News From ACFAS

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Don’t wait any longer to register! Join over 2,000 foot and ankle surgeons at ACFAS 2023, February 9-12. All ACFAS activities will be held within L.A. LIVE - the premier destination for entertainment in Los Angeles.

Enjoy unique opportunities for expert education and resources to help you grow and thrive. We’re sure you’ll find what you’re looking for with:

• 50+ sessions of exclusive content– including exciting new international sessions
• Hands-on workshops and cutting-edge clinical topics offering up to 34 CECH
• Over 150 companies in the Exhibit Hall featuring the latest and greatest products, technologies and solutions
• Networking opportunities to form long-lasting connections with your colleagues – including our Wrap Party at the GRAMMY Museum

View the ACFAS 2023 schedule, make your hotel reservation, and register at acfas.org/asc. Register by November 30 to take advantage of the early registration discount! Don't miss out on exclusive entry to member resources and benefits designed to advance and support your career. Your dues give you access to the College's robust education and professional development offerings, practice growth and management tools and the top-rated Annual Scientific Conference, set in Los Angeles.

NEW FOR 2023: We’re making it easier than ever to maintain your membership status and benefits with our new auto renewal option, available when you renew online.

We truly appreciate the value you bring to our community of foot and ankle surgeons! Be sure to renew by December 31, 2022 to ensure you don't miss out. Questions? Reach out to the Membership Department at membership@acfas.org or visit the Member Center at acfas.org. The ACFAS First Ray Virtual Symposium is just around the corner! Join us on November 19 to discuss and learn about surgical options to correct first ray deformity, along with complication and revision options. Get your questions answered as you interact with faculty and attendees during the live program and through an online discussion forum.

We know you’re busy, so we’re also making the First Ray Virtual Symposium available on-demand. Register now to get access to the recorded program. You’ll earn 4 CME no matter how you participate!
Secure your spot to join us live or on-demand at acfas.org/firstrayvirtualsymposium. We're looking for the latest advances in cutting-edge surgical techniques for correction of foot and ankle disorders for Foot & Ankle Surgery: Techniques, Reports & Cases (FASTRAC), the College’s open access journal.

FASTRAC’s streamlined submission process allows foot and ankle surgeons around the world to stay up to date on the best clinical practices. You can also help shape the profession by becoming a FASTRAC peer reviewer.

Visit acfas.org/FASTRAC for more information and to submit your research.

Foot and Ankle Surgery

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A systematic review was held to compare the effectiveness of proximal and local blocks in controlling postoperative pain after hallux valgus surgery. The authors searched Ovid-MEDLINE, Cochrane Central, PubMed, Web of Science, Scopus and Embase for observational and clinical trial publications in peer-reviewed English-language journals with a sample size of at least 20 subjects. Included were five of the 439 identified articles because they contained 459 participants. Ankle blocks were more effective than controls in two studies and superior to local blocks in one study. Moreover, one study revealed that popliteal and ankle blocks administered with lidocaine or levobupivacaine were equally effective, although one of the five studies showed ankle blocks did not effectively reduce postoperative pain.


Researchers searched the MEDLINE, EMBASE and Scopus databases to identify studies comparing anterior iliac crest (AIC) and proximal tibia (PT) autograft procedures. They conducted a meta-analysis using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. The analysis covered 15 studies, with six studies and 248 patients included for clinical outcomes. A significant pain reduction favoring PT at 24 hours was identified after the meta-analysis and corresponding sensitivity analysis. The estimated effect size ranged from -2.31 to -2.93 centimeters, with confidence intervals corresponding with the left indicating a steady lessening of pain across studies. This effect was not seen after one month, and the authors reported 18 complications, including 13 in the AIC group and five in the PT group. Of the four cadaveric studies, three favored PT on the quantity of bone graft harvested. Just one of the five cell-based studies favored AIC for quality of bone graft.


