News From ACFAS

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Congratulations to the newly elected 2023-24 ACFAS Board members from the election that ended on December 14:

• Incumbent: Matthew E. Williams, DPM, FACFAS
• Jason A. Piraino, DPM, MS, FACFAS

Dr. Williams and Piraino will serve three-year terms (2023-2026).

Also serving on the 2023-2024 Board of Directors are Eric A. Barp, DPM, FACFAS, President;George T. Liu, DPM, FACFAS, President-Elect; Alan Ng, DPM, FACFAS, Secretary-Treasurer; Michael J. Cornelison, DPM, FACFAS, Immediate Past President; Shane M. Hollawell, DPM, FACFAS; Alan A. MacGill, DPM, FACFAS; Andrew Meyr, DPM, FACFAS; Amber M. Shane, DPM, FACFAS; Gregory P. Still, DPM, FACFAS; Jason Piraino, DPM, FACFAS.

Learn more at acfas.org/nominations. Don’t wait any longer to secure your spot and hotel for the ACFAS 2023 Annual Scientific Conference! Join us for cutting-edge sessions, hands-on workshops and networking opportunities with your friends and colleagues February 9-12 in sunny Los Angeles.

Register now, or if you’ve already registered, 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 for more information. ACFAS and Zimmer Biomet are launching a new ACFAS Resident Scholars Program – Powered by Zimmer Biomet to help five fortunate residents with a check for $1,500 to offset travel costs to the ACFAS 2023 Annual Scientific Conference in Los Angeles, along with complimentary registration. All applicants must be ACFAS resident members and not have their travel completely covered by another source – no double-dipping.

Applications are due January 3 and recipients will be notified by January 25.

Learn more and apply at acfas.org/residentscholars. The 2023 Residency Directors Forum is going Hollywood! Earn 6.0 CME credits when you attend on Wednesday, February 8, from 12:00 – 6:30 pm. This year’s event is co-hosted by the Council of Teaching Hospitals (COTH) and generously sponsored by Organogenesis.
The agenda is geared toward how to optimize your resident review and oversight, with sessions including:

• Somewhere Over the Rainbow: Diversity, Equity, and Inclusion of Podiatric Residency Programs
• How You Doin’? CPME Mock Site Visit
• Smarter than the Average Bear: Faculty Development A to Z

The day will conclude with a special CPME dinner session for residency evaluators at 6:30 pm. You must RSVP for the dinner. CPME will contact you directly to see your availability to join them for this special event.

The Residency Directors Forum is complimentary for all residency directors, faculty and program coordinators (up to two representatives from each program), fellowship directors and school Deans.

There will be no onsite registration for the Forum. Register online at acfas.org/asc.

Foot and Ankle Surgery

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The use of anterior superior iliac spine distraction to treat severe and recalcitrant diabetic foot ulcers was assessed, compared to ulcers treated with proximal tibial cortex transverse distraction. There were 87 patients (87 feet) with severe and recalcitrant diabetic foot ulcers treated from February 1998 to February 2020, while another 91 patients underwent proximal tibial cortex transverse distraction. The two groups' respective mean preoperative ankle-brachial indexes were 0.41±0.07 and 0.39±0.05 while respective mean preoperative limb pain was 3.42±2.84 centimeters (cm) and 3.52±3.11 cm. Ulcers healed in 72 (83 percent) and 74 (81 percent) patients, respectively, at the two-year follow-up visit. The mean postoperative limb pain was 0.52±0.23 cm and 0.49±0.41 cm, respectively. Pin-site infection ensued in two patients and right patients, respectively, while ulcer recurrence occurred in 13 (15 percent) patients and 15 (16 percent) patients, respectively.


A study estimated the five-year clinical and radiographic outcomes and survivorship of the Trabecular Metal total ankle arthroplasty. Two fellowship-trained foot and ankle surgeons used this implant system to treat 38 end-stage arthritic ankles over three years. Radiographic analysis compared postoperative coronal and sagittal alignment in weightbearing radiographs at a minimum of five years with that at three months postoperatively, as well as cyst or lucency formation. Three revision and nine reoperations were noted at five years. Reoperations entailed four fibular hardware removal and five medial gutter debridement procedures. All domains showed significant improvement in the Foot and Ankle Outcome Score, with no significantl change in implant positioning between three months and five years after surgery. Survivorship stood at 92.1 percent.


