The Top 10 Innovations in Podiatry

This year’s Top 10 Innovations include surgical solutions for hallux valgus and hammertoes, grafts and dressings for wounds, and practical tools for the diabetic foot and dermatologic conditions. 

A Minimally Invasive Solution for Hallux Valgus

Minimally invasive surgery (MIS) has been evolving in recent years, and a new screw system supports surgeons’ abilities to reduce bunions with MIS techniques. The Revcon^™ screw system features the new Revcon^™ Anchor line and manufacturer Voom Medical Devices notes it is the only single-screw minimally invasive hallux valgus system. The company notes that Revcon has multiple purchase zones to work with the bone’s natural density, and that the screw can optimize fixation and reduce soft tissue injury.

Lawrence DiDomenico, DPM, says Revcon’s pitch alternates to match the cortical/cancellous bones for which the screw is intended to capture the specific different types of bone for the given anatomy of the first metatarsal. He notes Voom’s technology is coupled with proprietary techniques that are commercialized as the Bunionplasty^® procedure.

“The minimally invasive bunion surgery market is the fastest growing segment of our surgical profession and Voom’s technology is unique,” says Dr. DiDomenico, who practices in Youngstown, Ohio and is the Director of Medical Education for Voom.

Bob Baravarian, DPM, has also used Revcon for one year, saying he has had “amazing outcomes.” He cites the screw’s “innovative all-inclusive design system,” including includes a guide for best practice osteotomy, screw placement and pitfall avoidance. Revcon is a “one-of-a-kind screw with 3 pitch designs that allow for single screw fixation with increased strength and a reduced OR time,” says Dr. Baravarian, who is the Director and Fellowship Director at University Foot and Ankle Institute.  

Voom adds that Revcon is optimized for both cortical and cancellous fixation, has a reverse conical shape, and is fully threaded with non-compressive uniform pitch throughout.

Shielding Diabetic Foot Ulcers With Fish Skin Grafts

Fish skin grafts are a useful tool to manage diabetic foot ulcers (DFU), pressure injuries, and other chronic wounds. A fish skin graft with new features, Shield (Kerecis), adds a borderless adhesive silicone, which the manufacturer notes permits the surgeon to cut the fish skin and protective silicone to fit inside the wound edges and also prevents the Shield from tenting over deeper wounds. As Kerecis notes, both the fish skin and soft silicone layers are fenestrated for wound drainage, helping protect the wound surface.

Lee C. Rogers, DPM, praises Shield’s adhesive silicone, saying the surgeon doesn’t have to secure the graft with staples or sutures in the clinic. He notes Shield comes in the most common size and shape of diabetic foot ulcers. The graft is “really a game-changer,” notes Dr. Rogers, the Chief of Podiatry and Associate Professor/Clinical in the Department of Orthopaedics at UT Health San Antonio.

Ian Barron, DPM, has extensive experience using skin graft substitutes and has used Shield most recently, touting the graft’s faster application in clinic. The layer protects the graft and helps maintain the graft on the wound bed, notes Dr. Barron, an Assistant Professor in the Department of Orthopaedics at UT Health Science Center San Antonio, and a paid consultant for Kerecis.  

Kerecis notes Shield has been processed using the company’s proprietary EnviroIntact^™ method. Aside from DFUs and pressure injuries, Shield is also indicated for venous ulcers; chronic vascular ulcers; trauma wounds, including abrasions, lacerations, second-degree burns, skin tears; surgical wounds, including donor site/grafts, post–Mohs surgery, post–laser surgery, podiatric, wound dehiscence; and draining wounds.

Better Anatomic Contouring With 3D Printing

A new additive manufactured plating system can improve intraoperative and postoperative visualization of bones and joint spaces.

The Apollo Ankle Fracture (AFX) Plating System plates are constructed of a 3D printed titanium shell injection molded with a novel polyetheretherketone (PEEK) polymer (Ti-PEEK), notes manufacturer GLW Medical Innovation. The company says Apollo AFX offers a selection of 26 unique plate options from 6 plate families. Its design is pre-contoured and low-profile with rounded edges, which the company says can decrease the risk of soft tissue irritation.

Lowell Weil Jr., DPM, says the Apollo AFX is the first ever plating that is mass produced (3D printed), noting this allows for anatomic contours that typical milled plates cannot achieve. He says the titanium cage is molded with PEEK, which provides strength equivalent to typical titanium plates. Dr. Weil, the Executive Chairman of Balance Health and physician at the Weil Foot & Ankle Institute, says the device’s radiolucency allows the surgeon to “visualize the fracture and fixation intraoperatively more clearly and assess healing during the postoperative period.” He notes this allows for less scatter for future magnetic resonance images or computed tomography.

