ACFAS Update (Vol. 26 No. 5) by ACFAS

aCfaS

neWS from the aMerICan COLLege Of fOOT and ankLe SurgeOnS

vOLuMe 26 ISSue 5

The Ripple Effect Of “Radical Possibility” How “5 Steps to Make the Impossible Possible” Can Change Your Practice and Your Life

Ben Nemtin New York Times Bestselling Author ACFAS 2020 Keynote Speaker

Our ACFAS 2020 keynote speaker, Ben Nemtin, rose to fame when he and three friends committed to achieving everything on their list of “100 things to do before you die” and helping a stranger with something

on their list for every item the group accomplished. What started out as a two-week journey became a popular TV show (MTV’s “The Buried Life”), a #1 New York Times bestselling book and an inspiring movement that encourages individuals to realize their dreams and help others in the process. The mental health and opioid epidemic are overwhelming healthcare providers, and the instability and rapid legislation changes are stressing our healthcare system. Exacerbating this issue is the fact that physicians tend to put other people ﬁrst which, unfortunately, leaves their own self-care on the backburner, sometimes making it diﬃcult to maintain a positive outlook. (continued on page 10)

Battling Burnout

SAVE

the

DATE

February 19-22, 2020 Watch for registration information coming soon! See y’all in Texas!

President’s Perspective

THe OPPOrTunITY Of CHange page 4

page 3

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perspective

THe OPPOrTunITY Of CHange

“Great moments are born from great opportunity.” These are the words of Herb Brooks, coach of the 1980 United States Olympic Hockey Team, prior to “The Game” against the Soviet Union. This phrase has been a driving force for me over the years and will certainly be embraced by the College in the coming year. Why? On May 13, after a 45-year career in association management (the last 16 years as the College’s Executive Director), J.C. (Chris) Mahaffey, MS, CAE, FASAE announced his retirement effective February 28, 2020. While any leadership role has ebbs and flows, Chris has provided the stability, expertise and support that ACFAS required. A few milestones during the past 16 years include: 䡲䡲

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ACFAS became an independent organization Membership increased by over 2,000 foot and ankle surgeons Revenues and net assets more than doubled without a year-end deficit Annual Scientific Conference attendance tripled Transformation of the Board of Directors into a strategic, evidence-driven governing body And many new initiatives were launched, yet operational costs and staffing stayed below industry means

In his resignation letter, Chris said, “It is time for fresh leadership who can help take the College to even greater heights.” In any endeavor, change is imminent and while Chris will be missed, it is time to take this opportunity to propel ACFAS to the next level. Executive coach Carol Kinsey states the greatest challenge for leaders is to know the difference between what must be preserved and what needs to be changed. The key is for leaders to be able to preserve an organization’s core values yet change and adapt as times require. The ACFAS Board will keep these words in mind during the process of selecting our next Executive Director. Following our CEO Succession Plan, our first task was to select the right executive recruiting firm. Korn/Ferry leads the marketplace in high-profile CEO association/nonprofit talent acquisitions, conducting over 100 senior-level nonprofit searches in this arena in the last two years. A significant portion of these searches are in the health and life sciences arenas. The Board worked with Korn/Ferry on the desired candidate qualifications and attributes — and the search is now underway.

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With change comes the opportunity for creativity, innovation and improvement. Over the years, ACFAS has demonstrated an innate ability to create, adapt and always move forward. It is now time to capitalize on the opportunity presented and choose a new executive leader to support your leadership. Together we will continue to inspire excellence in every foot and ankle surgeon and change patient lives, every day, for years to come.

