News From ACFAS

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Congratulations to the newly elected ACFAS Board members from online balloting that ended on December 27:

• Amber M. Shane, DPM, MS, FACFAS
• Shane Hollawell, DPM, FACFAS
• Alan A. MacGill, DPM, FACFAS

Previously elected to serve as Chair of the Region Presidents Council and ex-officio board member:

• Gregory P. Still, DPM, FACFAS

Drs. Shane and Hollawell will serve three-year terms (2022-2025) and Drs. MacGill & Still will serve a two-year term (2022-2024).

Also serving on the 2022-2023 Board of Directors are Michael J. Cornelison, DPM, FACFAS, President; Eric A. Barp, DPM, FACFAS, President-Elect; George T. Liu, DPM, FACFAS, Secretary-Treasurer; Thanh Dinh, DPM, FACFAS, Immediate Past President; Andrew Meyr, DPM, FACFAS; Alan Ng, DPM, FACFAS; and Matt Williams, DPM, FACFAS. You’ve packed your cowboy boots, but don’t forget to pack your CV and stop by the eighth annual ACFAS Job Fair in the ACFAS 2022 Exhibit Hall.

Hosted by PodiatryCareers.org, the College’s official online job board, the 2022 in-person Job Fair invites available candidates to post their CVs on the Job Fair bulletin boards and for employers to hunt for a new employee by posting descriptions of open jobs. Throughout the conference you can even sign up for a virtual CV review. Stop by the booth on Thursday from 12:30-1:30pm for an open Q&A with Careers Consultant, Christopher Hood, DPM, FACFAS.

Need a professional headshot, and better yet, for free? Be sure to dress your best and visit the Headshot booth in the Exhibit Hall on Friday and Saturday of the conference to have your picture taken. Your photo session will include a brief meet and greet with a makeup artist, and you will receive both hardcopy and digital versions of your headshot. Congratulate your colleagues who win Manuscript, Poster, Honor, and Merit Awards at the ACFAS Honors and Awards Ceremony during the Annual Scientific Conference on February 25. The year’s best research will be recognized, new Fellows will be presented their College keys and the 2022-23 Board of Directors will be introduced with remarks from incoming ACFAS President, Michael J. Cornelison, DPM, FACFAS.
Check out the latest podcast addressing physician burnout available now in ACFAS OnDemand.

In this podcast members Kyle C. Fiala, DPM, FACFAS, Barry I. Rosenblum, DPM, FACFAS, Laurence G. Rubin, DPM, FACFAS, and Calvin J. Rushing, DPM AACFAS provide insight and delve into the signs and characteristics of physician burnout. Hear their shared experiences and take away important tips and tools to address physician burnout and well-being. Access the newest podcast now at acfas.org/OnDemand.

Foot and Ankle Surgery

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Chronic pain syndrome (CPS) is a common complication after operative procedures, but limited research has been done on the evaluation of CPS in foot-forefoot surgery, in particular hallux valgus (HV) percutaneous correction. The purpose of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anesthesia prior to HV percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. A consecutive patient series was enrolled and evaluated prospectively at seven days, one month, three months and six months after surgery.

The participants were divided into two groups according to the regional anesthesia received. The parameters assessed were postoperative pain at rest and during movement based on numerical rating scale, patient satisfaction using the Visual Analogue Scale, quality of life and return to daily activities. A total of 155 patients were assessed, consisting of 127 females and 28 males. Pain at rest and during movement significantly decreased during the follow-ups; at six months, 13 patients suffered from CPS. Over time, satisfaction remained stable, quality of life significantly increased, and patients returned to daily activities and work. No significant impact of type of anesthesia could be detected. ASA (American Society of Anesthesiologists) class 3 score was associated with higher pain during movement. The researchers concluded that both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up.


A study sought to assess the rate of tibial fracture with half pin placement in conjunction with tensioned wires in Ilizarov static external fixator in subjects with peripheral neuropathy. Concentric visualization through a rancho cube and careful identification of anterior, posterior, medial and lateral borders of the tibia was applied to guarantee a cortical breach did not ensue. Both tibial stress fractures and early removal of pin/wires from external fixator secondary to breakage occurred at statistically significant higher rates in patients in which the "perfect circle" technique was not utilized. The overall rate of tibia stress fractures was 2.08 percent with the perfect circle technique and 18.18 percent without. The study highlighted a significantly low rate of tibia stress fractures with half pin use versus prior literature, and should provide foot and ankle surgeons confidence, especially when appropriate placement is presented in this high-risk population.


Malposition of the sesamoids relative to the first metatarsal head may relate to intersesamoid crista underdevelopment or erosion. Researchers used 3-dimensional models created from weightbearing CT (WBCT) scans to examine crista volume and its relationship to first metatarsal pronation and sesamoid station. Thirty-eight hallux valgus (HV) patients and 10 normal subjects underwent weightbearing or simulated WBCT imaging. The crista was outlined by the inferior articular surface, and a line was drawn to connect the lowest point of each sulcus on either side of the intersesamoidal crista throughout the length of the crista. The volume was calculated; the sesamoid station and first metatarsal pronation were calculated from the 3D reconstructions.

