News From ACFAS

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Voting for the ACFAS Board of Directors closes today, Wednesday, December 14 at 11:59 pm EST.

ACFAS eligible voting members received an email from the College’s independent election firm (acfas.ballot@intelliscaninc.net) with a unique link to the Board of Directors Election website.

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.

Your vote is important to advancing our profession and surgical specialty. Visit acfas.org/nominations for more information. Will you be at ACFAS 2023? Don’t miss the chance to join your colleagues and peers in Los Angeles February 9-12 for education you won’t find anywhere else!

ACFAS 2023 will have its largest gathering of international thought leaders and practitioners. Experts from Germany, South Korea, Switzerland, Argentina, Canada, and England will present two exciting new sessions:

Total Ankle International Session
Leading foot and ankle surgeons from around the world, including Drs. Naohiro Shibuya, Markus Walther, Markus Knupp, and Tom Roukis will discuss various techniques regarding total ankle replacement.

International MIS Session
US and international speakers Drs. Noman Siddiqui, Javier Del Vecchio, Andreas Toepfer, Guido A LaPorta, Eric Baskin, Marie Gdalevitch, and David Gordon will focus on high-level MIS Techniques.

Earn up to 34 CECH with pre-conference programs beginning on February 8. Register today at acfas.org/losangeles. The new ACFAS/PICA Future Leader Scholarship provides a $40,000 academic scholarship to one very fortunate student, supported by an unrestricted grant from PICA - and we are thrilled to announce the nominees and recipient of this incredible opportunity. The future of the foot and ankle surgical profession will be in good hands with these 10 stand-out students and burgeoning leaders.

2023 ACFAS/PICA Future Leader Scholar

• Trevor Page, Scholl College of Podiatric Medicine ‘23

A huge congratulations to Trevor! ACFAS Student Club Faculty Advisors on all 10 campuses nominated the top student leader from each podiatric medical school to apply for this award. ACFAS President Michael J. Cornelison, DPM, FACFAS shared, “The ability of ACFAS to provide the absolute best programs and services to its members depends on the excellence of those very members — these 10 exceptional finalists leave me excited for their futures, as well as that of ACFAS.”

2023 ACFAS/PICA Future Leader Scholar Finalists

• Sheena Cherukara, Barry University School of Podiatric Medicine ‘24
• Jeneen Elagha, Temple University School of Podiatric Medicine ‘24
• Jake Loitz, California School of Podiatric Medicine ‘23
• Chanelle Mariano, Western University College of Podiatric Medicine, ‘24
• Shadi Mattar, Arizona College of Podiatric Medicine ‘23
• Madeleine Mehaffey, UT Rio Grande Valley School of Podiatric Medicine, ‘26
• Gabriel Roberts, Des Moines University College of Podiatric Medicine & Surgery ‘24
• Gregory Rose, New York College of Podiatric Medicine ‘23
• Jonathan Westerveld, Kent State University College of Podiatric Medicine ‘23

“PICA, the nation’s market leading malpractice insurance carrier for foot and ankle surgeons, is privileged to partner with ACFAS to fund the ACFAS/PICA Future Leader Scholarship! Since our founding, PICA has had a singular mission: We Protect Podiatrists,” said PICA President Ross E. Taubman, DPM, FACFAS. “By partnering with ACFAS to create this scholarship, we continue our commitment to developing the future leaders of our specialty.”

Thank you to PICA for your generous support of our future leaders, and congratulations to Trevor and all the finalists! Are you a resident or post-graduate fellow presenting an accepted poster or manuscript at the ACFAS Annual Scientific Conference in February? Could you use some extra money to apply toward your travel costs? The ACFAS Regions can help!

If you've submitted a poster or manuscript that is accepted for presentation at the conference and you are interested in receiving funding from your local Region, complete an application for support. Poster submitters are potentially eligible for $250, and manuscript presenters are potentially eligible for $500. Complete rules for acceptance and provision of funds can be found on the application form.

Please submit the completed form directly to your Region's President by Friday, January 13, 2023. Each Region will determine the number of awards they can provide based on the number of submissions received and will contact you directly with next steps. Region Presidents are listed on the form and on their individual Region webpages.

The ACFAS Regions are happy to support the next generation of researchers in their parts of the country. Don't lose your member benefits! Renew your ACFAS dues to ensure you maintain access to 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. Renew today and you’ll be able to register at the member rate for ACFAS 2023 in Los Angeles.

And now, maintaining your membership status and benefits is even easier with our NEW auto renewal option! Enroll when you pay your dues online and we will automatically renew your membership each year to ensure continuous access to your ACFAS member benefits.

We truly appreciate the value you bring to our community of foot and ankle surgeons! Be sure to renew by December 31 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.

