News From ACFAS

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Profiles and position statements are available online for the candidates recommended by the Nominating Committee to fill two vacancies on the ACFAS Board of Directors:

• Incumbent: Matthew E. Williams, DPM, FACFAS
• Jason A. Piraino, DPM, MS, FACFAS
• Ronald G. Ray, DPM, FACFAS, WCC, PT
• Brett D. Sachs, DPM, FACFAS

Online voting will be open November 28-December 14. 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.
Don’t wait any longer! Register today to join your peers in Los Angeles, CA February 9-12 at the 2023 Annual Scientific Conference. ACFAS 2023 is being conveniently held in L.A.’s largest entertainment district, L.A. LIVE, offering sports, music, restaurants, games and more. Register by Wednesday, November 30 to save with Early Bird registration rates!

Earn up to 34 CECH with cutting-edge sessions and hands-on workshops, including pre-conference programs on Wednesday, February 8. Don’t miss the chance to join experts from across the globe, see the latest and greatest in the Exhibit Hall, and reconnect in-person with your friends and colleagues.

Once you’ve registered, be sure to book your hotel with our official housing partner, onPeak. Booking through onPeak guarantees you the lowest hotel rate and also protects you from unauthorized third-party vendors or “hotel poachers.” ACFAS will not be responsible for any room reservations or deposits made through other companies or websites, so please book through onPeak for your own safety.

Visit acfas.org/asc to register, book your hotel and get the latest on what to expect at the premier foot and ankle surgery conference in the profession. We can’t wait to see you there!
Ramp up your research skills with the next installment of the ACFAS Virtual Journal Club.

Reconstructive Foot and Ankle Surgery
Tuesday, November 29 | 7:00 pm CT.
Hosted by: North Jersey Reconstructive Foot and Ankle Fellowship
Fellowship Director: Michael Subik, DPM, FACFAS

Brought to you by the ACFAS Research Committee, the Virtual Journal Club is complimentary for ACFAS student and resident members and provides an informative and interactive way to learn about research. Monthly sessions will be presented by research experts from fellowship programs with ACFAS status. Register today! It’s time to write your holiday wish list! Head to the ACFAS Logo Store to show your College pride and get decked out in College gear. The ACFAS Logo Store has shirts, jackets, pullovers and scrubs in a wide range of colors and sizes. You can also pick up drinkware, pens and other one-size-fits-all items to show off your membership in the College to your healthcare colleagues.

On behalf of the The Podiatry Foundation, please see the below opportunity for ACFAS members:

As a member of ACFAS, you appreciate the value of research in the field of podiatric medicine. To stimulate the interest in this critical area, The Podiatry Foundation has developed a Request For Proposals for research covering most areas of podiatry.

We invite you to review this proposal and apply online through your IRS approved not-for-profit organization (as either a 501c3 or 501c6) for a research grant. Submit your intention to participate by November 30, 2022. Proposals received between October 1, 2022 and June 30, 2023 will be considered for support.

If you have any comments, questions, or concerns, please email david@thepodiatry.foundation.

Foot and Ankle Surgery

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Researchers compared a removable orthosis versus a cast regarding safety and functional outcome in the nonoperative management (NOM) of stable type B ankle fractures. A systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score. Five studies were included, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95 percent confidence interval (CI) 1.52-14.35)]. Functional outcome in OMAS did not vary significantly at six weeks, mean difference (MD) - 6.64 (95 percent CI - 13.72 to + 0.45) and at 12 weeks, MD - 6.91 (95 percent CI - 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD - 2.63 (95 percent CI - 5.01 to - 0.25).


Researchers evaluated relationships between common hallux valgus radiographic parameters measured in the three cardinal planes by means of a multivariate regression analysis. Serial analyses utilizing the first intermetatarsal angle, hallux valgus angle, tibial sesamoid position, proximal articular set angle, Engel's angle, first metatarsal inclination angle and the sesamoid rotation angle were performed with varying dependent and independent variables. The tibial sesamoid position (p<0.001) and proximal articular set angle (p=0.014) were found to be independently associated with the first intermetatarsal angle, while the hallux valgus angle (p=0.712), Engel's angle (p=0.646), first metatarsal inclination angle (p=0.097) and sesamoid rotation angle (p=0.099) were not. The tibial sesamoid position (p=0.003), proximal articular set angle (p<0.001), Engel's angle (p=0.006) and sesamoid rotation angle (p=0.003) were found to be independently associated with the hallux valgus angle, while the first intermetatarsal angle (p=0.712) and first metatarsal inclination angle (p=0.400) were not. The first intermetatarsal angle (p<0.001), hallux valgus angle (p=0.003) and proximal articular set angle (p=0.015) were found to be independently associated with the tibial sesamoid position, while Engel's angle (p=0.400), the first metatarsal inclination angle (p=0.088) and the sesamoid rotation angle (p=0.649) were not.


Researchers compared total ankle replacement (TAR) and ankle fusion (AF) for the treatment of end-stage ankle osteoarthritis. The primary outcome was change in Manchester–Oxford Foot Questionnaire walking/standing (MOXFQ-W/S) domain scores between baseline and 52 weeks after surgery. A total of 303 patients were randomly assigned treatment. Twenty-one patients withdrew before surgery, and 281 clinical scores were analyzed. At 52 weeks, the mean MOXFQ-W/S scores improved for both groups. The adjusted difference in the change in MOXFQ-W/S scores from baseline was -5.6 (95 percent CI, -12.5 to 1.4), showing that TAR improved more than AF, but the difference was not considered clinically or statistically significant. The number of adverse events was similar between groups (109 vs. 104), but there were more wound healing issues in the TAR group and more thromboembolic events and nonunion in the AF group. The symptomatic nonunion rate for AF was 7 percent. A post hoc analysis suggested superiority of fixed-bearing TAR over AF (-11.1 [CI, -19.3 to -2.9]).

