*Physician is a paid consultant of Treace Medical Concepts, Inc.

PAUL DAYTON, DPM: So one of the interesting and very exciting things about the Lapiplasty is that we are able to offer patients a much more reliable and consistent correction, and that means we have really changed the way we approach bunion surgery with patients. We used to tell patients, “put this off as long as you can possibly can,” because we know the two-dimensional break the metatarsal bone procedures or osteotomy procedures do no work well, therefore we would ask patients to put it off as long as possible. And now that we have a reliable way to correct all three planes of the deformity and do that very consistently, we realize that we’re giving patients an advantage by operating before arthritis sets in in the big toe joint, which is one of the things we see when the deformity has been there for a long period of time, and also reducing the adaptation of all of the tissues within the foot. So being able to have a procedure that provides us a reliable platform, we can comfortably offer that to patients at an earlier date.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

ROBERT SANTROCK, MD: It’s a common question whether or not high heels cause bunions, and in my belief they do not. They may contribute, that’s for sure, but any shoe contributes to bunions. Most people who have bunions have a propensity for bunions. They were born with the chance of getting a bunion because of deformity in the middle of the foot, so shoewear can contribute because it squeezes the toes together. So the tighter the toe box, or the pointed part of the toe box of the shoe, and the higher the heel, you do have a higher chance of making the bunion worse.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

RYAN FLANIGAN, MD:

*Physician is a paid consultant of Treace Medical Concepts, Inc.

PAUL DAYTON, DPM: The Lapiplasty procedure really came out of many years of our dissatisfaction with bunion surgery. We started looking at the anatomic makeup of bunions and trying to figure out what it was about the procedure that led to such a high recurrence rate and really so many problems, and the one thing that is clearly evident with bunion surgery is that there is a high amount of variability. Every surgeon approaches a bunion different, every surgeon really does a different procedure for it, and that amount of variability really is a recipe for less-than-optimal quality. So the genesis of Lapiplasty was to take a complicated procedure that we believe needed to be done in three planes, and provide instrumentation that could make the procedure reproducible, make it reliable, and then offer it to any surgeon that wanted to perform a three-dimensional correction. And the interesting thing about the concept of Lapiplasty is it really isn’t based on what many times we see sold as innovation, which is a new plate or a new screw. This really isn’t about the hardware or the fixation. It’s about a philosophy of fixing the deformity in three dimensions, and from there being able to do it in a very reproducible way to make it good for both the surgeon and for the patient.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

BRET SMITH, DO: In my practice, a lot of my patients started to ask me about, “Well, what’s this three-dimensional or 3D bunion correction?” And it’s really kind of an issue that I think is important to understand so I take a little bit of time and explain this. So if we think about the bunion, what we traditionally thought was that the bunion happened in really just kind one position only, it was sort of a deviation or the bone had moved outward, but what we really understand now is the bone has actually moved outward and turned as well. So it’s just a change in our understanding, just like anything else. You know, you can drive a Pinto from 1970s or you can drive a brand new Lexus. They’re both cars but one’s a whole lot nicer and more refined than the other, and it’s just like anything else. Over time, we start to learn more and more about a problem and we get a better understanding, and that’s exactly what this is. We have taken and elevated our understanding of the bunion problem from being simply the flat earth now to the round earth.

MINDI DAYTON, DPM: We’ve spent an extensive amount of time over the past 12 years researching bunion surgery and bunion outcomes, and we’ve been able to find a procedure and help develop a procedure called the Lapiplasty that really is a game-changer for bunion patients. This procedure provides excellent outcomes with three-dimensional bunion correction and good anatomic restoration with an excellent profile. So it’s exciting for us to have patients walk in the door, have something they are super scared about talking about or the idea of surgery specifically for bunions because they’ve heard so many horror stories from family members, neighbors, many of them even having had surgery for their bunion themselves in the past and had a recurrence. Being able to take the 30 minutes, 45 minutes, an hour, whatever it takes to really explain the procedure, the deformity, why they had the recurrence, and how we can fix the problem for them, and give them an excellent-outcome is so rewarding for us.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

