ACFAS Update (Vol. 27 No. 7) by ACFAS

ACFAS VOLUME 27 ISSUE 7

NEWS from the AMERICAN COLLEGE OF FOOT AND ANKLE SURGEONS

Meet FASTRAC, The New Journal in Town ACFAS and the Council for Journal Management are excited to announce the launch of the College's new, open access journal, Foot & Ankle Surgery: Techniques, Reports & Cases (FASTRAC). As an online companion to JFAS, FASTRAC, with Thomas S. Roukis, DPM, PhD, FACFAS as the new Editor in Chief, will be the home of case reports currently submitted to JFAS and other brief communications such as techniques videos as it’s intended to be a

more rapid publication of papers that allows ACFAS members and other foot and ankle surgeons around the world to stay up to date on the best clinical practices. FASTRAC will publish the latest advances in surgical techniques for correction of foot and ankle disorders and focus on clinically relevant articles, reviews and case reports for an in-depth look at all areas of the medical and surgical treatment of foot and ankle disorders. The new journal will also give readers access to practice-based evidence via case reports and articles on novel techniques to advance clinical research and daily clinical practice. Members being able to submit directly to the journal gives authors a more stream-

Physicians Balancing Pregnancy page 6

Residency Directors Forum Returning in 2021 page 8

lined transfer process for articles that are not accepted for JFAS but may be more suitable for FASTRAC. Articles will be published under a Creative Commons license allowing contents to be accessed for free anywhere in the world. ACFAS Members will receive a discount on submissions to the new journal. The Open Access Fee for 2021 will be $700 for case reports and $2,000 for research papers, video, techniques, protocols and review type articles. FASTRAC is set to make its debut in early 2021! Watch for submission and launch information as it becomes available.

President’s Perspective

RESEARCH page 2

perspective

RESEARCH If you want to rule the world, keep it amused—which is probably why you hear a lot of jokes in and around the surgery department. For instance, “Why do surgeons make great joke tellers?” “Because they leave everyone in stitches.” Or another classic, “If a surgeon fails an eye surgery, no one bats an eye, but a surgeon fails a brain surgery, and everybody loses their minds.” We have all also heard the classic general surgery joke “all bleeding stops…eventually” one as well. Those are just a few of jokes you often hear around the operating room because they are fairly benign (no pun intended) and easy to remember. Some of my more memorable ones came from Larry Rubin, DPM, FACFAS, with his ‘surgeons prayer,’ which simply states what the surgeon says before his extremely difficult case on a person of poor health, “Dear God, please get us through this surgery with great results and if you do, I will never do this again.” One of my favorites is “my outcomes seem to be the best when patients are lost to follow up” because if we don’t know how they are doing then all is well, right? Well unfortunately that last joke makes you stop and think a little. Part of the humor comes because we all know how important follow-up is to understanding the results and without them, it can lead to a false sense of security. Without follow-up and knowing

your outcomes you live in some parallel universe, which is rich with euphoria and toxic positivity. Over the years it has been emphasized by several prominent members of the College how research needs to be done to propel and promote our profession, but where can this come from? Wouldn't it be reasonable to start emphasizing to the training programs at the schools and residency programs the importance of research? In fact, it's probably more appropriate to make this a requirement in my opinion. Shouldn't it be required when molding the future of our profession that we would like them to think scientiﬁcally and have a full understanding of the importance of clinical outcome data? The recent surge in fellowship programs are another excellent option for research. This should be a breeding ground given the fact that fellowship is an area dedicated to a speciﬁc type of pathology/procedure type. If we need information on Charcot reconstruction vs sports medicine vs total ankle replacement outcomes, we have those available and fellows dedicated to learning about these conditions. We have excellent training programs dedicated to teaching the intricacies of these conditions. This seems to be an excellent resource, and part of the program could include data collection for publication. I believe, this should be part of

Questions for Dr. Nelson? Write him at president@acfas.org. 02

volume 27 issue 7

the program and being a part of a research project should be required to be recognized by the College. The problem to implement these requirements is multi-fold. First, we need to have a method to collect data and second we need to be vigilant in data acquisition. Doing so with certain financial considerations is part of our fiduciary duty but this member benefit is important. This is just the starting point, but it has the possibility to have tremendous power for all of us. We need to strive to think scientifically and verify what we all already know—we have great outcomes and our surgical recommendations are based on evidence. That should be standard and exactly what you would expect from someone doing surgery on your loved ones. If outcomes aren’t being researched and published, then our profession is doomed to whither. At this point the College has ramped up its outcomes/registry investigations and we are looking to find the best fit for our organization. We will continue to pursue this potential and hope the entire profession gets behind it as we try to make it a reality next year. Maybe 2021 will have better sight than 2020?