The mean crista volumes between HV and normal patients were statistically compared, as were the crista volume and pronation angle between sesamoid stations. Mean crista volumes were found to be statistically significantly different between the sesamoid stations with decreasing crista volumes significantly and strongly correlated with increasing sesamoid station. No difference was found in the mean pronation angle between the 4 sesamoid stations. The pronation angle was not associated with crista volume. The researchers concluded that HV patients have lower mean crista volume than normal patients. Crista volume is correlated with sesamoid station. Pronation of the first metatarsal was not associated with crista volume.

Practice Management

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The COVID-19 pandemic has upended rules for launching or growing healthcare practices. A recent survey by Deputy shows that 69 percent of roughly 2,000 respondents postponed healthcare services because of the pandemic, while 82 percent had difficulties scheduling their appointments. In addition, 62 percent of respondents chose to go to an urgent care facility instead of an emergency department because of the pandemic. Providers can encourage more visits by including a patient requirement checklist, displaying vaccine status and using social media and online channels for current protocols.

The survey also found that people are booking their appointments via phone (53 percent), app (45 percent) and online (43 percent). To encourage more appointments, providers can update their call service, go digital and make their website more accessible. Patients are choosing specific facilities because of location (52 percent), insurance (44 percent) and level of care (43 percent). Sixty-six percent of respondents said their trust in urgent care facilities has increased because of COVID-19. To boost patient trust, providers can partner with local businesses, create insurance cheat sheets and showcase their talent. Finally, 40 percent of respondents said price strongly influenced their decision to visit a clinic.


PatientPop's 3rd annual Patient Perspective Survey found that 36 percent of patients opted to leave a healthcare provider in the previous two years, and 8 out of 10 of these patients cited a negative in-person experience or lack of communication. Poor bedside manner remained the second-most listed reason behind negative online reviews. Patients also reported a 29% increase in staff-related issues. Physicians need to take the lead in directly responding to negative online reviews or feedback via direct emails. Of patients surveyed who submitted complaints, one in three said their doctors responded instead of a practice staffer, representing a 61% increase over PatientPop's 2020 survey results. Doctors can help put forward a more tailored and personalized experience.

Meanwhile, 47% of patients consider the speed at which practices respond to questions as a component of a good or bad patient experience. Practices can utilize a simple, automated text message exchange program that synchronizes with the practice's system. Online scheduling tools can also allow patients to book or request an appointment online, which 64% of patients prefer. Finally, the survey found that patient satisfaction was strongly defined by practice wait times, with 60% of patients feeling frustrated if their appointment wait times exceeded 20 minutes. Practices can address this issue by leveraging a HIPAA-compliant text messaging program that lets patients check in virtually and complete initial registration and intake paperwork online.


Doctors should not rely on cryptocurrency to provide for their retirement, not least because it is designed not as an investment, but a decentralized form of digital currency using blockchain technology. Cryptos' massive gains do not reflect a similar reason why stocks and bonds rise in value as they are purely speculation, and this cycle will eventually reach a breaking point. Volatility is also an inherent characteristic of cryptos, making such products an excessive risk as a retirement tool. The anonymity of crypto is spurring governments to impose regulations to limit or ban its use, and growing intervention also elevates the risk that authorities may attempt to replace digital currency with a new version. Doctors who truly see the future in cryptos and expect continued price appreciation should restrict their exposure by only investing a small amount of capital, using discretionary income, and no more than they would consider to be "fun money."

Health Policy and Reimbursement

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The US Centers for Medicare & Medicaid Services (CMS) estimated that insurers paid out roughly $2 billion in rebates for 2020 to almost 10 million consumers under the Affordable Care Act's (ACA) medical loss ratio provision. ACA requires insurers to spend a certain amount of a consumers' premium payments on medical claims and the rest on administrative costs. The medical loss ratio is 80 percent for individual and small group market insurers and 85 percent for larger group schemes. A plan is mandated to send rebates to customers by Sept. 30 through either a premium credit, lump-sum check, credit card or direct debit. CMS said insurers provided approximately $1.3 billion in rebates in the individual market, $384 million in the small group market and $291 million in the large group segment for the 2020 reporting year. The Kaiser Family Foundation reported that the $2 billion in rebates easily tops the $1.3 billion insurers had to pay out for the 2019 plan year. Insurers last year faced a much lower healthcare utilization due to the COVID-19 pandemic, but that sum was below a $2.7 billion estimate Kaiser had forecast insurers would have to cover.


