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Top 10 Innovations in Podiatry
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Innovations can come in multiple forms, and for over 2 decades, Podiatry Today has shone a spotlight on new, exciting, and emerging products and services for podiatric practitioners. In this year’s Top 10 Innovations in Podiatry, the highlighted products (in no particular order) each have unique aspects that make them stand out in the space.
Could a Newer Plating System Provide a Unique Viewpoint for Surgeons?
Over the years, foot and ankle implants have evolved from steel to a titanium alloy. The CoLink PCR Plating System (In2Bones) has evolved further, with plates constructed of carbon fiber–reinforced polyether ether ketone (PEEK), which manufacturer In2Bones says is layered in alternating directions, adding that the orientation of the fibers is custom and enhances performance.
Bradley Abicht, DPM, has been using the CoLink PCR Plating System since its release last year, most commonly for arthrodesis, osteotomies, and fracture fixation. He notes the material has 2.5 times greater fatigue strength compared to a titanium plate, and also reduces the risk of cold weld that might happen with other plates.
Dr. Abicht says the CoLink is radiolucent on X-ray, making it very convenient for the surgeon to monitor the osseous healing site. “There’s really not another plating system on the market that gives you this type of visibility. So that’s the main reason why it’s so unique,” he says.
Dr. Abicht recalls using the CoLink recently on a failed hemi implant in the great toe joint. He explanted the hemi implant and converted to a fusion of the great toe joint, augmented with structural autogenous iliac bone graft, one oblique compression screw, and a dorsal plate utilizing the PCR plating system. Dr. Abicht notes this permitted clear visibility of that iliac crest bone graft, beneficial in the postop period to monitor incorporation and healing of the arthrodesis site.
In2Bones says CoLink facilitates earlier callus formation and return to function, and revisions are easier. The metatarsophalangeal fusion plates come in options of neutral and 4-degree dorsiflexion, while the PCR plating system additional offers straight utility plates with several length options.
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A New Solution for Reconstruction at the Subchondral Level
A recently developed surgical platform is versatile enough to provide osteochondral reconstruction in various forms. The S-Core® (Subchondral Solutions) is indicated for the fixation of trabecular fractures, osteotomies, bone edema, and as a fixation point for soft tissue and graft augmentation. Manufacturer Subchondral Solutions says the device is available in a wide range of sizes to address most lesions.
Bob Baravarian, DPM, FACFAS, has used the S-Core for the last year for patients with subchondral and articular damage. He has mostly used it in the first metatarsal for hallux rigidus cases, but says it also works very well for second metatarsal arthritis or avascular necrosis changes.
Dr. Baravarian notes that he believes sometimes podiatric surgeons will treat patients with arthritis but no pain, and the thinking is that it is not the cartilage that is damaged but instead that the subchondral bone is involved, or the patient has cystic changes. He says that in his observation, S-Core can uniquely treat such subchondral damage and cystic changes through its fibrocartilage layer.
For patients with hallux rigidus, Dr. Baravarian says there was not a good system that could treat avascular necrosis of the second metatarsal, other than doing a fusion or joint replacement. He emphasizes that with the S-Core, one only has to replace the damaged subchondral area, keeping the anatomy of the joint relatively intact.
If the surgeon opens up the joint and is surprised by the level of subchondral damage, Dr. Baravarian says one can use the S-Core to fill the area of osteochondral damage in a specific region.
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A Closer Look at a 3-Dimensional Wound Matrix Option
When facing wounds that are deep, tunneling, irregular or undermined, a new wound matrix may provide a protective environment for management. Reprise Biomedical says Miro3D is a collagen matrix that surgeons may cut to a necessary size for full wall apposition and conformity to wound beds.
Raymond Abdo, DPM, says he has used Miro3D primarily for deep tunneling wounds, after an incision and drainage of an abscess, or for a bone resection. He notes that the three dimensions of the wound matrix make it unique, saying it is 2 cm thick, whereas other matrices are flatter and do not provide the volume necessary for wounds with deep tunneling. Dr. Abdo says the porous structure is malleable after hydration and can fit in different size wounds.
In patients, Dr. Abdo has seen quick integration of granulation tissue when using Miro3D. He advises against debriding or excising some of the granulation tissue and letting the Miro3D do its job, based on his experience.
Reprise Biomedical says one can use Miro3D for stage III and IV pressure ulcers, necrotizing fasciitis, partial and full-thickness wounds, perirectal abscesses, wound dehiscence, pilonidal sinus disease, diabetic foot ulcers, and trauma wounds.
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Minimizing Bone Damage While Enhancing Marrow Access
Rich in stem cells, bone marrow is growing in utility in microfracture surgery. The SmartShot (Marrow Access Technologies) can be used for standalone marrow stimulation therapy or with biologics, and manufacturer Marrow Access Technologies says it delivers double the marrow access of traditional microfracture with less disruption to native bone.