Scott C. Nelson, DPM, FACFAS ACFAS President

update: news from the american college of foot and ankle surgeons

www.acfas.org

patient outreach

ACFAS Embraces the “New Normal” in Video Campaign

2020-21 EDUCATION PROGRAMS November 15-December 15

Coding & Billing for the Foot and Ankle Surgeon Virtual Course ACFAS OnDemand March 20-21, 2021 (Saturday/Sunday)

What’s the “new normal” in your practice? We know 2020 has been challenging for everyone but as you know, we all must continue to provide healthcare for our patients and encourage them to not skip their appointments out of fear. To help encourage and educate patients, ACFAS is launching the “New Normal” campaign as a continuation of our Welcome Back national public relations campaign to highlight the safety precautions foot and ankle surgeons are taking to keep their offices safe for patients. The video campaign acknowledges in two videos the old and new normal we’re facing amid the ongoing pandemic. The “New Normal” shows the new reality we’re navigating showing how foot and ankle surgeons and their practices are adjusting with new safety protocols in place to keep patients and staff safe from exposure. The “Old Normal” video shows that while we’re making all these adjustments to keep everyone safe, the one thing that hasn’t changed is the caliber of care patients are still receiving from the foot and ankle surgeons they know and trust who are open to address patients’ foot and ankle needs. The campaign is circulating on Facebook as a way to remind patients foot and ankle surgeons are still here for them, open and operating as usual and especially to encourage patients who may have been putting off doctor’s visits to make those appointments to help keep themselves healthy. While there are new protocols in place, a patient’s visit to the doctor will be very much like what it always was.

volume 27 issue 7

Arthroscopy of the Foot and Ankle Surgical Skills Course Orthopaedic Learning Center (OLC) Chicago, IL April 17-18, 2021 (Saturday/Sunday)

Arthroscopy of the Foot and Ankle Surgical Skills Course Orthopaedic Learning Center (OLC) Chicago, IL May 18-21, 2021 (Tuesday–Friday)

79th Annual Scientific Conference Mandalay Bay Resort & Convention Center Las Vegas, Nevada

Watch for more educational offerings for 2021! *To be waitlisted for sold-out courses, contact Michelle Majewski at michelle.majewski@acfas.org

In Memory Irvin I. Donick, DPM, FACFAS Baltimore, MD Charles E. Pankratz, DPM, AACFAS Shelby Township, MI James J. Salonen, DPM, MS, AACFAS Duluth, MN

update: news from the american college of foot and ankle surgeons

www.acfas.org

news from the college

CALL TO SCHEDULE A SURGERY

844. 602. 6637

Learn More at www.PitStop-Implant.com

EMAIL US NOW Info@i2b-USA.com

ACFAS Board Nominees Announced After careful review of applicants to serve on the ACFAS Board of Directors, the Nominating Committee recommends these four Fellows for two positions in the upcoming election: 䡲䡲䡲䡲

George T. Liu, DPM, FACFAS – Incumbent Shane M. Hollawell, DPM, FACFAS Andrew J. Meyr, DPM, FACFAS Gregory P. Still, DPM, FACFAS

45°

Two, three-year terms will be ﬁlled by election. Candidate proﬁles and position statements will be posted at acfas.org/nominations on November 25. Online voting will be conducted December 11-28, 2020. All eligible voters will receive an email with a unique link to the election website in advance. The 2020-2021 Nominating Committee included ACFAS Fellows: Christopher L. Reeves, DPM, MS, FACFAS, Chair; Eric G. Walter, DPM, FACFAS; Adam M. Budny, DPM, FACFAS; Brandi M. Johnson, DPM, FACFAS; Scott C. Nelson, DPM, FACFAS; Roland S. Ramdass, DPM, FACFAS; Ronald G. Ray, DPM, FACFAS