Health officials nationwide are predicting more infections from the Omicron variant of SARS-CoV-2, alongside more Delta variant and influenza infections. Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, notes that modeling information and data from Europe suggest the number of Omicron cases could potentially double every two days. She says, "That modeling implies that sometime in January, we will be at a different stage of recognizing Omicron, maybe as even a predominant virus. However, we still are learning about the severity, transmissibility."

As of December 15, the United States was averaging 119,888 new COVID-19 cases each day, data from Johns Hopkins University (JHU) show, roughly 50 percent higher than a month ago. The data also show the United States is averaging 1,261 deaths each day, 5 percent higher than one month ago. Data from the U.S. Centers for Disease Control and Prevention indicate that Delta causes 96.8 percent of cases. The agency also reported that in the first week of December, 841 people were admitted to U.S. hospitals with influenza, up from 496 new influenza admissions in the previous week. The majority of influenza cases were detected in young people aged 5-24 years, although the proportion of influenza virus detections among adults age 25 years and older increased in recent weeks.

Legal Briefs

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The US Supreme Court announced that it will hold a special session on Jan. 7 to evaluate challenges to Biden administration policies concerning vaccine mandates for millions of workers, amid rising coronavirus cases. A three-judge panel of the 6th US Circuit Court of Appeals ruled last Friday that the vaccine or testing regime for workers at larger companies could be implemented. Workers at larger companies must be vaccinated or wear masks and get tested weekly; about 84 million US workers would be affected by the mandate, and Republican-led states, conservative organizations and businesses have challenged it. The Supreme Court also will hear arguments over a rule issued by the Centers for Medicare & Medicaid related to numerous healthcare providers that receive federal Medicare or Medicaid funding, requiring employees to receive the first dose of a COVID-19 vaccine by Dec. 6 and be fully vaccinated by Jan. 4. This rule was forecast to affect over 17 million workers in about 76,000 healthcare facilities, as well as home healthcare providers. Rulings by the 5th and 8th Circuit Courts of Appeals, and by a federal judge in Texas, have the mandate blocked in about half of states. The White House has defended its policies, arguing that with the emergence of the omicron variant, "it is critical to protect workers with vaccination requirements and testing protocols that are urgently needed."

Medicine, Drugs and Devices

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The American Red Cross is soliciting blood donations amid its lowest blood supply and donor turnout ahead of the holiday season in more than 10 years. This trend is especially troubling, said Krystal Smith with the American Red Cross North Texas Region. A lack of blood means patients who are seriously injured may not be able to receive needed transfusions, and can lead to some patients postponing major surgeries like organ transplants. Although people were keen to donate last year during the peak of the COVID-19 pandemic, that urgency has not continued into 2021, and Smith noted that the pandemic is responsible for many of the drivers of the low turnout and increased need for blood. "Part of that is [donors'] nerves over there being a pandemic and wanting to make sure that they stay safe," she said. "Part of it's been increased needs from hospitals from patients delaying services during the pandemic's height and now coming back and needing additional transfusions." Smith said patients should not be concerned about visiting a donation center, as the Red Cross is continuing to take additional health precautions to ensure patients' safety. It has encouraged people to book appointments online, keeps donors at least six feet apart, requires masking and has added extra cleanings between patients.


Based on the results of laboratory testing, Moderna says a booster of its COVID-19 vaccine appears to be protective against the Omicron variant. The company reports that a third dose increased neutralizing antibodies against Omicron about 37 times more than the previous levels. "What we showed is when you boost, you get a good brisk increase in antibody levels and they would be correlated with protection," Moderna's chief medical office, Paul Burton, confirmed. That is welcome news to public health officials, considering the concern over the highly mutated Omicron variant, which early research indicated was much more transmissible than other strains and likely more resistant to existing vaccines. Evidence showing now that both the Moderna and Pfizer-BioNTech boosters, developed to fight off early versions of the virus, also stand up against variants is reassuring although the findings come from lab testing rather than clinical trials.


Bottlenecks are affecting the delivery of roughly 8,000 to 12,000 containers of critical medical supplies and equipment, according to research from the Health Industry Distributors Association (HIDA). The group estimates that healthcare resources are being delayed an average of up to 37 days throughout the U.S. transportation system. Medical shipments are being held up at U.S. ports for approximately 17 days. The Long Beach and Los Angeles ports in California have the highest number of delayed medical containers on the West Coast. The Port of Savannah, Georgia, is the most congested on the Eastern Seaboard, HIDA reports. It also estimates that a single shipping container carries about 190,000 medical gowns, 360,000 syringes and 3.5 million surgical gloves.

These containers are being delayed an average of 11 days by train and nine days by truck, according to HIDA, whose 111 members oversee logistics, offer customer services and deliver medical products and supplies, including 51 billion units of personal protective equipment last year. HIDA says it is working with several associations and port leaders to provide healthcare professionals and frontline workers with equipment more quickly and efficiently. Matthew Rowan, HIDA president and CEO says, "Rules and regulations impeding timely and efficient movement of critical medical supplies must be relaxed during a public health emergency."