News From ACFAS

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Congratulations to the newly elected ACFAS board members from online balloting that ended on December 28:

• George T. Liu, DPM, FACFAS (Incumbent)
• Andrew J. Meyr, DPM, FACFAS

Drs. Liu and Meyr will serve three-year terms (2021–2024).

Also serving on the 2021-2022 Board of Directors are Thanh Dinh, DPM, FACFAS, President; Michael J. Cornelison, DPM, FACFAS, President-Elect; Eric A. Barp, DPM, FACFAS, Secretary-Treasurer; Scott C. Nelson, DPM, FACFAS, Immediate Past President; Christopher Lotufo, DPM, FACFAS; Alan MacGill, DPM, FACFAS; Alan Ng, DPM, FACFAS; Barry Rosenblum, DPM, FACFAS; and Matt Williams, DPM, FACFAS.

The new board will be installed in March 2021. 2020 has been a challenging year, but your College made the most of it by adjusting to an ongoing pandemic while still working hard to continue to provide the highest-quality educational opportunities — all while keeping members safe. As the year ends, we reflect on overcoming the challenges of 2020 and celebrating our successes. Cheers to another great year in the books for ACFAS!

2020 Accomplishments of Note:

• Member Support During COVID-19
  • The College hosted a record-breaking webinar Practice Survival During COVID-19 to help members maneuver through the muddy waters of the pandemic to help keep their practices afloat
  • At the start of the pandemic through the end of the residency/school year, the College offered provision of free ACFAS OnDemand eLearning access in support of all podiatric residents and students, regardless of membership status
  • ACFAS released 30 new Educational Pathways and re-organized the College’s electronic educational tools into basic, intermediate and advanced by topic, to assist residents and students who lost access to in-person surgical training
  • Provided complimentary access for members to select educational offerings during the COVID-19 crisis
  • Two research videos, eight webinars and eight ACFAS Virtual Journal Clubs were developed to promote the importance of research for the College and profession
  • ACFAS’ letter expressing financial challenges for our members and the profession due to COVID-19 was sent to Speaker Pelosi, Leader McConnell, Leader McCarthy and Leader Schumer
  • APMA, ACFAS, ABFAS, ABPM and ACPM’s joint letter was sent to the National Governors Association to offer our profession’s assistance in addressing the healthcare workforce shortage during the national health emergency
  • A letter was sent to Speaker Pelosi, Leader McConnell, Leader McCarthy and Leader Schumer from ACFAS to extend telemedicine provisions for 12 months
  • Transitioned Coding and Billing For the Foot and Ankle Surgeon to a virtual and ACFAS OnDemand program, receiving record attendance of 135 for the virtual program and 141 for the OnDemand course to ensure attendees would receive accurate information to help them with the coding changes set to hit in 2021
  • Expanded the College’s national public relations campaign to reassure the public that our members were taking all the necessary precautions to ensure a safe visit to the offices for care
  • Practice management tools were developed for members to use in their practice to help during the pandemic
  • The 2021 Annual Scientific Conference dates were moved to May 18-21, 2021 and the conference redesigned to offer a virtual option to allow for more members to participate in earning their educational needs
  • Five new virtual CME offerings on complications were developed
• Nine New ACFAS Position Statements were developed
• New Foot and Ankle Surgery: Techniques, Reports & Cases Journal (FASTRAC) being launched under the direction of Thomas S. Roukis, DPM, PhD, FACFAS, the new editor in chief
• Naohiro Shibuya, DPM, FACFAS named new deputy editor for The Journal of Foot & Ankle Surgery
• Two new Clinical Consensus Statements were released
• Received a record-number of manuscript submissions for ACFAS 2021
• A new patient education animation video series was launched for members to use in their practices to help explain complex medical conditions and to also use to promote their practices
• New Marketing Tools were developed to help members in their practices - such as PowerPoint presentations and infographics
• ACFAS/ABFAS Board Liaison virtual visits to all nine podiatric medical school campuses to offer support to students, teach them about the College and Board, and provide online surgical lectures
• Three new fellowships granted ACFAS status, with a total of 51 programs currently on the College’s list of approved programs
• Complete re-vamp of the College’s fellowship tools on acfas.org while continuing to standardize programs with ACFAS status and to offer stronger support to prospective fellows seeking positions
• Creation of a special task force to review the CPME 320/330 residency oversight documents revisions and to recommend comments back to CPME to ensure these documents are well-balanced, supportive of strong surgical education for residents and are continuing to work toward parity with our MD/DO counterparts
• Membership hit an all-time high of 7,800 – showing that, in a year of uncertainty, ACFAS members agree there is strength in numbers