PEEK Subtalar Implant

PitStop

• Anatomical Shape with Lock-in Flanges • Biocompatible PEEK • No metal sensitivity concerns [nickel] • Invisible on x-rays Lock-in Flanges

X-ray Markers for Placement Confirmation

Cannulated Implant

In2Bones See Our Full Line at www.In2Bones.com PitStop, In2Bones and the In2Bones logo are registered trademarks of In2Bones and its subsidiaries. • In2Bones USA Memphis, TN, 38119 USA • In2Bones SAS, 69130 Ecully, France © 2019 In2Bones USA, Memphis, TN • All rights reserved • Patent Pending • AU1120_PTS-A, 1120

volume 27 issue 7

A G LO B A L E X T R E M I T Y C O M PA N Y

update: news from the american college of foot and ankle surgeons

www.acfas.org

research

There’s strength in membership.

ACFAS Contributes to the National Advocacy Dialogue on Behalf of Foot and Ankle Surgeons Last month, the College sent two important letters on behalf of ACFAS members. The ﬁrst, sent on October 26, was a joint letter from ACFAS, the American Academy of Orthopaedic Surgeons, the American Podiatric Medical Association and the American Orthopaedic Foot and Ankle Society to Anthem Blue Cross Blue Shield to revoke policy changes to the AIM Specialty Health (AIM) Musculoskeletal Program. The proposed changes would create new appropriate use criteria (AUC) requirements for clinical interventions to small joint surgery of the foot and ankle. Speciﬁed procedures include: 䡲䡲䡲

䡲

Hallux Rigidus Surgery Hallux Valgus and Bunionette Surgery Lesser Toe Deformities (Elective, Non-Emergent Surgical Intervention) Ankle Arthritis (Elective, Non-Emergent Surgical Intervention)

volume 27 issue 7

Renew today! acfas.org/paymydues, mail or fax. On October 30, the American Podiatric Medical Association (APMA) sent a letter on behalf of APMA and ACFAS and the Federal Services Podiatric Medical Association to the Department of Veterans Affairs (VA) supporting higher reimbursement rates for podiatric surgeons. The letter recommended that surgical podiatrists be moved from Table 1 (the lowest reimbursement rate) to Table 4 (the highest reimbursement rate) with other surgical specialties. Follow up on both of these important issues will be conducted by ACFAS and will be communicated to ACFAS members upon further exploration. Many thanks to the ACFAS Health Policy Committee for their diligence and expertise in making sure these letters served the interests of foot and ankle surgeons. For these and other ways ACFAS is advocating for our members, please contact erin.ravelette@acfas.org.

update: news from the american college of foot and ankle surgeons

www.acfas.org

practice management

Physicians Balancing Pregnancy Finding out your family is growing is an exciting time for any mother-to-be. Whether it is the ﬁrst child or you’re a seasoned pro with other kids awaiting a new sibling’s arrival, pregnancy is an exciting journey. While the adage goes nothing in life worth having is easy, this can be true for pregnancy. As if growing another life isn’t a challenging enough task, many women balance pregnancy with a demanding career in foot and ankle surgery. Then top that with the long list of things to do before the baby arrives. Pennsylvania-based foot and ankle surgeon Kristin Strannigan, DPM, FACFAS discusses some challenges pregnant foot and ankle surgeons face, and how to plan to ensure a safe delivery for you and your baby while balancing your practice and career. After the initial shock and excitement subsides, moms-to-be begin planning the arrival of the new addition. Of course, there are the

regular decisions pregnant moms have to make but as a foot and ankle surgeon there are a few additional items on the list. Dr. Strannigan shares, “The main things to consider are time off during pregnancy, who will manage your patients while you are on leave and ﬁguring out childcare when returning to work.” Some questions she suggests asking include, “Is your hospital or group large enough to provide FMLA? If your company does not provide FMLA, is there anything in your contract regarding pregnancy? Are there other doctors who can cover your patients while you are gone?” Typically if a company employs 50 or more employees, it should provide FMLA, but that is something you should ﬁnd an answer to immediately so you can begin planning your leave ahead of time to avoid a headache of pooling vacation or sick time closer to your due date.

