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The global foot and ankle market is growing rapidly. We estimate the market to be $1 billion and growing in the high single digits in the U.S. The market pace is set thanks to a heightened focus on new technologies and patient outcomes by foot and ankle companies and greater specialization by surgeons. Innovation, of course, plays a significant role, as well as the increase in an active, older population.
We spoke with three device companies to get their perspectives on foot and ankle market dynamics. Our interviewees were:
● Ryan Schlotterback, Chief Technology Officer, Nextremity Solutions
● Patrick Fisher, Vice President and General Manager, Stryker Foot & Ankle
● Manuel Schaer, Chief Technology Officer, Medartis
Here’s what they had to say.
What is driving the growth of the foot and ankle market?
Schlotterback: Hammertoe and bunion procedures, particularly the Lapidus procedure, still get quite a bit of attention, as they should. Growing patient populations that want to remain active and pain-free continue to drive growth as it does in other areas of orthopedics. We’re continuing to see more attention from our surgeons on midfoot and hindfoot procedures, at least in terms of new and exciting technology. I believe we’ll continue to see growth and expansion in those areas as more technology and innovation get applied.
Fisher: The growth in the foot and ankle market is primarily driven by market innovation and new surgical techniques that improve patient outcomes.
Schaer: I see three reasons for the pleasing development in the foot and ankle market. A burgeoning elderly population coupled with the trend towards a more active lifestyle stimulates the prevalence of foot and ankle deformities. Thanks to consumer-oriented information on the internet, patients are now better informed about treatment options, which increases confidence in elective procedures in particular. And thirdly, outpatient surgery centers lower the psychological barrier to undergo treatment compared to traditional large hospitals.
What are foot and ankle surgeons asking for regarding their implant, instrument and technology needs?
Schlotterback: Our surgeons continue to desire well-designed implants and instrument systems that help them reproduce great clinical outcomes. We’ve found that surgeons still want to be surgeons and don’t necessarily want to be confined to a strict set of procedural steps or even tied to a singular type of fixation. Surgeons want systems that help them to be better surgeons, but that provide them with flexibility, which you’ll see reflected in a number of our upcoming product launches.
Hardware cost and the impact on our healthcare system is always a topic of conversation. Bringing innovative technology to the market while remaining cost-effective and efficient remains a delicate balance.
Fisher: Foot and ankle surgeons are interested in simplified and streamlined procedures. They want to see innovative technology — like custom implants and instruments — that provide value in the operating room. They also want to see benefits in the O.R., including improved visualization and reduced O.R. time.
Schaer: Surgeons are more accountable today and factors such as improved surgical outcomes, procedure time, revision rates, cost-effectiveness and patient recovery time are more important than in the past. Many clinics have to handle similar numbers of cases with fewer staff. Factors such as efficient set management or product training become more important.
The exchange with doctors has always been very important to Medartis, so we have to react with suitable offers to these changes. We do our part by developing products that are easy to use, lead to reproducible results, and allow for shorter treatment times.
How is your company differentiating itself in the foot and ankle market?
Schlotterback: What you’ve seen from Nextremity Solutions, particularly over the last five years and will continue to see, is a focus on the surgeon. We believe very strongly that their involvement in the development and commercialization process, from beginning to end, is essential. We have a great team of talented and creative product development engineers, but our surgeon partners play a vital role in our product and commercialization success.
Fisher: Stryker is the segment leader in foot and ankle, and we will continue to innovate and bring new ideas and technologies to our customers. While we have a broad portfolio to address our customers’ needs, our salesforce is what truly differentiates us. We have highly trained and specialized teams, providing dedicated service to our surgeon customers.
Schaer: Our company size enables us to react quickly to changing or individual needs. Medartis has set standards in quality in many areas. In the upper limb, we have driven important technical innovations. In the coming years, we want to continue this success story in the foot and ankle market and align our portfolio with the needs of U.S. surgeons.
How will the market evolve in the coming two to three years?
Schlotterback: Good fixation options, for the most part, have been available. But over the last five years or so, we’ve seen a much more thoughtful and instrumented approach to many foot and ankle procedures. Looking forward to the next few years, I believe we’ll continue to see that trend. But perhaps we’ll see systems evolve to more minimally invasive surgery (MIS) techniques. MIS is sort of a buzzword, but in the end, we’re trying to accomplish similar procedural outcomes with less disruption to the patient. This will likely be aided, in part, with better pre-op planning and custom instrument/implant solutions.
Single-use, disposable systems are something we’ll probably continue to see evolve. We’ve been in this particular space for some time, and we don’t think there is a one-size-fits-all approach. We’ve found success with a mix of reusable and single-use, disposable components. In my opinion, we’ll continue to see the market evolve in this regard.
Fisher: While there are no guarantees, we expect to see more consolidation in the foot and ankle market. After Stryker’s successful acquisition of Wright Medical, we may see other large players follow suit and adjust their strategies. We may also see more companies go public, if consolidation does not happen as fast as predicted.
Schaer: The foot and ankle market is one of the most dynamic fields in orthopedics, growing at 7+% annually. Lifestyle-related diseases, sports injuries, osteoporosis and various types of arthritis are on the rise and are not going away anytime soon. When it comes to innovation, patient-specific implants or 3D-printed guides and minimally invasive solutions are becoming increasingly popular. And interestingly enough, it is mainly the small companies that are setting the tone and driving innovation.
What excites you the most about the market?
Schlotterback: There are still plenty of opportunities to advance the standard of care in the extremity space with traditional hardware design and development. Much of what we do in lower extremities has application in upper extremities, and we look forward to expanding into that segment. In addition to the opportunities already mentioned, excitement surrounds some of the material developments that we, as well as others, are actively working on. We believe these materials will spur an entirely new portfolio of products. It’s a bright and exciting future.
Fisher: Foot and ankle is one of the fastest-growing markets with nearly limitless opportunities for innovation. This potential for innovation drives us to constantly look for new ways to treat pain, streamline the O.R. and enhance the surgeon experience. We are excited to continue to bring new tools and products to the market that can help improve outcomes for our surgeon customers and their patients.
Schaer: The foot consists of no less than 28 bones, and no two operations are the same. The large joints, in contrast, are much more standardized and almost boring. This, together with an invigorating competition and still a lot of innovation opportunities, excites me.