In addition, Dr. Weil notes the system is environmentally safe as it has less than 5% material waste compared to typical milling of plates, which creates 75–90% material waste. The system’s multi-directional locking screw technology with Ti-PEEK plate construct allows for screw head to be flush with the top of the slim plate. This unique elastic locking interface offers cold welding protection, according to Dr. Weil, an investor in GLW. He says the Apollo AFX comes with single-use instrument kits using high-grade plastics and surgical steel that are designed to assist surgeons with the precise fixation of the system’s plates and screws.

The company says this fusion of plastic and steel materials ensures both performance and affordability, making the system economically viable for a wide range of healthcare facilities, from ambulatory surgical centers to hospitals.

GLW Medical Innovation notes Apollo AFX has a comprehensive portfolio of one-third tubular, distal lateral fibula, posterior tibial, medial malleolar, hook, and syndesmosis plates. It adds that all plates are engineered to be malleable and provide a contoured fit, saying the surgeon can achieve additional contouring to patient’s anatomy during surgery.

Correcting Hammertoe With Less Scarring

Although hammertoe correction can provide better function for patients, traditional surgery can leave unsightly scars. For surgeons looking to correct hammertoe with MIS, a new arthrodesis guide may be a solution. OptimalHT offers surgeons a comprehensive range of implants and instruments, offering a precise and reproducible solution, notes manufacturer Forma Medical, Inc. The company says patients can attain their desired hammertoe correction in a noninvasive manner.

Vilayvanh Saysoukha, DPM, says the OptimalHT is unique as far as reproducible hammertoe arthrodesis correction with a K-wire and/or screw. She notes the guide limits the need to insert a K-wire more than once to get it where you need to, adding that the system offers cannulated and solid screws.

“There is nothing else in the market as this is the world’s first MIS hammertoe arthrodesis guide,” says Dr. Saysoukha, CEO and Founder of Premier Foot & Ankle Centers of Tennessee, an AdvancedHEALTH practice. She is a consultant for Forma Medical, Inc.

Compression Staples That Leave Nothing Behind

Surgeons can find both stability and fixation when using an innovative compression staple that integrates fully into the patient’s native anatomy. The OSSIOfiber^® Compression Staple utilizes bio-integrative compression for midfoot and hindfoot procedures such as Lapidus fusions, midfoot fusions, and flatfoot correction, according to manufacturer OSSIO.

The nickel-free staples are made of OSSIOfiber^® Intelligent Bone Regeneration Technology, the company’s proprietary bio-integrative mineral fiber matrix, which the company says is a biologically friendly way to restore patient stability and mobility that does not leave any permanent hardware behind.

OSSIO says the OSSIOfiber Compression Staples are stronger than many nitinol staples, providing better compression performance in comparison to many widely used compression staples. The company tests the screws’ fatigue strength to over a million cycles.

Jason R. Miller, DPM, FACFAS, FAPWCA, has used OSSIOfiber for tarsometatarsal joint fusions, Evans calcaneal osteotomies and metatarsus adductus corrections. He notes the staples are nearly completely radiolucent, like bone, and that they provide equivalent compression to traditional metallic staple fixation. Although there is slightly more cost than traditional staples, Dr. Miller, an Adjunct Associate Professor in the Department of Surgery at Temple University school of Podiatric Medicine, says with these staples there is no allergic reaction in patients with sensitivities to metal and no need for removal as they become part of the patient’s bone.

A Synthetic Wound Matrix in a Prefilled Syringe

An innovative wound matrix comes in a prefilled syringe for topical use as a wound dressing. G4Derm Plus Synthetic Wound Matrix is a sterile, biodegradable hydrogel matrix that utilizes an aqueous solution of synthetic peptide (≥ 98% sterile water), notes manufacturer Gel4Med. The company says the matrix is not derived from animal tissue and is non-cellular derived.

Stephanie Wu, DPM, notes G4Derm Plus is derived from amino acids and is manufactured synthetically via solid-phase synthesis to achieve the benefits of both biologics and synthetics. She notes the matrix leverages novel polypeptide technology to create a flowable three-dimensional biodegradable scaffold that resembles a native extracellular matrix to provide an optimal wound healing environment.

Dr. Wu cites the ease of use of the pre-filled syringe to maximize contact with the wound, especially for hard-to-access irregular wounds. She says it is shelf-stable for ease of storage.

Gel4Med says G4Derm Plus forms a 3-dimensional hydrogel scaffold made of a matrix of interwoven fibrils derived from individual peptide monomers. G4Derm Plus Synthetic Wound Matrix forms a clear, biodegradable hydrogel without expansion in volume, notes the company. G4Derm Plus is indicated for managing partial- and full-thickness wounds including pressure injuries, and DFUs; lower extremity ulcers including those of venous, arterial and mixed etiology; surgical wounds; first-degree and partial-thickness burns including management of abrasions and burns associated with dermabrasions and laser resurfacing.