Kristin Strannigan, DPM, FACFAS

Challenges A profession in surgery comes with a fair share of challenges. You take years of schooling, countless practice and continued education hours, challenging cases and long hours and that’s just the tip of the iceberg. Surgery is physically demanding to begin with, but when tasked with doing this while your body is changing so dramatically, it adds additional challenges. Dr. Strannigan shares, “Physically performing the surgeries can be a major challenge. Towards the end of my third trimester I did two tibio-talocalcaneal fusions back-to-back. Afterwards, I remember thinking I will never ever do that again.” She adds, “Maneuvering around the OR table and using the equipment all while pregnant can be very tricky and exhausting.” When planning out your days in the office and scheduling any surgical cases, be mindful of how much you are

Physically performing the surgeries can be a major challenge. Towards the end of my third trimester I did two tibio-talo-calcaneal fusions back-to-back. Afterwards, I remember thinking I will never ever do that again. — Kristin Strannigan, DPM, FACFAS

volume 27 issue 7

update: news from the american college of foot and ankle surgeons

www.acfas.org

It takes time and dedication, but you can be pregnant and have kids while also having an excellent career. — Kristin Strannigan, DPM, FACFAS taking on and be cautious not to overdo it as your body is changing in many ways and you want to stay safe. Safety Aside from physical demands of the job, for expectant mothers, the safety and health of their baby is the number one concern and as a medical professional, there are different risks you’d face in a medical practice than you would with an office job. Dr. Strannigan offers these tips for keeping you and the baby safe while working. “If using bone cement in the OR, leave the room while it cures.” When it comes to X-rays, she suggests, “Your hospital should provide you with a separate ‘baby badge’, which is a radiation badge you wear under your X-ray lead that monitors the baby’s radiation exposure.” This will help to give you peace of mind to make sure you’re doing everything in your power to be safe. She adds that during both of her pregnancies, her baby badge was always well below the recommendations, but it’s always better to be safe. Preparation Every practice, person and pregnancy are different, but the key is to look ahead and be ready for anything. Dr. Strannigan shares there isn’t a standard protocol or suggested time frame on when to stop doing surgery or taking call, but these are things you

volume 27 issue 7

should find out. “Every practice is different regarding who takes call, how often and what type of call, etc. I personally took call up to two weeks prior to my delivery date.” Again, everyone is different. Talk to your employer and your peers and work out a plan everyone is comfortable with. Know who can step in if you must leave suddenly. Know when you plan to stop taking call and when you want to stop performing surgeries. The more you have planned, the easier it will be to work around any bumps in the road. Fortunately for Dr. Strannigan, her employers were accommodating leading up to and during her maternity leave. The more you communicate and strategize now, the easier it will be when your leave comes. Have those conversations as soon as possible to make preparation for your leave as seamless as possible. Is planning for a child while balancing a heavy surgical case load easy? No, but Dr. Strannigan reminds us it’s all worth it. “Balancing motherhood and foot and ankle surgery can definitely be exhausting and challenging, but being a mom is honestly the most fulfilling aspect of my life. I still do 5-10 cases per week, but I have learned to manage my time and be home every night before dinner to see my children.” She adds, “It takes time and dedication, but you can be pregnant and have kids while also having an excellent career.”

Pregnancy Checklist 䡲䡲

䡲

䡲䡲

䡲

When should you stop doing surgery? Let malpractice know you will be taking a leave of absence Disability Insurance 䡲 Have your doctor ﬁll out for state insurance 䡲 If you also have private short term ﬁll out paperwork for that, too When to stop taking call? Adjust schedule after maternity leave for pumping if breastfeeding (approximately 15-30-minute break, depending) If you do plan to pump at the office, consider having a personal mini fridge Who will be covering your patients while you are on maternity leave? If pregnant during the COVID-19 pandemic, should you quarantine two weeks prior to delivery? Speak with your employer regarding difficult patients they may not know how to treat in your absence, possibly give names of similarly trained docs they could refer to 䡲 Give sign out to employer/covering doctor of post op patients and complicated cases Does your practice qualify for FMLA? If not, how long can you take off? Compensation during time off?