Next the Board selected a seven-person Search Committee who will review the candidate credentials, interview the best of them, then recommend a ﬁnalist to the Board. The Search Committee includes:

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

Scott Nelson, DPM, FACFAS – Chair Troy Boﬀeli, DPM, FACFAS 䡲 Thanh Dinh, DPM, FACFAS 䡲 Christopher Hyer, DPM, FACFAS 䡲 Robert Mendicino, DPM, FACFAS 䡲 Christopher Reeves, DPM, FACFAS 䡲 John Steinberg, DPM, FACFAS The plan is to approve the new CEO in November and have that individual onboard by February to ensure their presence at the 2020 Annual Scientiﬁc Conference in San Antonio. 䡲

Christopher L. Reeves, MS, DPM, FACFAS ACFAS President

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

www.acfas.org

education

It’s Oﬃcial — residents’ day 2020 is Happening!

2019 eduCaTIOn PrOgraMS October 18–19, 2019 (friday/Saturday)

Foot & Ankle Arthroscopy Orthopaedic Learning Center Chicago, IL

SOLD OUT

October 26–27, 2019 (Saturday/Sunday)

Managing Surgical Complications of the Foot (Advanced Content) MERCI Lab Chicago, IL november 1-2, 2019 (friday/Saturday)

On the Road with ACFAS – Fixing a Flat: Comprehensive Approach to Pes Plano Valgus Workshop and Seminar The Westin Cincinnati Cincinnati, OH november 8-9, 2019 (friday/Saturday)

It was informative, eye-opening and reassuring. But most of all, it was fun and wildly successful. The College’s inaugural Residents’ Day at ACFAS 2019 was so well-received it has already secured a coveted position on the schedule at ACFAS 2020 in San Antonio— February 18, 2020. Residents in attendance can expect to beneﬁt from many of the same kinds of content, with more of what attendees told us they liked and scrubbing the topics that didn’t resonate, all designed to usher you into ACFAS as a peer and make the transition to decision-maker - from resident to doctor.

Networking opportunities with speakers will be available throughout the day—our seasoned professionals are eager to share their “First and Worst” stories, among other experiences, as they welcome residents to ACFAS and the exciting profession they’ve chosen. The day will culminate with an informal Q&A driven networking event, intended to create a lively and meaningful discussion about top-of-mind issues while providing residents with tips and tools to take with them into the next stage of their career. Watch for more information so you can save the date and sign up early. Residents’ Day 2020 is sure to ﬁll up fast!

On the Road with ACFAS – Fixing a Flat: Comprehensive Approach to Pes Plano Valgus Workshop and Seminar Torrance Marriott Redondo Beach Torrance (Redondo Beach), CA november 16–17, 2019 (Saturday/Sunday)

Foot & Ankle Arthroscopy Orthopaedic Learning Center Chicago, IL

SOLD OUT

december 6-7, 2019 (friday/Saturday)

On the Road with ACFAS – Fixing a Flat: Comprehensive Approach to Pes Plano Valgus Workshop and Seminar Hilton Garden Inn Boston/Burlington Burlington, MA february 19-22, 2020 (Wednesday-Saturday)

2020 ACFAS Scientific Conference Henry B. Gonzalez Convention Center San Antonio, TX

*To be waitlisted for sold-out courses, contact Maggie Hjelm at hjelm@acfas.org.

volume 26 issue 5

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

www.acfas.org

practice management

Battling Burnout Danielle Butto DPM, FACFAS

Burnout — often marked by physical and emotional exhaustion, detachment, and a low sense of personal accomplishment — has been described as reaching epidemic proportions for U.S. physicians. The World Health Organization created a new definition for this syndrome, specifically tying it to workplace stress as an “occupational phenomenon.” For physicians, recent studies have indicated electronic health record systems and increased reporting requirements, combined with hectic schedules, have contributed to the issue. ACFAS Practice Management Committee chairperson Danielle Butto, DPM, FACFAS, of Saint Francis Hospital and Medical Center (Hartford, CT) and third year Resident, Catherine Jacobs, DPM, also of Saint Francis Hospital and Medical Center, shared their thoughts on the causes, and prevention, of burnout from the DPM view. What causes physician burnout? DB: It can be caused by multiple different factors that compound over time to eventually lead to burnout — the stress of your job, home life, increase demands by your employer in less time, keeping up with medical records. CJ: The idea and principle of putting the patient first is imperative to creating a good physician. However, many physicians and

