News From ACFAS

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Voting for the ACFAS Board of Directors closes next Wednesday, December 14. If you are an eligible voter and have not yet voted, a reminder email with the subject line ACFAS Board of Directors Election. We Need Your Vote! was sent on Monday, December 5, from acfas.ballot@intelliscaninc.net containing your unique link to the election.

Members without an email address or whose email system rejected our test email were sent voting instructions by US mail earlier this month. If you do not see the email and did not receive a letter, please check your junk mail folder.

Please contact our independent election firm at kwier@intelliscaninc.com if you are unable to locate your unique link or have questions about accessing the ballot site.

Visit acfas.org/nominations for more information. Have you registered yet? We can’t wait to see 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

The fun begins on Wednesday, February 8 with pre-conference activities including Surgical Management of Challenging Cases, MIS: From Reconstruction to Trauma, Coding and Billing for the Foot and Ankle Surgeon, Coding Fundamentals, Residents Day, and the Residency Directors Forum.

Register today and learn more at acfas.org/losangeles. Be sure to catch the next installment of the ACFAS Virtual Journal Club.

Diabetic Limb Salvage
Tuesday, December 13 | 7:00 pm CT
Host: UTSouthwestern Diabetic Limb Salvage Fellowship
Fellowship Director: Lawrence A. Lavery, DPM, MPH, FACFASF

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! Looking for a job? You won’t want to miss the ACFAS Virtual Career Fair on Thursday, February 23 at 5:00 EST.

Join easily from your desktop or mobile device to browse employer profiles, view open positions, and text or video chat with top employers.

Learn more and register today for this fun and FREE event!

Foot and Ankle Surgery

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Researchers evaluated the effectiveness of three-dimensional printing (3DP)-assisted supermalleolar osteotomy for ankle osteoarthritis (OA). Seven of 16 patients with ankle OA were treated with 3DP using the 3DP personalized osteotomy guide, while nine underwent traditional osteotomy. 3DP-assisted supramalleolar osteotomy for varus and valgus ankle OA was determined to significantly expedite operation time and reduce intraoperative bleeding and intraoperative fluoroscopy frequency. Personalized 3DP osteotomy guides and models can help in the accurate correction of varus deformity during operation, restore lower limb alignment and enhance biomechanical status of the lower limbs. The 3DP of porous tantalum also has good histocompatibility and an interface structure and porosity that promotes bone ingrowth. Matching implants can be printed individually for complex bone defects and revision prostheses.


A study was held to determine the impact of different syndesmotic screw insertion levels on postoperative clinical outcomes for treating ankle fractures with syndesmotic instability. The researchers analyzed data from 43 adult patients with acute closed ankle fractures plus intraoperative evidence of unstable syndesmotic injuries who received open reduction internal fixation from Jan. 1, 2017, to March 1, 2018. Patients underwent procedures with trans-syndesmotic, inferior-syndesmotic or supra-syndesmotic screw placement levels. The median follow-up duration was 15 months, and no fracture nonunion, malunion or hardware failure was observed. The entire group had an American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of 94.91 points, an Olerud–Molander Ankle Score (OMAS) of 83.1,4 a short-form 36-item questionnaire score of 96.65, a visual analog scale score of 1.77, 9.14 degrees for the restrictions in dorsiflexion and 1.30 degrees for the restrictions in plantarflexion. The three screw insertion level cohorts did not differ significantly in terms of clinical outcomes, while neither the AOFAS score nor OMAS substantially correlated with insertion level. Final follow-up indicated no postoperative arthritis or widening of the tibiofibular space.


A systemic review and meta-analysis analyzed various complications and associated clinical outcomes from the Scarf osteotomy procedure for correcting a hallux valgus deformity, with 116 publications identified and 25 meeting inclusion criteria. There were 1,583 Scarf procedures included, with a weighted mean follow-up of 26.4 months. The authors observed a 5.1 percent rate of recurrence, a 3.5 percent rate of troughing, a 1.0 percent rate of avascular necrosis, a 1.8 percent rate of nonunion, a 2.7 percent rate of malunion, a 2.4 percent rate of infection, a 5.3 percent rate of complex regional pain syndrome and a 3.4 percent rate of hallux varus. A 6.3 degree decline in intermetatarsal angle was noted, while outcomes of Scarf compared to those of Scarf with additional procedure performed at time of surgery did not differ statistically.

Practice Management

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Tulane University Professor Neil Baum offers advice for medical practices seeking to recruit dedicated employees that take the initiative while avoiding those who put in the least effort. He writes that go-getters "have lofty goals, and they genuinely believe that they can achieve them. When interviewing a potential go-getter, ask him\her where they want to be five and 10 years after they are accepted as an employee. Ask them how many goals they have already achieved." Baum also describes go-getters as the first employees to arrive in the morning and the last to leave at the end of the day, and employers should assess this quality by asking candidates about their last job and their typical workday and by checking with previous employers about their arrival and departure. Baum further observes that go-getters "recognize their own accomplishments and give themselves a pat on the back and not wait for others to acknowledge their success and achievement." Go-getters are also passionate about what they do. Baum adds that asking candidates if they have any questions at the end of the job interview can reveal whether they possess the innate curiosity typical of go-getters. Finally, "If you receive a thank-you note in a timely fashion from the interviewer, especially if it is handwritten, you are likely to identify an employee who will be nice to patients, physicians and fellow staff members," the author concludes.


