Top 10 Innovations in Podiatry 2022

Each year, Podiatry Today hears from leaders in the world of foot and ankle medicine and surgery about important developments and significant strides being made in the field. Here is this year’s slate of the Top 10 Innovations in Podiatry (in no particular order) that could have an impact on your patients and practice.

Pedilay med (Pedilay Care) is a ready-to-use secondary foot bandage that supports foot and ankle dressings associated with multiple conditions. The company explains that the bandage could save precious care time, as one can take it on and off in a swift and gentle fashion. The bandage, made up of a biocompatible, low-friction fleece material, has thin seams and can help protect the skin or primary dressing from external influences. Pedilay Care relates that the Pedilay med secondary bandage is appropriate for use in patients with limited mobility, or who are bedridden.

Animesh Bhatia, DPM, CWS says it simplifies and speeds up dressing changes for caregiver efficiency, reduces frequency of dressing changes, and secures the integrity of the primary dressing to support wound healing and compliance.

“(It is) easier and quicker to apply than rolled bandages,” he says. “There is no need to use scissors or tape.”

Alton Johnson, Jr., DPM, FACPM, CWSP points out that bandage rolls and gauze wraps, can, if applied incorrectly, cause complications that hinder wound healing.

“(Pedilay med) provides a quick and intuitive application, even for the untrained caregiver,” he adds. “(Selection of) proper size based on shoe size is important … but proper sizing is learned quickly.”

What Newer Wound Healing Modalities are Making an Impact?

Matrion (LifeNet Health) is one of the first decellularized placental grafts to utilize the amnion, chorion and trophoblast layers. According to the company, it is the first naturally intact, full-thickness, decellularized placental membrane, processed with Matracell technology. They say this design provides a graft up to 4 times thicker than traditional bilayer grafts, which may prevent fluid loss and bacterial entry. As such, providers may use Matrion as a barrier membrane for chronic wounds, including surgical dehiscence, pressure ulcers, diabetic foot ulcers or venous stasis ulcers.

LifeNet Health adds that, compared to other placental membranes without the full trophoblast layer, Matrion retains more endogenous growth factors and there is no special preparation necessary prior to application.

James Barksdale, DPM, practicing in Lawrence, TN, shares that Matrion is a game-changer for his wound care patients, citing easy handling and utility for chronic and challenging wounds.

“Having Matrion available for patients in my clinic has allowed … patients with wounds present greater than 2 years to completely heal in less than 2 months, and also for patients with stage 3+ decubitus ulcerations to heal in the same time frame,” he says.

Restrata Synthetic Hybrid-Scale Fiber Matrix (Acera Surgical) is fully resorbable and has a structure resembling human extracellular matrix, which supports ingrowth, retention and differentiation of cells, according to the company website. They share that Restrata’s non-woven fibers allow for resistance of enzymatic degradation to provide a porous scaffold. Due to its synthetic nature, Restrata may be an option for patients with ethical or religious objections to skin grafts. Acera Surgical also adds that the product does not require special storage or handling. Restrata is indicated for: partial and full thickness wounds, venous ulcers, diabetic ulcers, pressure ulcers, tunneled or undermined wounds, surgical wounds, traumatic wounds, and draining wounds.

Bradley Abicht, DPM, FACFAS, who has two years of experience with this product in La Crosse, WI, says that Restrata creates a whole new category among wound healing products.

“The bioengineering mimicking the ECM of human tissue results in less inflammatory cascade, better incorporation, no risk of disease transmission, and application potential in the clinic, operating room or wound center settings,” he says.

Dr. Abicht shares his participation in numerous studies that demonstrate Restrata’s utility, efficacy, and safety on multiple types of wounds.

Could Recent Developments in Surgical Systems Advance Options for Surgeons?

EasyWhip Suture (Winter Innovations) uses a patented two-part needle design to simplify and standardize suture techniques for tendon and ligament reconstruction, according to the company website. Citing speed and quality of stitching as crucial to successful repair, Winter Innovations says EasyWhip is the first suture needle designed to provide both of these elements.

