Top 10 Innovations in Podiatry 2022: Pecaplasty Percutaneous Bunion Correction System by Novastep

Dr. Abicht discloses that he is a consultant for Novastep.

My name is Brad Abicht. I'm based out of Gundersen Health System in La Crosse, Wisconsin. I currently serve as the department chair for the podiatry department at Gundersen and continue to be involved with our residency program and different research projects here at Gundersen. Why I think the Pecaplasty product or jig is so important is for a couple different reasons. The Pecaplasty jig is a guided system by Novastep that facilitates the PECA procedure itself for bunion and hallux valgus correction. I've been using the Pecaplasty system for about two years now, but also doing the PECA procedure for about five. And what the Pecaplasty system really does is it aids the surgeon with lateral translation of the capital fragment during their hallux valgus correction, as well as provides reproducible placement of the guidewires for the PECA fixation following the first metatarsal osteotomy that is made.

There's a well-known doc and well-documented learning curve for percutaneous and minimum incision, hallux valgus correction, but the Pecaplasty system makes successful outcomes more reproducible and has helped lower that learning curve associated with this procedure. I think what really makes the Pecaplasty system truly innovative is that it was the first of its type to be commercialized. And now many companies are also developing copycat versions. And so now you're seeing the market come up with more and more of these jig-guided systems to help with the percutaneous and MIS bunion correction. I can honestly say for myself that the Pecaplasty and PECA procedure has been probably the single most innovative product that I've encountered and that has changed my practice since I completed residency about 10 years ago. I was originally trained on open traditional bunion surgeries, like most of us are, and mainly performed either a chevron or a scarf osteotomy or did a Lapidus bunionectomy. And those are my three main go-to procedures.

The Pecaplasty has replaced about 95% of those procedures for me. And this is mainly attributable to the patient benefits that I've witnessed by using the system. Some of the advantages or benefits I would highlight with the Pecaplasty would be the cosmetically pleasing or tiny, barely visible scars that are left for the patient, the ability to allow them immediate weight-bearing following their surgery. There's less joint stiffness to the great toe joint, as you do not open up the capsule or violate any of the soft tissues around the joint. There's also been documented decreased postoperative pain following an MIS approach versus an open approach. And there is a study by Dr. Vulcano's group that recently came out in Foot & Ankle International in January of this year that demonstrated that patients, on average, were only using about 2.2 pills postoperatively for their narcotic pain medication consumption. And then finally, a faster return to regular shoe gear and activity has also been witnessed. So all these things are achieved, while at the same time achieving all the goals that are set forth for hallux valgus correction.

So it really has become an innovative benefit for my patients. Pecaplasty and the PECA procedure has made us have to reevaluate some of the more traditional procedures and, I think, really shifted the status quo of hallux valgus correction into a new paradigm. A product, I think, is truly innovative when it can do that, while at the same time offering some of these aforementioned benefits. I think one thing to recognize with the system and any other systems that are similar to it is it's not a robot and it won't do the procedure for you. So a surgeon must still respect and pay attention to the tenants of percutaneous technique, as well as the goals of hallux valgus correction. I would encourage anyone interested to review the literature and do some hands-on labs, talk to MIS experts, as well as, above all, practice to try and lower your own learning curve associated with the procedure. And in the future, I think having early exposure to these techniques during medical school and residency will be a benefit to all, but so far I've seen a Pecaplasty be a major innovative product in my practice.