Managing Postop Drainage With an Innovative Dressing

Postop drainage can be a problem for patients, so surgeons need a reliable way to manage it. ExuCare^™ is an absorbent wrap that manufacturer Sun Scientific says can effectively manage bleeding postop drainage. The company notes the dressing has superior functionality, providing comfort, convenience, and enhanced wound care for patients.

Windy Cole, DPM, CWS, FACCWS, says ExuCare dressings are made with superabsorbent materials shaped to fit around difficult lower extremity topography to accommodate circumferential lower leg wounds, interdigital wounds and large foot wounds.

“These superabsorbent dressings are easy for the patient or caregiver to apply and stay in place without slipping or loosening,” says Dr. Cole, Director of Wound Care Research for Kent State University College of Podiatric Medicine. “The dressings effectively manage high amounts of exudate to protect the periwound tissues.”

Cushion and Comfort for Patients Who Work on Their Feet

For patients who work on their feet all day, podiatrists might consider recommending two new work insoles that could provide comfort without sacrificing function.

Superfeet Work Cushion insoles are designed for work boots, work shoes and safety toe footwear. Manufacturer Superfeet notes the insoles are flexible and lightly structured, offering durable support and comfort. The company says the insole has dual-layer cushioning to protect against foot fatigue, with a Moisturewick^™ top cover to reduce odors. For those patients wearing tight-fitting work shoes, Superfeet’s Work Slim-Fit Cushion insoles fit in snug shoes, including some shoes without removable liners.

Both insoles can be trimmed to fit. The Work Cushion and Work Slim-Fit Cushion each feature orthotic support for all arch heights, Adaptive Comfort Technology^™, and a tapered forefoot.

Podiatrist Simon Bartold notes that since industry makes many demands of workers on their feet all day, lots of issues can occur such as plantar fasciitis. “Both these insoles should have an immediate effect on this most painful and lingering of conditions,” he notes.

Overall foot fatigue and general comfort in safety boots is an issue for many workers on their feet, notes Dr. Bartold, a Fellow of Sports Medicine Australia and a paid consultant of Superfeet Worldwide. He says the double layer of foam in both insoles “will have an immediate effect on step in comfort and offer all day cushioned comfort for those on their feet.”

As Dr. Bartold notes, the layered construction of the Superfeet insoles is unique, offering an environmentally friendly super critical foam on top of a tough polyurethane base foam, which can provide longevity to the insole with minimal degradation of the foams over a significant period of time. He adds that the insoles’ proprietary Superfeet contouring in the arch and cupping of the heel can provide  better pressure distribution and rezoning of stress.

Relieving Dry Skin in the Diabetic Foot

The complications of diabetes can range from skin irritation to DFUs. The new Lavior Diabetic Wound Gel can not only protect DFUs from further harm but can also soothe dry, cracked lower extremity skin. Manufacturer Lavior says the active ingredient, allantoin 0.5%, can provide an optimal environment for wound healing and skin regeneration. The company cites “visible progress” with its hydrogel in speeding recovery and shortening time to healing.  

Alton R. Johnson, Jr., DPM, DABPM, FACPM, FASPS, CWSP, has used the Lavior gel for 6 months, saying he finds it effective for wounds. “It’s easy for patient to use and get without hassle,” he notes. “It’s affordable for patients and can be used on any stage wound.” Dr. Johnson, Clinical Assistant Professor at the University of Michigan Medical School in Ann Arbor, MI, notes the hydrogel is available at big box retailers. Dr. Johnson is on the Scientific Advisory Board for Lavior.

A New Treatment Option for Lower Extremity Atopic Dermatitis

Podiatric physicians have a new biologic in their armamentarium for eczema as dupilumab (Dupixent) recently received an updated FDA label for atopic dermatitis in the foot.

In a Phase 3 placebo-controlled trial of 133 patients, at 16 weeks, 40% treated with dupilumab achieved the primary endpoint of clear or almost clear skin on hands and feet in comparison to 17% of placebo-treated patients. In addition, 52% of dupilumab patients saw a clinically meaningful reduction in itch on hands and feet compared to 14% of placebo-treated patients, notes the study.¹

As manufacturer Regeneron/Sanofi notes, Dupixent is a fully human monoclonal antibody that inhibits the signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways. The company adds that Dupixent is not an immunosuppressant, and can manage itch and inflammation.

Reference
1.    Simpson EL, Silverberg JI, Worm M, et al. Dupilumab treatment improves signs, symptoms, quality of life, and work productivity in patients with atopic hand and foot dermatitis: Results from a phase 3, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2024;90(6):1190-1199. doi:10.1016/j.jaad.2023.12.066