ACFAS Changes Dual APMA Membership Policy

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In a change to a longstanding policy, the American College of Foot and Ankle Surgeons (ACFAS) recently lifted a requirement that renewing college members must maintain a membership in the American Podiatric Medical Association (APMA). The policy change only affects renewing members as new ACFAS members still must belong to APMA when they join the college.
In a letter sent to the college membership, ACFAS President Daniel Hatch, DPM, noted that the college has been contacted by those who cite a financial hardship of having to belong to two groups, or have professional differences with various podiatric associations. Dr. Hatch says he has received “mixed” feedback from the membership following the decision.

“The college maintains the policy promotes fairness by giving individuals the right to select options for themselves,” says Dr. Hatch. “We fully support the APMA and encourage members to join and maintain their membership. It is the college’s sincere belief that the policy change should not affect our working relationship with the APMA.”
To that end, the ACFAS has adopted a policy that encourages its members to maintain APMA membership during their careers. Dr. Hatch’s letter notes that the college plans to continue working with the APMA on issues like professional parity, reimbursement, policy statements and other mutual concerns.

How Will The Decision Affect The Groups’ Memberships?
APMA President Christian Robertozzi, DPM, declined to comment on the issue. However, APMA Past President Lloyd Smith, DPM, believes the ACFAS decision “will harm both organizations” and urges the college’s membership to reverse the decision. He thinks the college and the association will each lose members, [3]revenue and credibility.
“The success of our profession has been, to some extent, based on our organizational unity. The ACFAS approach will end that unity and, ultimately, confound the opinions being offered by the podiatric profession on many critical issues,” opines Dr. Smith.
Dr. Smith notes the issue has come up before as he recalls an ACFAS survey eight or nine years ago. He says the survey predicted the ACFAS would lose members if it discontinued the APMA membership requirement. Dr. Smith notes that the ACFAS, at that time, decided to maintain its affiliation with the APMA.
During his tenure as APMA president, Dr. Smith urged the ACFAS “to be an integral part of the APMA process and contribute and be part of any relevant APMA activity.” He notes that he met with college leadership twice to that end.
Lowell Scott Weil Sr., DPM, a Past President of ACFAS, supports the ACFAS decision. For 15 years, Dr. Weil says the ACFAS has struggled with the issue of “either offending APMA or being inclusive of board certified podiatric surgeons who would like to be members of ACFAS but who refuse to join their state society and, in turn, the APMA.”
Dr. Weil says the APMA bylaws are “flawed” by mandating that its members belong to state podiatry associations.
“I have heard from many who have ‘no use’ for their state society and believe that the dues are a waste,” says Dr. Weil. “Much of this came about when the guild was forced upon us at the state level and has been nothing more than a black hole for funds while APMA provided all of the leadership needed.” As Dr. Weil explains, in Illinois, one must join the guild to maintain membership in the Illinois Podiatric Medical Society and state society membership is a prerequesite for joining the APMA.
Dr. Weil plans on continuing his 42-year membership in the APMA. He feels “(the APMA) plays an important role and has an infrastructure available to deal with the national issues of medicine and third party reimbursement.”
Initially, Dr. Weil predicts that 5 to 10 percent of ACFAS members will leave the APMA due to discontent with state societies. However, he notes this will be offset by a surge of new members joining APMA from the list of board qualified and certified surgeons who wish to become members of the ACFAS and must join the APMA for at least one year. Dr. Weil also speculates that 1 to 2 percent of ACFAS members will feel ACFAS has made a mistake and resign membership. Yet on the other hand, Dr. Weil feels new membership in ACFAS by the previous “non-members” could reach 500 in the coming year.