Foot and Ankle Surgery

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Research sought to clarify relationship between ankle morphology and the size of non-trauma related osteochondral lesions of the talus (OLT), given that about half the OLT found in children is of unknown origin. The authors assessed 34 ankles in 30 skeletally immature children with OLTs who underwent preoperative magnetic resonance imaging. The trauma cohort was composed of 13 ankles in 13 patients, while 21 ankles in 17 patients comprised the idiopathic group. Four patients in the idiopathic group had bilateral OLT, while malleolar width (MalW) was significantly correlated with the area in the trauma group. MalW and tibial axis-medial malleolus angle were significantly correlated with area the idiopathic group. Talar surface angle had positive correlation with area in the idiopathic group but negative correlation with area in the trauma group. No significant correlation was evident in the other parameters.


A study was held to assess the effect of changes in coronal ankle alignment on sagittal alignment of the foot, with concentration on changes in medial longitudinal arch height as indicated by medial cuneiform height (MCH), Meary's angle and calcaneal pitch angle (CPA). The authors analyzed the radiographic findings of 37 patients undergoing open ankle arthrodesis without inframalleolar correction of severe varus ankle arthritis. Patients were divided into two groups according to the post-operative decrease in MCH. A post-operative MCH decrease of =2 millimeters (mm) was noted in 16 patients, and while the degree of coronal ankle varus correction was similar, the decrease in the Meary's angle was much greater in the cohort with a post-operative MCH decrease of =2 mm than in those with #60;2 mm. CPA changes did not differ significantly.


A study analyzed the impact of hospital characteristics and teaching status on outcomes for total ankle arthroplasty (TAA) using the Nationwide Inpatient Sample (NIS) database from 2002 to 2012. A total weighted national estimate of 16,621 discharges for patients receiving TAA was reported over those years. Although significant differences in length of stay and total charges between all hospitals were noted when comparing location and teaching status, no significant differences for in-hospital mortality emerged. The odds of perioperative complications were higher in rural, non-teaching hospitals, while length of stay and total charges also differed substantially across hospital sizes. Generally, the risk of mortality after TAA did not grow regardless of hospital size or setting, although rural facilities saw higher rates of perioperative complications compared to urban hospitals.

Practice Management

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A new group calling itself the Coalition for Health AI is urging the establishment of independent testing bodies and a national registry of clinical algorithms to allow doctors and patients to rate the suitability and performance of artificial intelligence (AI) tools and eliminate bias. “We don't have the tools today to understand whether machine learning algorithms and these new technologies being deployed are good or bad for patients,” said Mayo Clinic Platform President John Halamka. He added that the only way to address this oversight is to thoroughly assess their impact and make the results transparent. The coalition is tasked to build consensus around ways to quantify an AI tool's usability, reliability, safety and fairness. The group will also have to set up the testing labs and registry, determine which parties will host and maintain them and persuade AI developers to cooperate with new oversight and added transparency that may be at odds with their business interests.

The coalition is also debating the creation of an accrediting party to certify algorithms' suitability for use on a given task or set of tasks as a pathway for quality assurance. “We need a mind shift from admiring the algorithm's output and its beauty to saying 'All right, let's put in the elbow grease to get this into our work system and see what happens,” explained Stanford University's Nigam Shah. “We have to quantify usefulness as opposed to just performance.”


Guard My Practice founder Amanda Hill suggests four strategies to help physicians contend with "difficult" patients. The first strategy is to build a doctor-patient relationship that engenders trust and encourages patients to be more open. "Asking personal questions and building a rapport with the patient beyond the presenting issue creates a bond, and if the patient is challenging or pushing back, you can correct the behavior easier if there is a trusting relationship between the two of you," Hill notes. The second strategy is for doctors to emphasize positive developments among patients, even those who are non-compliant, rather than focus on the negative. The third strategy involves physicians and not patients controlling the narrative. "You can try empathetic phrases about how you value the patient's time and the time of those in the waiting room and you want to 'focus on the most pressing issue' so that it can be dealt with," Hill writes. The final strategy is to establish appropriate boundaries early to avoid bullying.


Short- and long-term medical practice loans carry notable differences, with the former going up to $500,000 while the latter maxes out at $2 million. Short-term loans can typically be obtained faster and with more flexible documentation than long-term loans. Short-term small business funding is best applied toward opportunities with a more immediate return on investment, like hiring new staff or upgrading practice management software; such loans can also offer a quick infusion of working capital that can help close the gap between insurance payments, invest in marketing or stimulate growth. Long-term loans take longer to approve and have stricter conditions and are most suited for investing in longer-term ventures that may not have immediate returns but are essential for growth. Short-term business loans are perfect for smaller costs that the practice can act on and pay off quickly, while long-term funding is more appropriate for large expenses or purchases that can be covered gradually. Factors determining the best type of loan include how quickly the practice needs the money, how much funding is required, what the money will be used for and the practice's financial history and financial health.