update: news from the american college of foot and ankle surgeons

www.acfas.org

news from the college

Residency Directors Forum Returning in 2021 Roya Mirmiran DPM, FACFAS

2021

RESIDENCY DIRECTORS FORUM

R D

Co-Hosted by ACFAS and COTH

Attention program directors and faculty— the Residency Directors Forum is once again on the College’s conference schedule! With the new challenges in surgical education under the current uncertain times, this year’s Forum will begin with a discussion on COVID-19 response by various residency programs and give directors a chance to share war stories, best practices – and how to pivot to short-term virtual education while still maintaining CPME requirements for resident learning. “The ﬂexibility of programs and educational organizations to adapt to new changes have been remarkable. The Forum will provide a platform for program directors to share and learn from best practices. An update will be provided by each educational organization (ie: CPME, ABFAS, AACPM) on changes they had to make in order to assure excellence in education while dealing with viral pandemic barriers.” says Roya Mirmiran, DPM, FACFAS, Forum Moderator. The idea of residents continuing on to take a fellowship has been a bit of a conundrum to residency programs. For 2021, representatives from fellowship programs will exchange their current and future plans for

volume 27 issue 7

our profession, explain why residents are interested in taking this next step in their career, and provide the best ways to support them. Also on the Forum agenda, a panel will discuss patient safety in regard to resident training, legal considerations, second victim phenomenon and best practices. Finally, back by popular request, attendees will have an opportunity to hear updates from CASPR/CRIP and clerkship processes, ACFAS news and PRR revisions. “The Forum is designed by program directors for program directors and any feedback to address residency issues or concerns are always welcomed” said Dr. Mirmiran. The Forum, co-hosted by ACFAS and the AACPM Council of Teaching Hospitals (COTH), is set for Monday, May 17 in advance of ACFAS 2021 in Las Vegas. The Forum is complimentary to all residency and fellowship directors and one additional faculty (space is limited). The Forum will provide a CPME approved certiﬁcate for Continuing Education Contact Hours (CECH). Interested in attending? Watch your email for an announcement when registration forms are available and register early to save your seat.

update: news from the american college of foot and ankle surgeons

www.acfas.org

news from the college

CALL TO SCHEDULE A SURGERY

844. 602. 6637

ACFAS Logo Store: Show your College Pride

Ready to do some holiday shopping? Don’t forget to add a visit to the College’s ACFAS Logo Store to your shopping list. ACFAS makes it easy to show your pride in your professional accomplishments and the College with merchandise from the ACFAS Logo Store, your one-stop shop for ACFAS gear. Shop 24/7 online through acfas.org for shirts, jackets, pullovers and scrubs in a wide range of colors and sizes. Also check out drinkware, pens and other items perfect for even the pickiest person on your shopping list. Visit the ACFAS Logo Store and create a new account to check out all the available products, make your purchases and provide payment.

Visit acfas.org/logostore today!

Learn More at www.ReferenceToe.com

EMAIL US NOW Info@i2b-USA.com

Reference Toe System 1 MTP Implant ®

Angled Metatarsal Stem Matches Natural Declination Angle No Angled Cuts • Broachless Implantation Sterile, Single-use Instruments

In2Bones See Our Full Line at www.In2Bones.com Reference Toe System, In2Bones and the In2Bones logo are registered trademarks of In2Bones and its subsidiaries. • In2Bones USA Memphis, TN, 38119 USA • In2Bones SAS, 69130 Ecully, France © 2019 In2Bones USA, Memphis, TN • All rights reserved • Patent Pending • AU01120_RTS-A, 1120

volume 27 issue 7

update: news from the american college of foot and ankle surgeons

A G LO B A L E X T R E M I T Y C O M PA N Y

www.acfas.org

news from the college

ACFAS Releases Patient Education Resources for Members The free patient education animation video library is growing already! Just released— the Post-Surgical Care Instructions (with crutch use) video. Head to the ACFAS Marketing Toolbox now to view and download to share in your practice. The second video in our animated patient education series is geared toward patients who have recently had surgery with instructions on how to use crutches as well as tips on pain medication usage, keeping incision sites dry and elevating to eliminate inﬂammation. The crutch-use tips visually show people how to use crutches after surgery and how to get around safely while walking, getting upstairs and getting up from sitting. Share the newest informational videos with your patients during their next visit to elaborate more on the common instructions you give during an appointment as well as on your website or on your social media channels for patients to reference. Access both animation videos now at acfas.org/Marketing.