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residents find themselves self-sacrificing too much to do so. I think the number one thing that causes physician burnout is time. Too much time at the hospital, working on charts and notes at home, thinking about patients during your “off time.” The hours can add up and seem relentless especially when there is not a good team environment or support system in the specialty’s group. A lack of team environment or isolation in the group can also contribute to burnout. What are the signs of physician burnout, and how can you spot them early on before they really take a toll? DB: Exhaustion, loss of passion for your job, lack of efficacy – just to name a few. When you start to get the feeling of "I hate my job" or "I'm always tired" take a step back and think about the true reasons why that is. CJ: The signs of burnout are similar to signs of depression and these signs are usually just brushed off as “just a tired resident.” The expectation that residents are going to work long hours and be tired and that is just part of the process contributes to furthering the burn out incidence. A person that goes home from the hospital and goes straight to sleep, does not engage in activities with friends or activities they once found enjoyable are some of the first signs of burn out.

Catherine Jacobs DPM

Why does physician burnout seem more prevalent today among all medical specialties? DB: Electronic medical records and other requirements (MACRA, MIPS) have contributed a lot. It takes longer to see patients and chart on them. Physicians are expected to see the same amount or more patients with less time. CJ: I think physician burn out has always been prevalent, but there is now a push to address it. I don’t think society knew how common burn out was or how to address it. What are the widespread effects of physician burnout? How does it affect patients, the economy, etc.? DB: The most drastic effect is suicide. Physician suicide rates have increased. Additionally, when a physician is burnt out patient care at some point can suffer. DB: Physicians that are burned out are more likely to make mistakes. They may be less attentive to their patients or less empathetic as they may not have much more to give of themselves to the patient. More mistakes cost society more money — more admissions, more diagnostic imaging, longer hospital stays.

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

www.acfas.org

Weekend Warrior Warning

What can foot and ankle surgeons do to avoid physician burnout? DB: Try to take a step back and evaluate how much you are involved in things outside of your practice — hospital committees, etc. Do you have time to be involved in all these activities? As hard as it is to do, take time off. While a week off can be hard to fit in, a break is sometimes what you need. CJ: When not at the hospital, try not to think about work. Try to take time to enjoy activities that make you happy. When on vacation, try to reset yourself so you come back to work as refreshed as possible. Adhere to the duty hour policies at the hospital. Try to remember that you will make mistakes, you are human and you can only do your best. Try to learn from your mistakes so they can help you grow as a person and physician. How much does talking to peers about stressors help alleviate possible physician burnout? DB: Building a network is very important. "Going at it alone" can contribute to burnout. Talking to colleagues about cases, treatment or even your general feelings of being overwhelmed can help relieve stress. CJ: Medicine can be an extremely lonely specialty and talking to others makes you feel less alone. It reminds you that you are not the only person going through this — feeling exhausted, overworked, underappreciated. Everyone in a high-stress environment needs a safe space to vent among peers.

In your opinion, what needs to change in healthcare/medical workplaces to prevent or address physician burnout?

Be on “defense mode” and protect your feet and ankles from injury by following these tips.

SLOW AND STEADY WINS THE RACE

DB: If asked to do things outside of your job, there needs to be time in your schedule to do so. My hospital has me on FTE. I am expected to be in the office 80 percent of the time and participating in committees and the residency 20 percent of the time. This is built in to my schedule, so I never feel overwhelmed by having the committee appointments compounded on my patient care time. CJ: Physicians should be viewed first as humans, then as physicians. There is a huge risk and constant pressure put on physicians today; they try their best but sometimes mistakes can happen. It is expected that physicians are always around, working and able to see patients. This stops them from being able to have the necessary vacation or off time to reset so he or she can offer the best patient care possible. A stronger push needs to be made for vacation time.

“As hard as it is to do, take time off. While a week off can be hard to fit in, a break is sometimes what you need.” — Danielle Butto DPM, FACFAS

volume 26 issue 5

Being physically active has long been applauded as an ingredient for good health, but, according to surgeons at the American College of Foot and Ankle Surgeons, doing too much too soon or being a “Weekend Warrior” can wreak havoc on the feet and can cause painful overuse injuries.