DANIEL HATCH, DPM: I personally choose Lapiplasty versus other bunion techniques mainly for the deformity correction. This operates at the CORA, the center of rotation angulation apex of the deformity. It also addresses any hypermobility at the base of that first tarsal metatarsal joint. No other bunion procedure can really address those factors with all one type of procedure.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Abdi Raissi, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

ROBERT SANTROCK, MD: Lapiplasty is a new procedure, and basically with modern technology such as new x-ray technology and weight-bearing CT scans, we’ve been able to see much more of the anatomy, and Lapiplasty was developed with that knowledge and allows us to use modern techniques and modern hardware to recreate the surgeries that were described many decades ago. So it’s new to most surgeons, and it is however founded in the long tradition of understanding bunion surgery.

ROBERT SANTROCK, MD: It’s a common question to hear about recurrence, which means, can the bunion come back? That’s been one of the big problems with traditional bunion surgeries. The Lapiplasty was designed with the intent to prevent recurrence. *Of course, no surgery has a 100% success rate. Our current published data, which we published in 2019, showed that the recurrence rate for Lapiplasty was only 3% after 13 months^1.

1. Ray J, et al. Foot Ankle Int. 2019 Aug;40(8):955-960.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

BRET SMITH, DO: So for me the biggest benefit for the Lapiplasty 3D Correction is number one, I’m restoring the anatomy of the foot back to what it should be. I’m taking away an unstable joint in the mid-foot, realigning the access to the first ray at all three planes and helping to restore the function of the foot to what it should be naturally versus what we used to do in the past, which was to take a normal bone, cut it, and deform it, which wasn’t restoring the natural anatomy. The other thing that really changed in terms of Lapiplasty for me was the ability to weight bear my patients immediately after surgery in a boot. That was a huge help for my patients and their satisfaction as well as their safety, by having their foot on the ground early.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Mark Easley, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Daniel Hatch, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Daniel Hatch, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Daniel Hatch, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Robert Santrock, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Robert Santrock, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

WILLIAM DUKE, DPM: The Lapiplasty procedure is covered by the majority of insurance plans. You will need to work with your provider to determine your level of coverage.

ROBERT SANTROCK, MD: Traditionally bilateral lower extremity surgeries, or surgery on both feet, is a difficult thing to go through. You can imagine if you don’t have any foot to get around and move around on, that’s going to be hard on you and the family that you live with, so I usually recommend patients do one foot at a time. It’s not impossible, so you need to talk to your surgeon. If you’re the right patient, the right candidate, and you have lots of support at home, you perhaps may be able to do Lapiplasty on both feet at the same time because it is a surgery that is compatible with immediate weight-bearing in a boot.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Abdi Raissi, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

JP MCALEER, DPM, FACFAS: I’ve had experience with multiple patients who have had failed two-dimensional traditional bunion approaches, who have come back with recurrence, and they have had surgery up to ten years ago. And we have successfully implemented the Lapiplasty procedure with its triplane correction, and providing these patients with an excellent clinical outcome.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

JUSTIN DAIGRE, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Yes, Lapiplasty® surgeries are performed in an outpatient surgical setting. Typically, the surgery will last just under an hour, meaning you are in and out the same day of surgery. If your doctor is performing any additional procedures at the same time, the surgery may take longer.