A retrospective review of failure rates and patient-reported outcomes for 122 patients who underwent revision total ankle arthroplasty (TAA) between 2006 and 2020 was held. Surgery included 69 polyethylene exchanges, 12 revisions of one metallic component and 41 revisions of both metallic components. The overall failure rate was 14.75 percent and the European Foot and Ankle Society (EFAS) score was completed by 94 patients. Median EFAS score was 12.51 ± 5.53, and median EFAS sports score was 2.97 ± 3.04. Revision rates following polyethylene exchange were substantially higher than after exchanging both metallic components, while the EFAS score indicated slightly improved outcomes in patients treated with polyethylene exchange. Adding procedures to induce axis correction yielded significantly lower revision rates, and the EFAS score also showed improvement but without statistical significance.

Practice Management

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Merchant cash advances (MCAs) can help medical practices boost cash flow to hire and keep qualified staff amid shortages. MCAs can allow practices to offer staff overtime pay by covering its cost. MCA funding also can be utilized to upskill current staff, as well as work with college training programs to create a hiring funnel or to develop paid internships; cover onboarding expenses or provide additional training to less experienced candidates. MCAs can also draw new employees with higher wages and better benefits and give new and existing employees flexible work hours. Automation technology funded by MCAs can reduce the staff's workload, and the funding can also pay for professional staffing agencies. Finally, MCAs can supply the working capital the practice needs to cover bonuses or other benefits for successful employee referrals.


GMR Web Team CEO Ajay Prasad writes that physician marketing must change to accommodate the rise of healthcare consumerism. "Practices most effective at patient acquisition and retention are the ones that understand that patients do extensive research on physician reputation, expertise and accomplishments," he notes. "These physicians also pay attention to what their existing patients might feel or tell others about their experience with their practice after an appointment or treatment. In other words, physician marketing in this healthcare consumerism age needs to be comprised of patient-focused digital efforts that allow practices to build happy, lasting relationships with patients."

A key goal of digital physician marketing is increasing online visibility, as is establishing a reputation as an expert or thought leader in one's medical field. To stand apart from the competition, physicians can generate content relevant to patients; use artificial intelligence and consumer data to analyze patient sentiment; optimize content for top search engine rankings; deploy online reputation management; enhance access to care with telemedicine and set up a website with high online visibility. "Physicians who incorporate these elements in their digital marketing make it easier to attract and retain more patients by providing what they want, how they want it and where they want it," Prasad concludes.


The US Centers for Medicare and Medicaid Services is due to release a final fee schedule that is expected to continue phasing in reductions to medical specialties and likely prompt appeals to Congress for a year-end reprieve. A draft fee schedule released in July put most specialties in line for modest cuts. Medicare cuts could drive down other payer rates and lead to access issues, with providers rethinking how they deliver services particularly to rural regions or regions beyond their practices. Physicians are the only health provider group not receiving an inflation adjustment to their Medicare payment rates in 2023, and there's a statutory freeze through 2026. Those practicing in independent or small practices say the cuts, combined with inflation and staffing pressures, could be economically ruinous and prompt more mergers and buyouts. "The discrepancy between what it costs to run a physician practice and actual payment, combined with the administrative and financial burden of participating in Medicare, is incentivizing market consolidation," provider groups wrote in a September letter to congressional leadership. A relief bill from US Representative Ami Bera (D-CA) would delay the physician payment cuts a year. Separately, a bipartisan group of lawmakers has announced plans to work on longer term physician payment reforms.

Health Policy and Reimbursement

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The US Department of Health and Human Services reported that between 2020 and 2022, there was a 53 percent increase in health insurance enrollments among Hispanics, a 49 percent rise among Blacks and a 32 percent increase among Native Americans. These gains were attributed to government outreach and increased affordability of Affordable Care Act plans. Enrollment rates actually increased across the board over the same two year period for all demographics, according to the report. However, there are still coverage gaps, with 25.7 percent of adult Hispanics under age 65, 14.8 percent of Black adults and 6.9 percent of white adults still uninsured in early 2022.