Other Suggestions And Perspectives
Dr. Weil suggests an APMA bylaw change to permit membership in the APMA without state society membership. He adds that the ACFAS may have to add staff as it takes on more responsibilities of its membership. Dr. Weil suggests that the ACFAS board should consider a $100 yearly assessment to those members who do not [4]have APMA membership and donate the surcharge to the independent Podiatry Political Action Committee (PPAC).
Gary Jolly, DPM, a Past President of the ACFAS, does not feel the dual membership change is a “divisive issue.” He notes the fact that the college is, for the first time, encouraging APMA membership is a “resounding endorsement” of the APMA.
Dr. Jolly says the decision serves notice to professional organizations to ask if they are providing value for their members. “It allows members to vote with their pocketbooks,” notes Dr. Jolly.
“Loyalty to an organization is based upon performance, not a mandate,” says Dr. Hatch. “We will all work harder for the profession accomplishing things that really matter such as universal scope of practice, hospital privileging, equality in reimbursement, ankle laws in all states and the further advancement of education and parity.”

Can Skin Temperature Monitoring Predict Ulceration?
By Brian McCurdy, Senior Editor

Given that lower extremity ulcers are a potentially serious complication of diabetes, can monitoring skin temperature help predict the risks of these complications?
A study in the American Journal of Medicine notes that temperature can be a predictive factor. The 18-month randomized study tracked 225 patients with diabetes at high risk for ulceration. Researchers assigned patients to a standard therapy group or a dermal thermometry group.
Using an infrared skin thermometer, patients in the dermal thermometry group measured skin temperatures at six sites on the foot twice a day. The study notes that temperature differences greater than 4ºF triggered patients to contact a nurse and reduce activity until temperatures became normal.
According to the study, 8.4 percent of patients ulcerated during the study. In comparing patients who ulcerated to a sample of 50 patients who did not ulcerate, the study authors found that patients who ulcerated had temperatures that were 4.8 times higher at the ulcer site the week before the ulcer developed.
Researchers also noted the use of dermal thermometry “was associated with a significantly longer time to ulceration.”
David G. Armstrong, DPM, PhD, the lead author of the study, says temperature is merely a surrogate marker for inflammation. However, he points out it is the only marker that is non-invasive, quantitative and reproducible.
“This makes it tremendously powerful,” says Dr. Armstrong, a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine in Chicago.
Study co-author Lawrence Lavery, DPM, notes that testing skin temperature is inexpensive and noninvasive. The technology also has the potential to prevent pressure ulcers as well as identifying stress fractures and Charcot arthropathy, according to Dr. Lavery, a Professor in the Department of Surgery at Texas A&M Health Science Center College of Medicine.
Dr. Armstrong notes the study suggests that patients can use temperature monitoring to dose their activity by checking their skin temperatures. He says it could be similar to patients with diabetes checking their blood glucose.
“We are convinced that this is an area that has not yet been fully explored in medicine,” he says of temperature monitoring. “Not a day goes by in my clinic when we do not employ this temperature monitoring.”

Study Explores Potential Of New Gout Treatment
By Brian McCurdy, Senior Editor

A new treatment may show promise for patients with gout. An abstract presented at a recent American College of Rheumatology (ACR) meeting examined the effects of rilonacept, a long-acting IL-1 inhibitor, in treating refractive chronic, active gouty arthritis.
The multicenter, non-randomized, single-blind, placebo-controlled, study examined 10 patients who had gouty arthritis for an average of 13 years. Patients received two weekly subcutaneous injections of placebo followed by six weekly injections of rilonacept. From week two to eight of the study, seven of 10 patients on rilonacept showed improvement of at least 50 percent in pain on a visual analogue scale and six of 10 people showed at least 75 percent improvement.

Matthew Rampetsreiter, DPM, says rilonacept appears effective, according to the ACR poster abstract. However, he notes that like many of the new rheumatoid medications, rilonacept may compromise the immune system and it may require proper perioperative discontinuation.
There also may be some difficulty in selecting which patients may be required to be on long-term therapy, according to Dr. Rampetsreiter, who practices in Minnesota. “Do we go by clinical exam, uric acid level, pain level, radiographic evidence? Who qualifies for this treatment?” he asks.
What are the most effective treatments for gout? Dr. Rampetsreiter believes alterations to lifestyle and diet are the most effective ways to counteract gout. In his experience, Dr. Rampetsreiter notes that many gout patients continue taking allopurinol for chronic gout although they still experience periodic flare-ups that require the use of colcichine, prednisone or indomethacin.