Dr. Kurt Kinghorn, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

William Duke, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

DANIEL HATCH, DPM: Lapiplasty in my experience is reproducible utilizing precision anatomic cut guides. Before that we would make free-hand cuts, and we’d call it a leap of faith type of osteotomy where it’s not very accurate, or we use the curettage technique that again can lead to unpredictable results.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

WILLIAM DUKE, DPM: Many people are concerned about the potential of fusion of the unstable joint that’s present in your hallux valgus deformity. The truth is you don’t even know that that joint is unstable, and by making it stable through fusion, you will actually feel better with walking and ambulation and exercise. So will the fusion bother you? Absolutely not, it will actually help you.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

BRET SMITH, DO: It’s an excellent question. The plates themselves do not limit your functionality. The joint that we are actually taking away or fusing is actually an unstable joint and by actually stabilizing that joint and fusing it, we’re actually making the foot more functional that way. And so the plates are designed to actually help the function of the foot by taking away an unstable joint.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

PAUL DAYTON, DPM: The Lapiplasty implants, which are plates and screws, are made from a medical grade titanium, which typically does not cause any problems with patient reactions. There are rare instances where patients are allergic to stainless steel and although instruments and tools that are not implanted may have other metals in place, we find in our practice that it is rare to have any issues with the titanium.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

ROBERT SANTROCK, MD: Most typically the Lapiplasty surgery is done as an outpatient, meaning you can go home the same day. Our typical patient would undergo a nerve block, which is a type of anesthesia that numbs you from about the knee down. We also then have the patient go to sleep, but it’s a little bit lighter than our average, general anesthesia. This helps you wake up a little faster. Our recovery typically is going to be about six weeks in a weight-bearing boot. We’re going to send you home with crutches, but you’re likely going to be able to put weight on it within just a few days.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

DANIEL HATCH, DPM: Having diabetes alone does not exclude you from having the Lapiplasty procedure. Everybody heals at different rates and times and variabilities. The main thing with having diabetes is being under good control. Seeing your primary care prior to surgery, and making sure your hemoglobin A1Cs are within normal limits is probably one of the more paramount things to do. Also being evaluated by your foot and ankle surgeon to have good circulation and no evidence of neuropathy are key factors as well. But you can successfully have Lapiplasty procedure along with having diabetes as a co-medical condition.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

PAUL DAYTON, DPM: Many of our patients in our practice have hammertoes, tailors bunions, and possibly other deformities like a flat foot. And with Lapiplasty we’re able to perform the three-plane correction at the same time that we correct the other deformities.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

J.P MCALEER, DPM: Typically following surgery, we provide our patients with long-lasting anesthetic blocks to maximize pain relief that coupled with the use of oral anti-inflammatory medication and oral narcotics, depending upon the patients’ needs.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

THOMAS C. BOLDRY, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

WILLIAM DECARBO, DPM: Any surgeon trained in the Lapiplasty technique is eligible to perform this procedure. With that said, there is only one Lapiplasty procedure.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Bret Smith, DO

*Physician is a paid consultant of Treace Medical Concepts, Inc.

William DeCarbo, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Daniel Hatch, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

WILLIAM DUKE, DPM: With the Lapiplasty procedure, a cast or the use of a scooter to be non-weight-bearing is not required. You can walk within days after the procedure in a protected fashion in a cast or boot.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

PAUL DAYTON, DPM: An important question about any surgical procedure is how long is the recovery and what can you do during the recovery, and with Lapiplasty one of the great benefits is that people can get back to activity quite quickly. I generally will allow my patients to start walking on the foot that we corrected usually in the first two to three days, and then they have a walking boot that they wear for the first six to eight weeks, and depending on how fast their healing, we start at that point, at that six week point, to transition them usually into a running shoe. With any procedure, and the Lapiplasty is no different, we have to allow enough time for the bone to fully heal so that there’s not any problems, and so generally I will ask my patients not do any high level or high energy activity on their foot until they’re at usually around three months, we’ll let them start doing some light sports activity and other things to get back. But the one important thing is with any surgery, you want to allow an appropriate amount of time for your body to heal so that there’s not any issues or problems.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

MINDI DAYTON, DPM: The recovery is so much better than previous procedures. Our patients are able to start walking just several days after surgery, and get back into a shoe around six weeks which obviously has a profound impact on their quality of life and overall outcome.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

JUSTIN, DIAGRE, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

THOMAS C. BOLDRY, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Jason Miller, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