Health Policy and Reimbursement

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The Biden administration released a proposal which would require Medicare Advantage (MA), Medicaid managed care, Affordable Care Act (ACA) plans and state Medicaid agencies to implement electronic prior authorization systems by 2026. The proposed rule, released by the US Centers for Medicare and Medicaid Services (CMS), would require payers and states to streamline prior authorization processes and improve the electronic exchange of health data by the above-mentioned deadline. It also contains incentives for hospitals and physicians to adopt electronic prior authorization.


Self-insured employer health plans nationwide are leveraging patient financial assistance programs that drugmakers use to make their products more affordable in order to defray the cost of expensive drugs for certain medical conditions. Sometimes the employer terminates coverage for a specific drug or class of drug, and the patient applies to receive the prescription for free through charity initiatives targeting the uninsured. Other times, the employer maintains coverage of high-cost drugs but designates them "nonessential," which allows the associated copayment to exceed federal limits. Patient responsibility is reduced markedly, if not eliminated, but if the employee agrees to enroll in financial aid programs intended to cover copays — as much as $20,000 yearly for some drugs — which were lower for patients who independently signed up for assistance in the past. The employer is still liable for some of the drug costs under the new schemes, but less the amount of copay assistance that is tapped. Although drugmakers insist financial assistance is meant for patients, pharmacy benefit managers and other proxies claim the savings employers realize through the initiatives could mean the difference in whether workers are extended coverage or not.


A survey of 1,006 US adults by Wolters Kluwer found 61 percent would rather use primary care services at pharmacies, retail clinics and/or pharmacy clinics than see a primary care physician, reports HealthLeaders Media. This desire is generational, with 70 percent of millennials, 66 percent of Gen Z and 65 percent of Gen X expecting this shift, versus only 43 percent of baby boomers or older Americans. At least half of consumers see potential savings on medical costs as an enticement to look beyond exclusively physician-credentialed providers. Moreover, 56 percent of respondents would trust pharmacists, 55 percent would trust nurse practitioners and 50 percent would trust physician assistants to provide healthcare and prescriptions if it meant lower expenses. Furthermore, 51 percent are concerned about accessing prescriptions from understaffed pharmacies, while Gen Z and millennials are even more likely to express worries about pharmacy staffing gaps than Gen X and boomers. "Americans made it clear: it's time for healthcare to get ready for big changes," said Wolters Kluwer's Peter Bonis. "Gen Z and millennials are thinking differently about the who and where of healthcare and medication prescribing."

Medicine, Drugs and Devices

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A system being tested by CVS Health Corp. would enable pharmacists to process prescriptions remotely while adhering to patient-privacy rules. The technology has been deployed at about 8,000 of the company's 9,000-plus US drugstores, and around 400 of its 30,000 pharmacists are preparing prescriptions from their homes or stores other than the one dispensing the medicine. CVS indicated that the remote prescribing process would free up store pharmacists to provide vaccinations, health screenings and other services to customers amid chronic staffing shortages. However, the initiative faces challenges given that some states require a certain number of on-site pharmacists and prohibit remote drug verification or remote work among pharmacists. Further, the California Pharmacists Association's Richard Dang said, "If you verify remotely, you're losing tactile, in-person verification of the color of the pill or the pill count. It leaves room for some error."


Shear-wave elastography can be useful for evaluating tendons in patients with chronic midsubstance Achilles tendinopathy, suggests a study presented recently at the Radiological Society of North America's annual meeting. Scott Crawford, PhD, from the University of Wisconsin, presented the results, which found lower shear-wave speed in the free tendon compared to the contralateral limb. "Using shear-wave speeds to estimate tendon stiffness may be beneficial for clinical studies to address treatment effects on tendon remodeling," Dr. Crawford said.


The US Food and Drug Administration (FDA) is taking a harder line on its program that fast-tracks drug approvals based on preliminary evidence, spurring drugmakers to remake plans for their drugs or pull them from the market. Under the accelerated-approval program, the FDA clears the use of prescription medicines faster than it normally would. The agency relies on preliminary data to make the decision but asks companies to conduct follow-up studies to confirm that the drug works. Yet companies haven’t always done the studies—or been willing to pull drugs when a follow-up study failed to show a true benefit. In recent weeks, the agency has taken action, prodding GSK to withdraw a blood-cancer drug after it failed a follow-up trial and announcing that Viatris Inc. stopped selling a burn treatment because the company never finished its confirmatory study. Meantime, the FDA told ImmunoGen Inc. and ADC Therapeutics SA, which have been developing cancer drugs, that it wouldn’t grant the speedy approval until they had begun follow-up studies. The requests suggest a shift for the FDA, which some doctors and scientists have criticized for failing to make sure some companies conducted the confirmatory studies and withdrew therapies, especially costly ones, that proved ineffective.