Foot and Ankle Surgery

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The authors present the reverse dermis flap as an easy and reliable choice for covering soft tissue defects of the distal third of the leg and ankle. They refer to their experience in nine cases in which clinical, operative and follow up data were recorded. Of the nine flaps performed, eight survived completely and one presented a partial flap necrosis, requiring additional surgery. No other operative procedure was required.


The aim of this study was to assess the prospective, longitudinal outcome after arthroscopically assisted open reduction and internal fixation (AORIF) and to compare the results with open reduction and internal fixation (ORIF) in complex ankle fractures. The patient-reported outcome measurement (PROM) following AORIF was assessed at one and four years of follow-up using the Olerud and Molander Ankle Score (OMAS) and Tegner activity scale (TAS). The OMAS and Foot and Ankle Ability Measure (FAAM) were compared between the resulting groups. Twenty-six AORIF patients had a prospective four-year follow-up. No significant differences were identified for the OMAS and TAS. The severity of the cartilage lesions had no significant influence on the PROMs. Twenty-five patients per cohort (AORIF vs ORIF) were matched. The OMAS and FAAM Activities of Daily Living revealed significantly better outcomes for AORIF. More patients in the AORIF cohort returned to sport, with a higher FAAM Sports score.


The study sought to determine boundary values among the most widely-used radiographic measurements to evaluate juvenile flatfeet. Twenty-two patients with normal hind-, midfoot configuration and 19 patients with flatfoot deformity were retrospectively analyzed. Nine radiographic parameters were measured, and receiver operating characteristic curve analysis was used to calculate optimal differentiating thresholds of each parameter. Four out of nine parameters were not statistically different between the groups and their ability to distinct between normal foot and flatfoot was low. Calculation of reference values for these parameters was not performed due to threshold ranges between the groups of >10 degrees.

Practice Management

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Healthcare practices can take numerous steps to help protect themselves from ransomware attacks. This includes investing in a robust IT department, which will ultimately save practices time and money. It is also crucial to keep information systems and the application infrastructure up-to-date. If the older systems are not properly maintained, updated and/or patched, they become vulnerable. Older medical devices have vulnerabilities that are well known to seasoned ransomware attackers, such as password-related backdoors due to weak manufacturer-set passwords or poor password security practices.

All employees, from doctors to front office staff, must be educated and on high alert. Particularly with an increase in remote work, medical networks are even more vulnerable, and staff need to be extra cautious. Staff should enable two-factor authentication on network devices and systems and follow a password management policy that enforces regular updates and strong passwords.


The article offers advice for physicians in choosing where to practice medicine. Sometimes this choice is best made during residency, but waiting until the third year is also acceptable. Regardless of timing, physicians should not rule out independent and/or small group practices, which may offer greater reward potential, more autonomy, less bureaucracy, greater flexibility and an ability to limit payors, among other benefits. Of course, there is also the potential for increased financial risk, reduced negotiating power for contracts, reduced benefits or fewer referrals.