Let your body adjust to increased activity. If you haven’t worked out or played sports in a while, slowly increase your level of activity rather than doing it aggressively to help strengthen your muscles and joints to prevent injuries. Use the 10 percent rule — increase your activity by only 10 percent each week.

OTHER FOOT & ANKLE CONDITIONS? If you have anatomical issues, such as flatfeet or hammertoes, you may be more prone to overuse injuries. Make an appointment with your foot and ankle surgeon before starting any rigorous activity to find out ways to help fix these issues to prevent future injuries.

LISTEN TO YOUR BODY All pain is not gain! If you feel discomfort that differs from how you normally feel after a workout, listen to your body and slow down and rest to allow time for your body to adjust and restore itself.

For more foot and ankle health information, visit FootHealthFacts.org, the patient education website of the American College of Foot and Ankle Surgeons.

Remember, if you do experience an injury while exercising or playing a sport, stop the activity, apply the RICE protocol (Rest, Ice, Compression, Elevation) and seek the care of a foot and ankle surgeon for proper treatment.

new in Marketing Toolbox — Weekend Warrior Infographic Infographics are a great way to promote your practice and educate your patients both in the office and via social media. Download our newest release, Weekend Warrior Warning, from the ACFAS Marketing Toolbox and customize it — and all the infographics in the library — as part of your overall practice marketing plan. Each infographic PDF has a fillable section in the lower right corner for you to add your practice, name, website URL and other contact information. Print them in full color to post in your office or building’s shared information centers (bulletin boards). You can also post infographics on your social media channels, distribute copies to patients and referring physicians, and hand them out at the community events you sponsor or attend. Visit acfas.org/marketing to access Weekend Warrior Warning and the entire infographics library. Check the Toolbox often for the other great and free resources to educate your patients and promote your practice.

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

www.acfas.org

from SaKfe e r Feet idenetpsYour Feet S u o Y afe at th Keep ower Acc e Gym Back-t Lawnm o S Prevent Trips, Slip c hool s & Falls Sh DON’T

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patient outreach

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Infographics Work to Help Build your Practice and reputation Dr. Brett Sachs discovered early on in his practice how helpful it was to use the College’s marketing tools to boost his office and his career. Infographics in particular “are pretty good conversation starters,” when patients first come in, said Dr. Sachs, DPM, FACFAS. He uses the online resource—and other ACFAS tools—to promote his co-owned practice in Wheat Ridge, Colorado. Dr. Sachs uses the ACFAS Marketing Toolbox's infographics in his office and hands them out as part of an information packet whenever he is speaking to other physicians and at community events. “I print them out and leave them in my office waiting room for reading material— both for patients and for the people bringing in patients,” he said.

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Brett Sachs DPM, FACFAS

The infographics “tend to disappear” from the check in desk as patients take them for the information they provide and for future reference, Dr. Sachs said. He often finds they need to be reprinted to keep up with patient demand, he added. Most popular for his office, Dr. Sachs said, are the seasonal infographics like Keep Your Feet Safe at the Beach and Keep Your Feet Safe from Lawnmower Accidents. Second to those are the infographics specifically focused on kids and helping parents determine current or prevent future problems, like 5 Signs of Kids’ Foot Problems and Back-to-School Shoe Shopping Tips. Tips for athletes, like Prevent Foot & Ankle Running Injuries, are also popular. The customizable infographics—PDF documents each practice can customize with a

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practice name, phone number, address and website information—are also perfect when attending business and organization lunches and dinners. Whether presenting at these events or just trading information with others, Dr. Sachs uses the ACFAS infographics as part of his marketing packet. “We print them out and put them in with our pamphlets and business cards as marketing tools for primary care referrals—to keep our name at the top of their list,” for seasonal and sports-related injuries, Dr. Sachs said. With their bright graphics and easy-to-digest information, Infographics are also perfect for sharing on social media platforms— Facebook, Twitter, and Instagram. Online audiences can repost the infographics from the practice’s page, helping to market your oﬃce to your followers’ friends.