According to a new Kaiser Family Foundation Employer Health Benefit Survey, employer-based health insurance remained mostly flat this year, averaging approximately $22,500 for families, with workers covering $6,100 on average. Individual employer-based policies cost over $7,900 on average in 2022, with employers covering around $1,350. Matthew Rae, associate director for the Program on the Health Care Marketplace at Kaiser, says that because healthcare service utilization remained low in 2021, employers were able to keep premiums steady, trailing behind inflation and wage increases. However, it's expected health insurance premiums will rise in 2023, along with out-of-pocket expenses, reflecting inflation.


Inflation in health insurance is on the verge of a sharp decline. "With the magnitude of each forthcoming [US Federal Reserve] hike this year hanging heavily on the latest consumer-price index print, the swing in healthcare insurance's steady contribution could help provide the 'compelling evidence' of inflation slowing on a consistent basis that the [Federal Open Market Committee] is looking for to ease up on its current pace of tightening," said Wells Fargo economist Sarah House. Inflation Insights founder Omair Sharif estimated the consumer price index's (CPI) health-insurance index could fall 38 percent by September 2023 from September 2022, losing about 0.42 percentage points from the 12-month increase in core inflation next year.

October's CPI projects deflation as the Labor Department updates the index, which should continue for the next 12 months. HSBC's Ryan Wang said the Fed is factoring in other metrics to inform its strategy, such as the Commerce Department's personal-consumption expenditure price index. The lagged status of the CPI's health-insurance index means it may not mirror current underlying price pressures in medical-care services, which are likely accumulating. Sharif said higher medical services inflation is likely next year, and the degree of inflation will "determine how much of the health insurance drag is going to get offset."

Medicine, Drugs and Devices

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Of the four leading manufacturers of amoxicillin, three are reporting supply problems in the United States. Teva Pharmaceutical Industries and Hikma Pharmaceuticals reported reduced supplies of several dosages of the antibiotic to the University of Utah's drug information service, which monitors drug shortages. Sandoz, a division of Novartis, is also experiencing supply limitations in the United States and other countries because of "significant" demand for the drug, according to a spokesperson. Children typically take the liquid version of the drug, which is where most of the shortages are occurring, the drug tracker shows. Hikma spokesperson Steve Weiss said the company has all its amoxicillin oral products "on allocation," indicating that Hikma is restricting new orders to ensure it is fulfilling existing contracts. FDA said it is aware of nationwide "intermittent supply interruptions" of amoxicillin products and is working with companies to address the situation. Canada and Australia have also reported short supplies of amoxicillin.


Global Action for Fungal Infections estimates that each year, more than 1.6 million people die from fungal infections, and the death toll is on the rise. Researchers believe fungi are adapting to rising temperatures in ways that could make it easier for them to flourish in the human body. In the United States, at least 7,000 people died from fungal infections in 2021, according to the US Centers for Disease Control and Prevention (CDC), and more than 75,000 people are hospitalized annually because of fungal infections. One-fifth of the these cases are caused by Aspergillus, CDC said. Research shows that fatality rates associated with certain fungal infections, including severe cases involving Aspergillus, can exceed 50 percent. Last month, CDC advised healthcare providers and patients to consider fungi a potential cause of an infection if it is not responding to treatments. The World Health Organization also said it plans to release a list of priority fungal diseases that it hopes will trigger funding for research and drug development. FDA has approved four classes of antifungal medications for invasive infections; most antifungals for serious infections are toxic, some even at low doses. There are no approved vaccines against fungi. However, new drugs are in development, such as fosmanogepix, which underwent a Phase II trial by Amplyx Pharmaceuticals and was found to be effective against Aspergillus,Candida and other rare molds.


Through a childhood vaccination strategy, US authorities had eradicated polio, but the first case since 2013 was reported in July, when an unvaccinated man was diagnosed with the disease in New York. Polio was detected in wastewater in several counties, forcing Gov. Kathy Hochul to declare a disaster emergency. The most recent infection developed from vaccine-derived polio in wastewater, which is related to poor vaccination coverage. The World Health Organization said approximately 7 million more children missed their third dose of the polio vaccine last year compared with 2019. Last year's drop in overall childhood vaccinations, with at least 25 million infants not receiving routine vaccines, was the largest in three decades.