Collecting money from patients is an ongoing challenge that high-deductible health plans have exacerbated, and there are seven strategies medical practices can follow to alleviate this burden. Taking advantage of the No Surprises Act is one tactic, which practices can follow by providing patients with a good faith estimate of cost for services. Practices should also collect the amount the patient is responsible for as close to the time of service as possible, while training staff to communicate fees upfront with patients is also helpful. Practices can also compose a written financial policy or update their current policy to incorporate language about upfront payments. A fifth option, recommended only as a last resort, is using collection agencies, and Hutson advises practices to limit this to pre-service collection. Practices should also prepare to issue refunds, and CodeRite Healthcare Consulting President Rozmin Bapat suggests they set aside a couple thousand dollars a month for this purposes. The seventh and final suggestion is to ease patient payments by offering multiple options.


Nearly one in seven older adults die within a year of undergoing major surgery, according to an important new study that sheds light on the risks seniors face when having invasive procedures. Especially vulnerable are older patients with probable dementia (33 percent die within a year) and frailty (28 percent), as well as those having emergency surgeries (22 percent). The study was published in JAMA Surgery.

Health Policy and Reimbursement

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The US Centers for Disease Control and Prevention (CDC) announced it will award $3.2 billion to fortify the public health workforce and infrastructure of state, local and territorial health departments amid a shortage of healthcare workers. "The COVID-19 pandemic severely stressed these agencies, which were already weakened by neglect and underinvestment," stated CDC Director Rochelle Walensky. "This grant gives these agencies critical funding and flexibility to build and reinforce the nation's public health workforce and infrastructure and protect the populations they serve. We are meeting them where they are and trusting them to know what works best for their communities." $3 billion of the grant money comes from the American Rescue Plan Act and will enable jurisdictions to recruit, retain and train their workforce. Another $140 million will be allocated to jurisdictions to reinvigorate their public health infrastructure, while $65 million will go to national partners to help train, assess and provide additional technical support.


An apprenticeship program in rural western Colorado helps participants gain healthcare experience amid a shortage of direct care workers for older residents. The program additionally unlocks opportunities for improving earning power to residents who live at or below the poverty line, who lost their jobs during the pandemic or who are unemployed or underemployed. They receive training to become personal care aides who help patients with daily routines like bathing or housekeeping or certified nursing assistants who can provide some direct healthcare. Apprentices take classes at the Western Colorado Area Health Education Center in Grand Junction, which covers the cost for students who live in more rural areas to attend classes at Technical College of the Rockies in Delta County. Participants get on-the-job training with one of 58 local employers, and they must work there for one year. Each apprentice is assigned an employer mentor. “Traditionally, healthcare employers have hired people after they finish a training program,” said University of California-San Francisco Professor Susan Chapman. “Now, we're asking the employer to take part in that training and pay the person while they're training.”

Medicine, Drugs and Devices

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Researchers from McMaster University in Hamilton, Ontario, Canada, studied 1,009 healthcare workers who provided direct care to patients with suspected or confirmed COVID-19 in 29 inpatient or long-term care settings in Canada, Israel, Pakistan and Egypt to determine if medical masks offer similar protection against COVID-19 compared with N95 respirators. They found that confirmed COVID-19 occurred in 10.46 percent of the medical mask group versus 9.27 percent in the N95 respirator group. However, the results varied by country: 6.11 percent versus 2.22 percent in Canada; 35.29 percent versus 23.53 percent in Israel; 3.26 percent versus 2.13 percent in Pakistan; and 13.62 percent versus 14.56 percent in Egypt. This may have been due to differences in vaccine use, the number of people with previous infection and the type of variant circulating in the study countries which were enrolled during different times in the pandemic. The authors indicate that while medical masks were found to be not significantly less effective than N95 respirators and the efficacy estimate was within the noninferiority margin of two, this margin was wide, and between-country heterogeneity in an unplanned analysis may limit definitive conclusions about noninferiority.


The "skinny labeling" provision of a federal law designed to speed copycat drugs to market and foster competition saved Medicare $1.5 billion from 2015 to 2020, or nearly 5 percent of the $30.2 billion spent by the healthcare program, on just five medicines during that period, according to a new analysis. Skinny labeling refers to a move by a company that seeks regulatory approval to market a generic or biosimilar medicine for a specific use but not for other patented uses for which the brand-name drug is prescribed. By doing so, the company seeks to avoid lawsuits in which the brand-name manufacturer could claim patent infringement. The tactic originated with the Hatch-Waxman Act, a decades-old law designed to supply cheaper generic alternatives to pricey brand-name drugs. The maneuver has been a mainstay among generic companies and one way Congress attempted to boost competition. Research published in JAMA Internal Medicine suggests it has had a desired effect.