Surgeons can perform multiple stitch techniques with EasyWhip, including a traditional whip stitch, a proprietary WhipLock stitch (a combination of a whip stitch and a Krackow stitch), or custom patterns individualized to the needs of a case. Data from Winter Innovations found that the product led to 31 percent faster stitching and fewer premature failures than conventional needles.

Danielle N. Butto, DPM, FACFAS, who has over a year of experience with the product, says that in her experience, the detaching and reattaching of the suture loop allows for locking and more efficient whip stitching without requiring tendon detachment.

“Due to the design of the product, I find half as many needle passes are necessary to create a locking stitch compared to a Krackow method,” says Dr. Butto, who practices in Avon, CT. “This stitch technique is not possible with any other needle products, and the construct provides superior strength.”

Trigon Ostetotomy Wedge System (Nvision Biomedical Technologies) provides a stand-alone fixation system for Evans and Cotton osteotomies without the need for plating. The manufacturer shares that the wedge is made of PEEK-Optima HA Enhanced, with the hydroxyapatite fully integrated into the PEEK and available on all implant surfaces. According to Nvision Biomedical Technologies, this compound allows promotion of bidirectional bone healing and enhanced fixation without issues of bio-incompatibility.

Two different configurations for the target osteotomies and a variety of sizes allow surgeons to account for anatomic variations. The company adds that ergonomic instrumentation assists with accuracy and precision of screw placement.

“I think one of the major advantages of the fixation is within the graft, so no bridge plating is required,” says Patrick DeHeer, DPM, FACFAS, FASPS, who has used the system for a little under one year. “Maybe even more important is the maintenance of correction, which (surgeons often lose) with allografts during incorporation.”

Dr. DeHeer, who practices in Carmel, IN, notes that PEEK wedges are well-researched in spine surgery, and that the maintenance of correction, swift incorporation due to the hydroxyapatite, multiple sizes and ease of instrumentation are among the impactful features of the Trigon system.

SmartRelease Endoscopic Soft Tissue Release System (MicroAire) is intended for recession of the plantar fascia and/or gastrocnemius aponeurosis. This system has long-standing classic use in the upper extremity, but recently gained FDA approval in 2021 for these lower extremity indications. MicroAire shares that the custom instrumentation sets allow for single-portal endoscopic surgery and that the aluminum handpiece can rotate to accommodate the handedness of the surgeon, with both standard and Onyx low-profile blade assemblies. According to the company website, endoscopic procedures like that performed with SmartRelease could result in less postoperative pain and allow patients to resume normal activities in a short period of time.

Mark Tozzi, DPM, DABFAS, practicing in Mayfield Heights, OH, says that he particularly appreciates the low-profile (3.5 mm) scalpel blade, which he finds less aggressive and easier to control than hook blades in other systems.

“The ‘uniportal,’ one-incision (approach) can mean less scarring with both endoscopic plantar fasciotomy and gastroc recession, less incision complications with a lateral incision and less possibility of severing the entire plantar fascia,” he says.

In his 20 years of experience using this system, Dr. Tozzi says he finds keeping the incision away from the heel fat pad and instead making it slightly more distal toward the arch improves visualization and prevents suctioning healthy, shock-absorbing adipose tissue.

Pecaplasty Percutaneous Bunion Correction and Targeting Guide System (Novastep) allows for simple, precise, and reproducible percutaneous bunion correction using a targeting guide to help the surgeon control translation of the metatarsal head and accurately place K-wires. The system then uses Peca screws to fixate and stabilize the correction, says Novastep.

The company shares the easy positioning of the targeting guide on the foot, with the paddle beneath the medial capsule, after a transverse osteotomy of the first metatarsal. They go on to say that the stabilization sleeve guides the traction wire into the metatarsal canal before metatarsal head translation. Then, the surgeon adjusts the targeting arc to allow K-wire insertion.

Bradley Abicht, DPM, FACFAS finds that over 18 months of using this jig-guided system he has noted reproducible deformity correction and appropriate placement of internal fixation.