Practice Management

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Physicians can realize best-in-class billing for behavioral healthcare by using the right tools and guidelines. They should leverage billing best practices to maximize reimbursement, but do so patiently by setting reasonable income goals. Clinicians should also set up a reporting system with advanced features, including software that provides an overview of aging claims and how many days each claim has been waiting. Behavioral health practices should also formulate a written and repeatable process for billing procedures that every staffer will follow. A good billing cadence is also necessary, and this can vary depending on practice size and the number of individuals tasked with billing.


Amazon has introduced Amazon Clinic, a virtual platform that lets users get in touch with healthcare providers to treat common conditions. The company said its new health service will be available in 32 states and does not involve health insurance. Pricing will vary based on providers, according to Amazon. The company first piloted virtual care visits for Amazon staff members in Seattle in 2019, before offering services to other employers under the Amazon Care brand, which it now intends to wind down by the end of 2022. Amazon also hopes to finalize its $3.49 billion deal to buy One Medical in an effort to extend its virtual healthcare offerings and eventually add brick-and-mortar physicians' offices.


Once new physicians complete their training, it doesn’t take long for financial relationships and significant financial conflicts of interest to grow with healthcare industry players, according to research published in JAMA Network. Researchers found surgical specialists accepted more industry payments than internal medicine specialists, and more male physicians accepted payments than female physicians. The study analyzed records of the Open Payments Program, also known as the Physician Payments Sunshine Act, a payment database with figures reported yearly to the US Centers for Medicare and Medicaid Services.

Health Policy and Reimbursement

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On World Diabetes Day, November 14, several healthcare advocacy organizations urged US lawmakers to pass legislation to ensure access to affordable insulin. More than 40 organizations called on Congress to widen insulin access, in particular for people without insurance. Referring to the recent $35 monthly insulin cap for Medicare Part D beneficiaries in the Inflation Reduction Act, the groups said in a letter that the measure "barely scratches the surface of what is needed," and failed to address "excessive prices" set by insulin makers.


If the US Senate gets its way, the COVID-19 pandemic will shed the emergency status it was first granted in March 2020. The chamber voted to lift the declaration, with the majority of legislators agreeing that fewer infections, hospitalizations and deaths justify winding down the public health emergency. Other senators sided with the Biden administration, which has warned that the tools and resources the emergency classification affords are still needed to combat the pandemic. "Preserving our ability to respond is more important than ever as we head into the winter, when respiratory illnesses such as COVID-19 typically spread more easily," the US Office of Management and Budget (OMB) said. "Strengthened by the ongoing declaration of national emergency, the federal response to COVID-19 continues to save lives, improve health outcomes and support the American economy." While it is unclear if the House will also address the question of whether the emergency designation should be extended, OMB said the president has signaled that he will veto any congressional effort to end the emergency.


US Sens. Bill Cassidy (R-LA) and Tom Carper (D-DE) proposed legislation to allow people enrolled in PACE (Program of All-Inclusive Care for the Elderly) to select their prescription drug plan under Medicare Part D. The lawmakers estimate their bill, if enacted, would save PACE participants an average of $972.03 per month on prescription drugs and result in an average monthly payment of $43. At present, PACE enrollees must obtain their Medicare Part D-covered medications through the program. If they were to join another Medicare prescription drug plan, they would become unenrolled from PACE benefits. The legislation proposed by Cassidy and Carper, called the PACE Part D Choice Act, would allow PACE beneficiaries to enroll in stand-alone prescription drug plans not operated through PACE. This would make beneficiaries eligible for prescription drug plans subject to the $2,000 annual cap that was created by the Inflation Reduction Act.

Medicine, Drugs and Devices

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The US Centers for Disease Control and Prevention (CDC) reports that healthcare-associated infections (HAI) in US hospitals continue to surpass levels seen before the COVID-19 pandemic. CDC's assessment of quarterly 2021 National Healthcare Safety Network data points to steady increases in the quarterly standardized infections ratios for central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events (VAE) and methicillin-resistant Staphylococcus aureus bacteremia compared with 2019.


New research in the Arthritis & Rheumatology Journal suggests that abortion restrictions threaten to strip many US women with autoimmune disorders of their access to methotrexate, which is also used in reproductive medicine. Following Dobbs v. Jackson Women's Health Organization, the decision that overturned the constitutional right to terminate a pregnancy, a number of states have banned the procedure outright or allowed it only under certain conditions. According to the analysis of nationwide healthcare claims and electronic records, the biggest share of methotrexate users in the childbearing years of ages 15–49 live in such jurisdictions; however, the overwhelming majority — 82 percent — use the drug to manage rheumatoid arthritis or other autoimmune disorders.


Walmart proposed a $3.1 billion legal settlement over the toll of prescription opioids sold at its pharmacies. The retail giant’s announcement follows similar proposals from the two largest US pharmacy chains, CVS Health and Walgreen, which each said they would pay about $5 billion. Most of the drugmakers that produced the most opioids and the biggest drug distribution companies have already reached settlements. With the largest pharmacies now settling, it represents a shift in the opioid litigation saga. With the opioid crisis still raging, the focus now is on how the settlement dollars, now totaling more than US$50 billion, will be used.