volume 27 issue 7

update: news from the american college of foot and ankle surgeons

www.acfas.org

research

Highlight Your Latest Research During ACFAS 2021 It’s that time again! We are now accepting manuscripts and posters for ACFAS 2021! Now is your chance to showcase your latest research to an audience of your peers and colleagues in Las Vegas May 18-21 and shape this year’s Annual Scientiﬁc Conference. Mark your calendar with these important dates: December 16, 2020: Manuscript Submissions Due January 13, 2021: Poster Abstract Submissions Due

With your health and safety as our foremost concern, we're looking forward to welcoming back the ACFAS family to Las Vegas. And as we build out another robust scientiﬁc program, your podiatric surgery research is key. So, review our application deadlines, prepare your submission, and submit it today! Visit acfas.org/LasVegas for more information, manuscript submission policies and poster guidelines.

ION CENTER |

& CONVENT MANDALAY BAY RESORT

LAS VEGAS, NV

20 21 AC FA S

MAY 21, 2021 TUESDAY, MAY 18 – FRIDAY,

0 2 1 ST DON’T GET2LO IN THE SHUFFLE CA LL for M AN

Research is

D e a d l in e

SC IEN TIF MANDALA IC CO NF Y BAY RESO RT & CON ER EN CE VENTION CENTER MAY 18 – | LAS VEGA FRIDAY, MAY S, NV 21,

TUESDAY,

essential

US CR IP

2021

TS and PO ST

ER S

to the med foot and ankle ical profession surgeons. and the ACFA the Annual If you are Conference invol Program Com ved in a study that S is at the forefront abstract for of research woul cons mittee invite for May 18 – Frida ideration for pres s you to subm d be beneﬁcial to the enta y, May 21, profession 2021 in Las tion at the Annual Scien it your manuscript , or post Vegas, Neva tiﬁc Conferen da. ce, Tuesday, er

De a dli n e

DEADLINE MA NU SC

RI PT SU BM

ACFAS Manu ISS IO N script Awa | DE C 16, rds of Exce llence winn 20 20 ers will divid To submit your manuscri e $10,000 in prize mon regarding pt, log on man to ey. and “Instructi uscript requirements the ACFAS Website at acfas.org. and policies ons for Auth Detailed infor read these two documen ors Submitting a Manuis printed in the “202 1 Call for Manumation ts before subm script”. It is important scripts” itting a manuscri Manuscrip that authors pt. ts must be carefully submitted the Committe no later than e. December 16, 2020 to be eligible for review by

JAN 13, 2021

DEC 16, 2020

DEADLINE PO ST ER

SU BM ISS

IO N | JA To submit your poster, N 13, 20 log poster requ 21 irements and on to the ACFAS Web Guidelines”. site at acfas policies and It is important .org. Detailed sample abst poster abst racts information that authors ract. regarding carefully read are published in the “2021 Post these guid er elines befo Poster abst re submitting racts must a be submitted by the Com mittee. no later than Janurary 13, 2021 to be eligible for review

ACFAS CORPORATE SPONSORS Platinum Level

Gold Level

Silver Level

Bronze Level

Pewter Level

Copper Level

Arthrex

Stryker

DePuy Synthes

In2Bones

Arthrosurface

Organogenesis

Medartis, Inc.

PICA

Novastep, Inc.

ABFAS Amniox Medical Orthoﬁx Paragon 28

Treace Medical Concepts, Inc.

Wright Medical Zimmer Biomet

Medline UNITE Foot & Ankle MiMedx Group Podiatry Foundation of Pittsburgh

ACFAS.org | JFAS.org | FootHealthFacts.org | 773-693-9300

volume 27 issue 7

update: news from the american college of foot and ankle surgeons

www.acfas.org

VOLUME 27 ISSUE 7 | NEWS from the AMERICAN COLLEGE OF FOOT AND ANKLE SURGEONS

Get details about these member services at acfas.org/beneﬁtspartners.

in this issue

ACFAS Releases Another Animation Video

ACFAS Embraces the “New Normal” in Video Campaign

ACFAS Contributes to the National Advocacy Dialogue

page 10

page 3

page 5