Physicians should not hesitate to explore multiple locations to find a good cultural and clinical fit. If the goal is starting a private practice rather than joining an existing one, facilities planning should start up to two years in advance. The American Medical Association (AMA) recommends creating a checklist for investigating and acting on practice choices. Such a list might include lifestyle factors, available practice options, steps in becoming practice-ready and key components of employment contracts.

Health Policy and Reimbursement

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The latest coronavirus relief bill passed by Congress addresses charges that result from "surprise bills" sent by out-of-network medical providers. Starting in 2022, when the law would go into effect, consumers will not get balance bills when they seek emergency care, when they are transported by an air ambulance or when they receive nonemergency care at an in-network hospital but are unknowingly treated by an out-of-network physician or laboratory. Patients would pay only the deductibles and copayment amounts that they would under the in-network terms of their insurance plans.


The US Centers for Medicare and Medicaid Services has published a final rule to establish minimum standards in state Medicaid Drug Utilization Review programs. The rule also promotes value-based purchasing for drugs covered in Medicaid and modifies third-party liability requirements. The rule also tries to align regulation with statute and changes in marketplace, which enhance manufacturer and state understanding of the Medicaid Drug Rebate Program.

Medicine, Drugs and Devices

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CDC's Advisory Committee on Immunization Practices (ACIP) has recommended that older adults and certain essential workers be the next groups to receive access to limited doses of COVID-19 vaccine in the United States. The panel voted 13-1 for the recommendation. ACIP had previously recommended that Phase 1a include US healthcare workers and residents of long-term care facilities. The panel said that Phase 1b should include front-line essential workers and adults aged 75 years and older--for a total of about 49 million people when overlap between the two groups is taken into account.

Phase 1c would then include individuals aged 65-74 years, adults aged 16-64 years with high-risk medical conditions and essential workers who did not qualify for inclusion in Phase 1b. Phase 1c would cover about 129 individuals, with the overlap between groups. As state governments and health systems roll out the initial supplies of COVID-19 vaccines, they will factor in ACIP's recommendations. CDC's definition of front-line essential workers for Phase 1b includes first responders, such as firefighters and police officers. This group also includes teachers, support staff, daycare providers and those employed in grocery stores and agriculture, among others.


Across the nation, personal protective equipment (PPE) remains in short supply for frontline medical workers, forcing them to continue to ration the use of disposable gloves, gowns and N95 respirator masks. At Duluth, MN-based St. Mary's Medical Center, for example, healthcare workers must reuse their respirator masks up to six times before disposing of them. The used N95 masks are sterilized daily with ultraviolet light, but start to sag after 1 or 2 shifts, says Chris Rubesch, a cardiac nurse.

Supply chain experts and healthcare providers point to a lack of federal oversight, price gouging and counterfeit products for the extreme situation. Get Us PPE, a volunteer organization, says requests for assistance more than tripled in the first half of December compared with the same period in the previous month. A survey by the group found that nearly 90 percent of frontline workers nationwide said they continue to reuse masks designed for single use. Industry executives say the federal government must start considering the PPE sector as essential for national security and provide loans and subsidies to domestic companies and mandate that state and national stockpiles acquire American-made medical products.


The US Centers for Disease Control and Prevention (CDC) reports that approximately 81,230 drug overdose deaths occurred in the United States in the 12 months ending May 2020, the highest number ever recorded for a 12-month period. The CDC noted that the largest spike occurred between March and May 2020. The number of deaths increased 18.2 percent from the 12-month period ending in June 2019 to the 12-month period ending in May 2020. Among the 38 jurisdictions with available synthetic opioid data in the CDC's analysis, 37 reported increases in synthetic opioid overdose deaths. Eighteen reported increases greater than 50 percent, and ten states reported more than a 98 percent increase in synthetic opioid-involved deaths. Cocaine-related overdose deaths also increased by 26.5 percent in the 12-month period; the CDC said these were likely connected to using cocaine together with fentanyl or heroin. Overdose deaths involving stimulants increased by 34.8 percent and exceeded the number of cocaine-involved deaths.