Researchers analyzed Google Trends data on patient and geographic interest in total ankle replacement (TAR) from 2009 to 2019. Significant increases in search queries for the keywords “ankle arthritis” “ankle replacement” and “ankle fusion” were observed over time. Trend analysis indicated ankle arthritis strongly correlated with ankle replacement, as did “ankle arthritis” and “ankle replacement.”. The geographic distribution of these search terms revealed the greatest boost in interest for the keywords “ankle arthritis” “ankle replacement” and “ankle fusion” in Arizona, New York and Virginia respectively. These findings can be used effectively identify, educate and treat populations interested in TAR.

Practice Management

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A systematic review of 31 studies involving 51,680 participants in 17 countries analyzed the frequency of problematic alcohol use among physicians and the underlying characteristics. Problematic alcohol use showed wide variation irrespective of measurement method and increased over time from 16.3 percent in 2006 to 2010 to 26.8 percent in 2017 to 2020. Extent of problematic use by gender was examined in 19 studies, by age in 12 studies, by specialty in seven studies and by career stage in five studies. Seven of 19 studies found problematic alcohol use to be more common in males than females. The broad heterogeneity of methods for included studies yielded limited conclusions on the variation of problematic alcohol use according to physician age, sex, specialty and career stage.


A study published in JAMA Network Open found the quality of language used in electronic health records (EHRs) can indicate physician burnout and highlight areas where the patient experience requires improvement. The authors analyzed words in EHR-transmitted messages sent to 609 physicians, focusing on factors such as use of all capital letters or degree modifiers like “very” in more than 1.45 million inbasket messages sent from April to September 2020. A survey found physicians who reported more burnout generally received more messages than those not feeling burnout — although those differences were insignificant. The messages overall and from patients were much more positive than negative in both groups, and messages to physicians with burnout had the highest positive ratings at 69 percent. But the study found the list “of high-frequency words included many expletives, demonstrating the animosity of some messages arriving at physicians' inbaskets.” Suggested remedies for poor communication and incivility in EHR messaging include having health systems ensure the inbasket is not a channel for physician abuse and cyberbullying; posting reminders in EHR portals to use kind language when messaging; blocking expletives or threatening words with electronic filters and use of frameworks to identify patients who often send negative messages.

Health Policy and Reimbursement

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A Notice of Benefit and Payment Parameters rule issued December 12 by the US Centers for Medicare and Medicaid Services (CMS) for 2024 plan year Affordable Care Act (ACA) policies includes network adequacy standard changes and lower user fees. The CMS rule would limit insurers to offering two nonstandardized ACA exchange plans on HealthCare.gov for each product network type and metal tier level. The rule, which would not apply to state-run marketplaces, offers an exception for catastrophic plans. CMS will continue the 35 percent provider participation threshold for essential community providers and extend the threshold to family planning providers and health centers to increase provider choice and expand access to care.


The US Medicare Payment Advisory Commission (MedPAC) wants Congress to increase hospitals and clinicians' 2024 Medicare payment rates. If Congress opts not to follow the recommendations, the US Centers for Medicare and Medicaid Services has to make payment updates according to current law — setting up another year of providers running to lawmakers for relief from Medicare cuts after the fact.


A “secret shopper” accountability study indicates patients cannot readily schedule medical appointments by phone through Medicaid providers in New Mexico, despite the state and federal government's $8.8 billion annual Medicaid expenditure. About 13 percent of attempts to make an appointment ended in success, which for Sen. Nancy Roberts (D-NM) means patients health “would get worse in time if they can't be seen by good medical care or any medical care at all.” Appointments could not be made for about half of calls due to inaccurate phone listings or voicemails that were not returned. Over 25 percent of primary healthcare providers reached by phone were either not accepting new patients or had exited the practice, while patients who did connect with Medicaid care providers faced waiting lists or appointment times that exceeded contractual mandates.