“It was the first of its kind,” he adds. “The PECA procedure (or percutaneous bunion correction) demonstrates a high learning curve, and thus the jig was developed to aid surgeons in reproducible internal fixation placement and cut down the learning curve.”

Dr. Abicht shares that he feels minimally invasive procedures, like that afforded by the innovations in Pecaplasty, are continuing to evolve and grow in the surgical world.

Might These New, Innovative Features Show Promise for Patients?

Foot Defender(Defender Operations) is a protective, ambulatory brace designed to decrease the forces that walking and standing exert on the foot and ankle. The brace may support wound healing or treatment pathways for stable foot and ankle fractures, according to the company, Defender Operations. Defender Operations shares that a recent significant redesign of Foot

Defender stemmed from a combination of biomechanical engineering, modern footwear design, and patented manufacturing techniques. State-of-the-art textiles, advanced engineering, and proprietary materials for force reduction and impact attenuation allow Foot Defender to provide enhanced protection for the foot and ankle.

The device has an available removable cast extension and shoe-like design, contributing to a patient-friendly focus. According to the company website, they state that Foot Defender may result in less average maximum pressures compared to some CAM walker and protective boot models. The Foot Defender has an assigned HCPCS code of L4361. 

David G. Armstrong, DPM, MD, PhD relates that despite the importance of adequate offloading for diabetic foot ulcers, and other foot and ankle conditions, many boot devices available previously are heavy, unsightly and not optimally designed.

“This product is one of the first technologies where they really tried to listen to the patient and focus on design,” he says. In my opinion, this is the first offloading boot that people may want to wear.”

Dermeleve (Advanced Derm Solutions) is a unique over-the-counter moisturizer making waves in the dermatology world, says Tracey Vlahovic, DPM, FFPM, RCPS (Glasg), who has used the product for patients for about 6 months in her practice in Philadelphia.

According to the company, Dermeleve helps to provide relief for dry, itchy, and irritated skin, and contains aluminum acetate, strontium, vitamins C and E, shea butter, hyaluronic acid and ceramides. It assists in skin barrier function and helps retain skin moisture.

“It is a non-steroidal anti-itch cream, has a unique complex, and is not available in retail pharmacies,” says Dr. Vlahovic.

The product website goes on to say that Dermeleve has rapid absorption into skin, reducing the sensation of itch and interrupting the vicious cycle of inflammation that leads to itching, scratching, and more inflammation. As Dr. Vlahovic mentioned, the product has a steroid-free formula, and Advanced Derm Solutions shares that its uses include itch relief for minor skin irritations due to minor burns, allergic itch, poison ivy, poison oak, poison sumac and insect bites. Dermeleve is free of gluten, tree nuts and peanuts. One can obtain this topical cream through partnered physicians offices or on the product website.

Dayspring Active Dynamic Compression Treatment (Koya Medical) is the first system of its kind designed to allow for movement and activities of daily living during treatment. The company adds that Dayspring may assist in smoothing a patient’s care transition into a home environment, as it can fit into their existing routines. This mobile, non-pneumatic system offers a made-to-measure garment and customizable treatments and pressures through an app. Clinician resources and instructions for use are available on the product website.

Indications for Dayspring include lymphedema, edema following trauma or immobilization, venous insufficiency, and lipedema. The system comes in full-leg and lower leg forms, along with upper extremity options. The smart controller is rechargeable and Bluetooth-enabled with controls allowing adjustment of pressure. A compatible carrying case also allows patients to transport the system easily.

Windy Cole, DPM, CWSP, practicing in Independence, OH, shares that the mobility and convenience offered by the compression system are especially unique.

“Unlike pneumatic compression garments, the Dayspring device is segmental, programmable, and the patient can fully ambulate during the treatment,” she says. “I am currently developing study protocols to trial the product in patients with venous leg ulcerations (VLUs)”

The following commenters disclose that they are consultants to the companies they discussed: Drs. Abicht, Barksdale, Bhatia, Butto, DeHeer, Johnson, and Tozzi. Any commenters not mentioned had no relevant disclosures related to the products or services mentioned.