JP MCALEER, DPM, FACFAS: Time off from work following this procedure will vary, depending upon what your occupation is. The majority of our patients that are working behind a desk can get back to work within 5 to 14 days, just depending upon how they feel. However, if you are a day laborer or doing any type of work that requires for you to be standing on your feet for prolonged periods of time, we may restrict you and there may be a period of time of anywhere from four to six weeks where you may need to avoid doing those occupational things.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

THOMAS PIGNETTI, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Abdi Raissi, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

WILLIAM DUKE, DPM: Oftentimes we get patients asking question about what kind of shoes can they wear after they have the Lapiplasty procedure. The answer is whatever shoes you were most comfortable in before the procedure, we can certainly get you in afterwards. There are certain shoes that are not podiatrist approved but we can certainly get you back into any shoes that you wear on a normal basis.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

J.P. MCALEER, DPM: Following Lapiplasty® 3D Bunion Correction®, patients are not limited in their shoe choices once they’ve healed and returned to full activity. This means you can wear high heels. Even though that may not be my shoe of choice for you, it is okay to return to fashionable footwear when you feel ready.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

PAUL DAYTON, DPM: A question that comes up many times when talking about bunion surgery and also with the Lapiplasty is what activities can a patient do after they’re fully recovered, and there really are no restrictions. Once the bones are healed and the correction is over, then patients can get back to full activity and there really are no restrictions. Our patients are able to run, they’re able to participate in sports, and they’re really able to do all normal daily activities.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

BHARAT DESAI, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Daniel Cuttica, DO

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Jason Miller, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Dr. William DeCarbo, DPM: Most patients can return to all activities at three months status post-Lapiplasty and impact sport at four to six months.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Dr. Thomas Pignetti, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Daniel Cuttica, DO

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Dr. JP McAleer, DPM, FACFAS: With any typical surgical procedure, incisions are made, scarring does happen. However, we try to minimize scar with our approach to closure and our postoperative bandaging protocol. Typically my patients have a very fine scar. I use a subcuticular stitch underneath the skin, which is absorbable, so you won’t have those traditional railroad tracks crossing the incision lines.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Dr. Thomas C. Boldry, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Dr. Daniel Hatch, DPM: Follow-up depends on your personal physician criteria for post-op care. And this can vary somewhat. The average would be seeing somebody for three to four months post-procedure to make sure you have good wound and osseous healing with that. The normal post-op protocols, like I mentioned, can vary. Usually immediate after surgery for wound changes and dressing changes, and then followed by two, six, and twelve week follow-ups for radiographic studies.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Dr. JP McAleer, DPM, FACFAS: Following Lapiplasty, we typically allow patients in my practice to walk the day of surgery. We allow the patients to ambulate in the boot for six weeks, and then we transition them into their tennis shoes. Following that 12-week mark after surgery, we allow patients to wear whatever shoes they’d like. At the four-month mark, we allow our patients to return to high intensity activity. We don’t require the patients to sleep in the boot or wear it 24 hours a day. This allows for patients to perform range of motion exercises at their big toe and ankle joints, and it also allows them to tend to their incisions and perform icing of the area.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Dr. Bret Smith, DO: So for me, I have two requirements for my patients. One is that they have to be able to put their weight down fully on the ground so that they can push the brake and the emergency, in their post operative shoe, not the boot. I want them in the shoe when they drive, the post-op shoe, not the post-op boot. And they have to be off their narcotic medications if they’re taking any. They have to be off of those. That goes for left or right in my mind. Although obviously if it’s a left-sided surgery, sometimes getting back to driving is a little bit easier than the right side, just because the difference in comfort. But the same requirements I have, they still have to be in their post operative shoe and they still have to put all of their weight down and they have to be off their narcotic medications.

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Jason Miller, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Mark Easley, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Robert Santrock, MD

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Bret Smith, DO

*Physician is a paid consultant of Treace Medical Concepts, Inc.

JP McAleer, DPM

*Physician is a paid consultant of Treace Medical Concepts, Inc.

Paul Dayton, DPM