“We print them out and put them in with our pamphlets and business cards as marketing tools for primary care referrals— to keep our name at the top of their list.”— Dr. Brett Sachs, DPM, FACFAS 06

volume 26 issue 5

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

www.acfas.org

He encourages ACFAS members who may not have looked at the Marketing Toolbox in a while to check out all the online, practice-building marketing tools available. “Infographics, FootHealthFacts.org, the FootNotes newsletter: there are all kinds of tools for you that just make marketing a lot easier. They are already set-up, are easy to read and gives people some quick tips on what do to and not to do when marketing their practices,” he said.

The more a foot and ankle surgeon can connect with other physicians, other people and their community with information like the infographics and the other tools available at acfas.org, the better it will be for their practice, Sachs said. “It helps to establish your name and your reputation. Instead of going ‘Hi, I am Dr. Sachs!’ I had something to provide to patients and referring docs to help me keep my name out there.”

Attending those business lunches with handouts and putting branded ﬂyers into the community with infographics are a great way to build relationships in the community and bring in new patients, too. “Connecting with community is a good way to build your brand and market your practice,” Dr. Sachs said.

CALL TO SCHEDULE A SURGERY

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volume 26 issue 5

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

www.acfas.org

MarkeTIng TOOLBOx TaLk Each issue of ACFAS Update answers a question about how to market your practice and generate referrals from other healthcare providers. This issue’s featured Q&A focuses on print ads.

Q: Do print ads still bring in patients? A: It is diﬃcult to say if print ads bring in patients because there is no direct tie to people actually coming into a practice. You can only estimate the number of potential “eyeballs” that have seen the ad based on the publication’s circulation numbers.

for more practice marketing tools, visit acfas.org/marketing.

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volume 26 issue 5

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

www.acfas.org

patient outreach

Take another Look at “Take a new Look”

Thinking about how to grow your practice either through referrals from other health care providers or by marketing directly to potential patients? Then you should take another look at “Take a New Look at Foot and Ankle Surgeons.” The College developed this comprehensive and awardwining marketing program speciﬁcally to raise awareness of foot and ankle surgeons and educate both the healthcare provider and patient audiences about the beneﬁts of working with a true specialist. A wide variety of materials are available for download in the Marketing Toolbox at acfas.org/marketing. There are two versions —one for healthcare providers and one for patients —of a professionally produced, high-quality video that features interviews with referral partners attesting to the success they’ve had referring patients to foot and ankle surgeons for specialized care. This video is a strong and persuasive tool when shared with healthcare providers in a professional setting or when shown on a

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continuous loop in your waiting room. There is also a beautifully designed PowerPoint presentation that details, in a compelling manner, the education, training and skill level of foot and ankle surgeons, which can be customized to include your own partnership and patient success stories. There are several informational fact sheets and referral guides, including some speciﬁc to the diabetic patient, which can be shared as leave-behinds after meetings with or presentations to healthcare providers. There is also an in-depth webinar, led by ACFAS members, that provides deeper insight into how to use these tools to build your practice. When combined with the many other practice-building materials available at acfas.org/marketing, you have all the tools you need to design a marketing program that will increase your visibility with both referral partners and potential patients. It’s all downloadable and easy to use. Practice building success is just a few clicks away!

for more practice marketing tools, visit acfas.org/marketing.

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

www.acfas.org

The Ripple Effect Of “Radical Possibility” (continued from cover) Ben’s message of ripple eﬀect, combined with his “5 Steps to Make the Impossible Possible,” leaves people inspired and equipped to tackle the seemingly insurmountable. He’ll discuss how his system of achieving any impossible goal starts with demystifying daunting tasks (like marketing and growing your practice) and turns ‘dreams’ into ‘projects’ by creating a digestible pathway to success.

