Talk at AOFAS 2026 Outpaces the Market

 

Minimally invasive surgery (MIS) led the bunion conversation at AOFAS and IFFAS 2026 in Seattle, even though open surgery still dominates U.S. practice.

 

What surgeons present is one way to gauge where the foot-and-ankle market is heading.

 

MIS leads the podium

 

By the numbers:

 

• 37 presentations covered bunion correction.

• 15 titles mention MIS (41%).

• 4 titles mention open correction (11%).

• Among titles that name an approach, MIS outnumbers open nearly four to one.

 

Adoption lags interest

 

Reality check: The market does not mirror the podium. Only about 10% to 15% of U.S. bunion surgeries are minimally invasive, leaving 85% to 90% open. That estimate comes from device maker Treace Medical, as reported by BONEZONE; no authoritative national figure exists.

 

Yes, but 10 of the 15 MIS titles came from the international IFFAS sessions, so the podium reflects global interest, not just U.S. practice.

 

The bottom line is that interest in MIS bunion correction far exceeds adoption. Expect industry partners to keep investing in shortening the learning curve, improving outcomes, and reducing common risks.

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Does Restoring the Native Joint Truly Improve Total Ankle Arthroplasty (TAA) Outcomes?

by Vince Vacketta, DPM

 

Restoring native ankle anatomy appears important, but radiographic restoration alone does not guarantee better clinical outcomes or range of motion (ROM).

 

Published late last month, a study by Hintermann et al. compared 89 “good-progressing” and 89 “bad-progressing” TAAs from a cohort of 471 ankles. It evaluated joint-line level, talar height, talar radius, talar position, and tibial alignment. 

 

Key findings:

 

• Joint-line restoration and component positioning: No significant difference between the good- and bad-progressing groups.

• ROM: Improved significantly in the good-progressing group but not in the bad-progressing group.

• Talar height: The only radiographic parameter associated with ROM.

 

Why it matters

 

This challenges the increasingly emphasized idea that precise restoration of the native joint line is a primary driver of TAA success.

 

Restoring anatomy does not equal restoring function. Anatomic reconstruction remains a goal, but soft-tissue balance and the mechanical environment may ultimately determine final motion and clinical outcomes.

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Transverse Tibial Transport (TTT): Promising, but Not Unrpoven

 

TTT is a limb-salvage surgery that uses bone distraction to grow new blood vessels and heal chronic foot wounds. It may offer an alternative to amputation for diabetic foot ulcers that fail standard care.

 

How it works

 

• A surgeon cuts a small cortical window in the proximal tibia.

• An external fixator moves the bone segment sideways about 1 mm daily, then returns it.

• The fixator comes off after four to six weeks.

 

By the numbers

 

One comparative study reported 96% healing at two years versus 72% with standard surgery, and major amputation rates of 3% versus 23%.

 

Yes, but the evidence is mostly retrospective and from China, with few randomized trials.

 

U.S. status

 

The FDA cleared Orthofix’s TrueLok Elevate in December 2024 for “bony or soft tissue defects,” but diabetic ulcers are not specifically named. Six companies now have systems for TTT. 

 

The takeaway

 

TTT is biologically plausible and has a cleared device system in the U.S., but it still awaits rigorous trials.