According to a US Centers for Medicare and Medicaid Services (CMS) analysis, US healthcare spending growth slowed to 2.7 percent in 2021, totaling $4.3 trillion. This is down from a 10.3 percent increase in overall healthcare spending in 2020. In 2021, federal healthcare spending dropped 3.5 percent to $1.46 trillion after rising nearly 37 percent in 2020. As a share of gross domestic product, healthcare accounted for 18.3 percent in 2021, down from 2020's 19.7 percent. CMS data also found that Medicare spending rose 8.4 percent last year after increasing 3.6 percent in 2020. Meanwhile, there was a 5.8 percent jump in spending on private health insurance last year, compared with a 1.1 percent decrease in 2020. Increased enrollment and use largely pushed private health insurance spending to 28 percent of total healthcare spending for 2021.

Medicine, Drugs and Devices

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The annual American Diabetes Association (ADA) Standards of Care in Diabetes recommends new more aggressive targets for blood pressure and lipids, among the changes. The standards now advise a blood pressure target for people with diabetes of less than 130/80 mmHg and low-density lipoprotein cholesterol targets of below 70 mg/dL or no greater than 55 mg/dL, depending on the individual's cardiovascular risk. Other changes for 2023 include a new emphasis on weight loss as a goal of therapy for type 2 diabetes; guidance for screening and assessing peripheral arterial disease in an effort to prevent amputations; use of finerenone in people with diabetes and chronic kidney disease; use of approved point-of-care A1c tests; and guidance on screening for food insecurity, along with an elevated role for community health workers.


A growing number of states are urging the US government to allow them to import medications from Canada to reduce prescription drug costs. Colorado recently became the fourth state to request federal permission to use the strategy, estimating that residents and employers would save an average of 65 percent off the cost of several medications. Previously, Florida, New Hampshire and New Mexico had applied for permission. US President Biden has voiced support for the strategy, but other officials have not yet endorsed such plans. US Department of Health and Human Services Secretary Xavier Becerra said on December 5: "Sign up and submit an application, and we will take a look and see if you are able to get through the process." Florida sued the federal government in August, and in a December court filing it claimed the government was stalling. New Hampshire Health and Human Services Department spokesperson Jake Leon said his state's proposal was denied for failing to cite a Canadian wholesaler that would provide the drugs. He said the US Food and Drug Administration (FDA) told the state it could reapply when it secured a company. New Mexico remains in discussions with FDA, according to David Morgan, a state Health Department spokesperson. Meanwhile, the Pharmaceutical Research and Manufacturers of America sued the federal government in 2020 to prevent drug importation; the lawsuit is still pending. The Biden administration contends the lawsuit is without merit because it is uncertain when, if ever, the administration would approve a state's importation plan.


The latest worldwide data point to high levels of antimicrobial resistance (AMR) to therapies for treating infections, according to the World Health Organization's (WHO) Global Antimicrobial Resistance and Use Surveillance System (GLASS) 2022 report. The report gathered 127 countries' AMR data based on certain pathogens related to four types of infections—gastrointestinal infections caused by Salmonella spp. and Shigella spp.; bloodstream infections (BSIs) caused by Acinetobacter spp., E coli, K pneumoniae, Salmonella spp., Staphylococcus aureus and Staphylococcus pneumoniae; urinary tract infections (UTIs) caused by E coli and K pneumoniae; and genital infections caused by Neisseria gonorrhoeae. The report revealed that for BSIs, AMR in Acinetobacter spp. was more than 56 percent and in Klebsiella pneumoniae, more than 57 percent. These two pathogens represented more than 20 percent of the BSIs reported. The report also found that more than 20 percent of Escherichia coli isolates, which are the primary cause of UTIs, were resistant to first- and second-line antibiotic treatments and more than 60 percent of gonorrhea isolates were resistant to ciprofloxacin. More than 3 million bacterial infections overall were reported for 2020. The researchers noted variances in surveillance testing among countries. For instance, the median third-generation cephalosporin resistance in E coli BSIs was 41.8 percent and median methicillin resistance in S aureus BSIs was 34.7 percent. When focusing only on countries with the highest testing coverage, those rates were 10.6 percent and 6.8 percent, respectively. WHO said it would use strategies such as prospective national AMR prevalence surveys to reduce testing discrepancies while also strengthening lab and testing capacity in low- and middle-income countries.