioplasty prior to surgical fixation of the ankle fracture. In three of these patients, PAD had previously been diagnosed. After standardized diagnostics and treatment of malperfusion, a significantly reduced overall wound complication rate was found.


Researchers conducted a study to investigate the application of a telemedicine intervention in diabetes foot ulcer care and its implications for healthcare professionals. The researchers did field observations and individual interviews among healthcare professionals in home-based care and specialist healthcare in a diabetes foot care telemedicine setting. They discovered varying possibilities for applying telemedicine in diabetes foot ulcer care within the hospital and home care contexts. For example, various circumstances in home-based care made the application of telemedicine more difficult. The researchers concluded that application of telemedicine in diabetes foot ulcer follow-up may enhance the nursing staff's ability to conduct comprehensive assessment and care of the foot ulcer and the patient's total situation. They added that access to equipment and time, particularly in home-based care, is necessary to capitalize on telemedicine.

Practice Management

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Ambulatory surgery centers (ASCs) can be a viable alternative option for patients. However, success of ASCs depends on high patient satisfaction scores, which can be difficult to obtain. Nicholas Frisch, an orthopaedic surgeon, says the key to success for ASCs is to make sure the facility is prepared for a variety of situations, even those that may require additional equipment. Frisch also notes that it is important to distinguish which patients would be better off in a traditional hospital. This is important as other problems may arise during treatment. He also says having well trained staff and good infrastructure in place helps an operation run smoothly.


Socioeconomic issues can have major impacts on the health of some patients. These issues are commonly considered to be food insecurity, housing, transportation, education, violence or community safety, social support, health behaviors and employment. However, doctors can do several things to overcome these factors. Experts say identifying if any socioeconomic problems exist is the first step. Second, doctors may need to make committed efforts to help patients. Educating patients on alternative options and other solutions available to them can also be beneficial.


Keeping healthcare data secure has become a paramount issue in light of recent cyber attacks on hospitals. The following steps can be taken to ensure data and systems remain secure. Hospital managers often place all the focus on cyber security, but ensuring physical equipment is safe is just as important. Server rooms should always be locked, and computer equipment needs to be secured to desks to prevent theft. Protecting these assets from fire and floods is also important to prevent loss of data. Another important step is to train staff to recognize and avoid phishing scams used by hackers. Additional tips include backing up data, keeping software updated and using good encryption or passwords when needed.

Health Policy and Reimbursement

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The U.S. Centers for Medicare and Medicaid Services (CMS) has fallen short in two areas of preparing for the quality payment program for the Medicare Access and CHIP Reauthorization Act, according to a recent review by the Office of the Inspector General for the U.S. Department of Health and Human Services. Clinicians need technical assistance and greater program integrity to protect the program from risk of fraud and improper payments, according to the report. That means CMS should provide sufficient guidance to ensure that clinicians are ready to take part in the quality payment program and to develop IT systems that support data reporting, scoring and payment adjustment.


The looming demise of the Affordable Care Act individual mandate is spurring talks in a handful of "blue" states about enacting their own coverage requirements. State officials, who have been working to protect their insurance markets from recent efforts to dismantle the health law, are beginning to grapple with strategies for preserving coverage. Those officials—in California, Connecticut, New Jersey and elsewhere—are not ruling out a state-level requirement that residents must obtain health insurance.


President Donald Trump wants lawmakers to pass two bipartisan bills in early 2018 that would strengthen the Affordable Care Act (ACA), the White House said on Dec. 20. Trump is eager to see both bills passed in January and will sign them, the White House said. "We believe that we will work with the House to get those passed," according to a senior White House official. "We think that we will be in a more comfortable place in January to get that passed." Legislation proposed by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) would fund a key ACA insurance subsidy program. A separate bill from Sens. Susan Collins (R-Maine) and Bill Nelson (D-Fla.) would provide reinsurance funding to help insurers cover high-risk enrollees. "The president is grateful for the opportunity to work with Sen. Collins on this, and he is committed to following through on our agreement," the senior White House official said. The support comes in the wake of Congress’s passage on Dec. 20 of a major tax cut that also repeals the ACA's individual mandate. Although Trump said the tax bill "means Obamacare is being repealed," much of the 2010 health law actually remains in place.

Medicine, Drugs and Devices

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Some legal experts say U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb's proposal to form a quick route to market for certain products that may not meet the criteria for clearance under the agency’s existing fast-track pathway, known as 510(k), could exceed the agency's authority. The new proposal would dispense with the need to test a new product against a specific predicate and instead use a set of technical standards that would essentially serve as a proxy for the predicate. FDA intends to release further details in nonbinding guidance for industry in early 2018. Attorney Donald Migliori with Motley Rice LLC, who represents victims of defective medical devices and drugs, says the agency appears to be "regulating the law away by providing an alternative path for companies that may be far more attractive for them." FDA will need to get creative with the wording of its guidance if it hopes to justify the move legally, asserts Bethany Hills, a lawyer who chairs the FDA practice at Mintz Levin and represents device makers filing applications with the agency. She says one option would be for FDA to stretch the definition of "predicate" to mean a set of technical standards common to a basket of products in the same class. However, Lars Noah, an expert in medical technology and public health law at the University of Florida, doubts the argument would hold up under legal scrutiny.


The U.S. Food and Drug Administration (FDA) has created a webpage to provide up-to-date information for clinicians on antimicrobial drug susceptibility. The page will provide "direct and timely" access to information about when bacterial or fungal infections are likely to respond to a certain drug, FDA said in a news release. The goal is to help providers make more informed prescribing decisions that will benefit their patients and help prevent the spread of resistant bacteria. Susceptibility test interpretive criteria, also known as "breakpoints," help determine whether specific bacteria or fungi are susceptible to antibacterial or antifungal drugs. Under the old approach, each drug manufacturer needed to update drug labeling with new breakpoint information, which needed to be reviewed and approved by FDA on a case-by-case basis. The new approach allows FDA to simultaneously update the breakpoints for multiple drugs that have the same active ingredient and to share that information transparently and immediately via the new webpage, which will list FDA-recognized breakpoints.


Although market exclusivity rights on brand-name drugs typically expire after about 12 years, manufacturers have discovered a number of end-runs to box out generics that can save patients money on their prescriptions. Drug companies have realized that they can maintain their lock on a market by, for example, adopting stealth tactics to protect branded medications from being reproduced. Additionally, they have learned to defend exclusivity by getting new patents as old ones lapse and by manipulating Risk Evaluation and Mitigation Strategies, a U.S. Food and Drug Administration (FDA) initiative targeting drug safety. Others have resorted to filing citizen petitions, which delay generic competition by raising public concern about the drug in question. Yet another tactic entails negotiating exclusive deals—such as bundled discounts—with drug plans so that more lawmakers are keeping a close eye on these trends, which keeps customer costs and company profits high.