The company notes the SmartShot creates holes that are deep and precise, allowing twice as much access to stem cell–rich marrow than traditional microfracture, with 66% less bone disruption.
Brian Benson, DPM, notes the initial indication for the SmartShot was strictly for microfractures, and now he primarily uses it for joint preparation for hindfoot fusion. He notes the SmartShot avoids the heat generation that one may see with drill bits and K-wires during joint preparation, increasing the risk of thermal necrosis and the rate of fusion failure. In contrast, Dr. Benson says the SmartShot penetrates the subchondral plate to a specified depth and provides consistent, reproducible results, without any concerns regarding the thermodynamic process of the bone.
Dr. Benson also cites the angulation of the SmartShot, saying this lets the surgeon reach across the lower extremity without having to manipulate the limb. He has seen few nonunions and fewer complications with the SmartShot. Other advantages include quicker fusions, better joint prep, and quicker post-op weight-bearing, which he says has led him to use the device for all of his joint preparation.
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Paving the Way in Soft Tissue Reconstruction
After surgery, tendons and ligaments can lose their strength and elasticity. An innovative biomaterial aims to restore those properties and improve recovery time and postop function.
The FlexBand Solo (Artelon) has fibers made of a combination of two polymers, polycaprolactone and polyurethane-urea, notes manufacturer Artelon. The company notes the co-polymer was designed specifically for strength, elasticity, and biological integration.
Ryan T. Scott, DPM, has mostly used the FlexBand Solo in the lateral ankle complex and for tendon repairs. He feels the product is unique due to its elasticity properties, and its ability to function a little bit more like a native ligament or a native tendon. Christopher Hyer, DPM, adds that the weave material has a natural recoil, as well as a more natural and dynamic function for ligament and tendon repair, unlike static ribbon or suture devices.
Dr. Scott also cites the FlexBand Solo’s bio-inductive property, saying it can over time regenerate back into normal surrounding soft tissue.
Many of Dr. Scott’s patients are athletes and he can use FlexBand Solo “to get those individuals back up and out doing their activities that they enjoy that much faster than my old techniques, which would have taken significantly longer to heal.” He has seen the biggest impact with the product on his high school athletes, especially those who have a season-ending injury such as ankle, spring ligament, or chronic ankle instability.
Artelon adds that the FlexBand Solo includes a complete sets of tools and implants in a single-use, sterile blister, targeting specific indications.
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Connecting Technology and Foot Health Assessment
Temperature monitoring can be an important tool to alert DPMs to the risk of diabetic foot complications. Revealix (Revealix) is a new technology that offers tools for foot health assessment, risk stratification, and documentation, according to manufacturer Revealix. The company says the software provides custom images and risk scores for clinicians to streamline the diabetic foot health evaluation process.
Alton Johnson, DPM, says one can attach the Revealix to a smartphone (it is compatible with iPhones and iPads) and perform surface thermography scan of a patient’s foot, revealing potential hot spots. He cites the ability of the device to let physicians know if the patient is at mild, moderate, or severe risk, as well as how often the patient may need follow-up.
Dr. Johnson also uses Revealix to educate patients, adding that patients feel empowered by the device and its results, since they have a visual of the temperatures in their feet. He recalls using Revealix to show one patient with Charcot foot to illustrate his reulceration, saying this patient better understood what was happening.
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A Versatile Ankle Brace Option Provides Unique Features
For patients who don’t want to wear a walking boot, the Tri-Tower Ankle Brace may be an attractive solution. The Tri-Tower Ankle Brace (Tri-Tower) was designed by Terry Nayfa, DPM, and treats a number of different foot and ankle conditions while also providing added advantages over other traditionally used durable medical equipment. Dr. Nayfa says the brace can treat posterior tibial tendon dysfunction, Achilles tendonitis, ankle instability, peroneal tendonitis, acute and chronic ankle sprains, and shin splints. He says it is a particularly attractive solution for patients who don’t want to wear a walking boot, since walking boots are often uncomfortable and cumbersome when worn.
Dr. Nayfa says the device is supportive and patients can wear it in a tennis shoe, which is a distinct advantage. “Patients do not like walking boots, especially elderly people,” says Dr. Nayfa. “They can make your back hurt due to the uneven gait caused by their use. If it’s worn on the right, you can’t drive a car. It has to be taken on and off.” The Tri-Tower Ankle Brace is a solution for each of these problems, he notes, adding that since it is worn in a tennis shoe, there is no uneven gait and it is worn comfortably any time the patient is wearing shoes.