Ben will connect his “pay it forward” approach to your commitment to providing excellent care for your patients, and how building your best practice advances that commitment. Through it all, Ben reminds us that it’s never too late to start your list and leave a lasting impact on others. Be sure to catch Ben Nemtin and all that ACFAS 2020 and San Antonio have to oﬀer this coming February.

advanCe reSearCH & Care In THe PrOfeSSIOn

volume 26 issue 5

PRE-CONFERENCE WORKSHOPS FEBRUARY 18, 2020 ANNUAL SCIENTIFIC CONFERENCE FEBRUARY 19–22, 2020

SuBMIT TO YOur JOurnaL – JFAS!

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

www.acfas.org

CALL TO SCHEDULE A SURGERY

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Learn More at www.ReferenceToe.com. See our full line at www.In2Bones.com Reference Toe, 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 • AUP-RTSW0619-A, 0619

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Treace Medical Concepts, Inc. Zimmer Biomet

OCPM Foundation Paragon 28

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

volume 26 issue 5

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

www.acfas.org

vOLuMe 26 ISSue 5 | neWS from the aMerICan COLLege Of fOOT and ankLe SurgeOnS

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

in this issue Kee

p Your Feet Saf m e from at theESSGy Lawnmower GOALS. et Safe Accidents Your FeKEEP YOU FROM YOUR FITN Keep FOO RIES T INJU Avoid DON’T

LET

p shape in tip-to your feet your goals to keep gh with Be sure ge of ing throu ican Colle while follow offers The Amer to get fit. Ankle Surgeons ankle safety Foot and foot and tips for the gym. while at

KOUTS NEW WOR START LLY t length a and workou , such GRADUA stamin injuries e your . overuse Increas sprains lly to avoid or ligament gradua fractures as stress

T THE RIGH WEAR SOCK shoes designed SHOE & athletic that ting Shoes Wear well-fit e or sport. the foot or exercis of for the t the arch heel pain don’t supporheel can cause the cushion s). r fasciiti (planta

UE injury D TECHNIQ result in ues can and USE GOO e techniq in your feet strains. exercis nts er Improp and muscle s or ligame sprains to the tendon to joint leading ankles,

turning your lawn into a “toe-awa a power lawnmow y” zone and use er or other power extra caution of a lawnmow when operating gardening tools. er—the blades Don’t underest whirl at 3,000 times the kinetic imate the power revolutions per energy of a .357 minute and produce handgun. Follow three these precautio ns: Don’t mow a wet lawn—losing control from slipping on rain-soaked grass is the leading cause of foot injuries caused by power mowers.

Wear heavy shoes or work boots when mowing. No sneakers or sandals.

F T YOURSEL PROTEC TERIA BAC showers, exercise FROM

public are all shoes, Sweaty pool decks , viruses ent and equipm grounds for fungus sistant g ng drug-re ot in breedin a, includi go barefo and bacteri MRSA. Never cover cuts and like strains gyms and feet and ankles. areas of of your public in the skin cracks

Use a mower with a release mechanism on the handle that automatica lly shuts off when the hands let go.

Keep the clip bag attached when mowing to prevent projectile injuries.

Y R BODduring TO YOU or ankle an LISTEN your foot pain. Make injured

the If you’ve t, don’t ignore and ankle your foot sis. a workou tment with diagno appoin proper n for a surgeo visit and tips, ion educat information health the patient of Foot For more ts.org— Always keep althFac an College children away FootHe from the lawn of the Americ when mowing. ns. website Surgeo and Ankle

If a mower accident immediate treatmentoccurs—even just a minor injury— is necessary thoroughly and prevent infection. to flush the wound can be treated Superficial wounds on an outpatient injuries usually basis, but more require surgical serious intervention to tendon damage, repair deep clean the wound and suture any it.

For more foot and visit FootHealthF ankle health information, acts.org, the education website patient of Foot and Ankle of the American College Surgeons.

Take another Look at “Take a new Look”

MarkeTIng TOOLBOx TaLk

Infographics Work!

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