The Tri-Tower, says Dr. Nayfa, comes with an arch pad to treat various conditions. Since the brace comes in one size and will fit either the left or right foot, he notes this is convenient for stocking in the office. The brace is commonly dispensed in the office and is easily demonstrated to patients for future use. Dr. Nayfa notes available coverage under Medicare, with approval for three distinct billing codes, as well as coverage by private insurance and Tricare.
“It works very well, and it’s convenient,” says Dr. Nayfa. “Patients love the fact that they don’t have to walk around in a cumbersome boot. We actually put it in their shoe the first time when they come in and they’re set. Patients can remove it when they take off their shoe and simply slip it back on with their shoe the next morning.”
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Mobility Board Focuses on the Power of Pedal Mechanics
An innovative mobility board avoids the pitfalls of wobble boards and uses three principles to make the board easier for patients to stand on.
The Mobo Board (Mobo), built from bamboo, features a hollow box under the toes, which manufacturer Mobo says makes patients drive the first metatarsophalangeal joint down to find more stability through the arch. The company says the anatomical axis will move the way the foot moves. Finally, the Mobo Board will train the body in a spiral to sync the grounded foot with the patient’s hips and core. The company has a number of exercises designed for patients to use with the mobility board.
Rob Conenello, DPM, calls the Mobo Board “a great thing to utilize for any individual who suffers from lack of mobility, flexibility, and strength of the forefoot.” He adds that the product is also good for patients with overall foot weakness, hallux valgus and limitation of motion at the first metatarsophalangeal joint.
Dr. Conenello praises the Mobo Board’s simple setup and utilization, saying patients can bring the board anywhere, and it works on either foot. He notes a “great innovation” is that the board aligns itself with the subtalar joint, and adds that it can work the inside and outside of the foot to increase strength and mobility. In addition, Dr. Conenello says the board is inexpensive, and patients only need to use it for 5 or 10 minutes a day.
Dr. Conenello recently treated an athlete who used the Mobo Board and said his motion felt more stable when he used the product, whereas before there was an inherent weakness.
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First Topical JAK Inhibitor Opens Treatment Doors in Dermatology
An innovative topical treatment might be a new source of relief for patients with two common dermatologic conditions, including atopic dermatitis.
Ruxolitinib cream 1.5% (Opzelura, Incyte Dermatology) is a topical Janus kinase (JAK) inhibitor for mild to moderate atopic dermatitis. Manufacturer Incyte Dermatology says the topical provides short-term and on-continuous treatment for those who are not immunocompromised and who have not had control of their eczema with topical prescriptions. Incyte notes the majority of patients had achieved clear or almost-clear skin as well as itch reduction by the eighth week of treatment.1,2
Opzelura is also indicated for non-segmental vitiligo in adults and children 12 years of age and older, for which Incyte notes the topical has shown repigmentation by 24 weeks of treatment.1
Tracey Vlahovic, DPM, shares that Oplezura is the first JAK inhibitor in topical form. She calls this “exciting,” as it is a non-steroidal treatment option.
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New Allograft Addresses Human-Derived Tissue Variability
Human-derived placental allografts have established healing benefits but their effects may vary due to the medical histories and behaviors of the donor. A new allograft uses a porcine source to control for genetic variability, environmental and lifestyle factors, and diet and activity levels.
InnovaMatrix PD (Triad Life Sciences) is indicated for partial- and full-thickness wounds, pressure ulcers, venous ulcers, diabetic ulcers, chronic vascular ulcers, tunneled/undermined wounds, draining wounds, and partial-thickness and second-degree burns, according to manufacturer Triad Life Sciences. The company notes additional indications of surgical wounds (donor sites/grafts, post–Mohs surgery, post–laser surgery, podiatric, wound dehiscence), and trauma wounds (abrasions, lacerations, and skin tears).
Triad notes the allograft is manufactured with its proprietary TriCleanse™ Placental Extracellular Matrix (ECM) Process. The company notes InnovaMatrix PD is the first particulate placental extracellular matrix that has clearance from the Food and Drug Administration for wound management.
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Disclosures
Dr. Abicht is a consultant for In2Bones.
Dr. Baravarian is an advisor for Subchondral Solutions.
Dr. Benson is an investor in Marrow Access Technologies.
Dr. Johnson is a member of the advisory board of Revealix.
Dr. Nayfa is the owner of Tri-Tower.
Dr. Conenello is a consultant for Mobo.
Dr. Scott is a consultant and designer for Artelon.
Dr. Abdo is a consultant for Reprise Biomedical.
Editor’s note: For more information about this year’s Top 10 Innovations, check the special product category on PodiatrySource.com.
References
1. Opzelura. Prescribing Information. Incyte Corporation; 2022.
2. Papp K, Szepietowski JC, Kircik L, et al. Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: results from 2 phase 3, randomized, double-blind studies. J Am Acad Dermatol. 2021;85(4):863-872. doi:10.1016/j.jaad.2021.04.085.
