The Footnote
No. 2 · Seattle edition
Thursday, September 17, 2026. Nine stories across six beats, researched and summarized for DPMs running a practice.
On site this week AOFAS Annual Meeting + IFFAS 9th Biennial Seattle Convention Center, Sept 16 to 19 Up to 66.5 CME/CE credits, virtual registration open
Clinical & surgical · Conference

The orthopaedic foot and ankle world is in Seattle this week, and the program reads like a podiatric surgeon's case log

AOFAS and the International Federation of Foot and Ankle Societies are meeting jointly for four days, with AOFAS science running Wednesday through Friday morning and IFFAS taking over through Saturday. Strip away the society branding and the agenda is minimally invasive hallux valgus, Lapidus variants, total ankle planning, Charcot salvage, and GLP-1 patients on the table. The questions dominating an orthopaedic meeting are the same ones filling our clinics.

Thu 7:00 AMPaper Session 1A on injectables and outcomes, including corticosteroid injection timing and GLP-1 receptor agonist associations.
Thu 8:45 AMSymposium 6, Practice Management: AI utilization, private practice survival, in-clinic procedures and ambulatory surgery centers.
Thu 5:00 PMSymposium 10 on MIS learning curve and complications, alongside Symposium 11 on 3D-printed implants, total talus and wearable sensors.
Fri 8:45 AMPaper Session 5A on first TMT arthrodesis with early weightbearing and minimally invasive approaches.
Sat 11:45 AMIFFAS Paper Session 3A on minimally invasive hallux valgus, including sex differences in early recovery.
Why it matters. The ASC and in-office procedure conversation in Symposium 6 lands the same summer CMS proposed cutting same-day E/M payment in half. Surgical practices on both sides of the DPM/MD line are being pushed toward the same economics.
Source: AOFAS 2026 in-person meeting program · Keynote Wednesday: Gary W. Stewart, MD, "Who Gets to Innovate?"

Surgical research

Surgical research

GLP-1 use tied to more hardware failure and nonunion after ankle fracture fixation, not more infection

A propensity-matched retrospective cohort in Foot & Ankle Orthopaedics (June 2026) followed roughly 1,200 to 1,400 GLP-1 receptor agonist users through ankle ORIF. Hardware failure was elevated from 3 months and stayed elevated through 12 months; nonunion and malunion rose at 6 and 12 months. Infection showed no association. The authors call the findings hypothesis-generating because of residual imbalance between groups.

Why it matters. The risk signal points at bone, not wound. That shifts the preop conversation from "hold the drug for anesthesia" to fixation choice, weightbearing pace and follow-up films. AOFAS has a paper session on the same question this morning.
Monteiro SK et al., Foot & Ankle Orthopaedics, via PubMed
Surgical research

MIS and open Lapidus land in the same place at one year

Hospital for Special Surgery compared 66 minimally invasive and 74 open Lapidus procedures for moderate to severe hallux valgus. Both groups improved meaningfully on every PROMIS domain with no significant difference between them. Open correction edged ahead on some angles, MIS corrected Meary's angle more on weightbearing CT, and complications (nonunion, recurrence, infection, hardware removal) were comparable.

Why it matters. A single-center Level III study will not settle the MIS debate, but it removes "patients do better" as an argument in either direction at one year. The choice comes back to the surgeon's reproducibility and the deformity in front of them.
Ward L, Ellis S et al., Foot & Ankle International, July 2026

Clinical & surgical

Clinical & surgical · AOFAS podium

Five-year ALIGN3D data put triplanar Lapidus recurrence under 1 percent by the strict definition

The prospective multicenter ALIGN3D study (173 enrolled, 137 at five years, 13 surgeons at 7 sites) reported radiographic recurrence of 0.8% at an HVA threshold above 20 degrees and 5.3% above 15 degrees, with boot weightbearing at a mean 8.4 days. Daniel Farber, MD presents Friday. Two companion studies also report: MTA3D interim two-year data on combined metatarsus adductus and hallux valgus correction (Mark Easley, MD, today at 4:00 PM) and a 12-month SpeedPlate poster from Jody McAleer, DPM showing 96.6% union.

0.8%recurrence, HVA > 20°
5.3%recurrence, HVA > 15°
8.4 daysmean to weightbearing
137 / 173patients at 5 years
Why it matters. Five-year prospective numbers are rare in bunion surgery, and the two recurrence thresholds are worth quoting together. Pair them with the HSS comparison above before citing either in a consult.

Figures are from a manufacturer press release for company-sponsored post-market studies; peer-reviewed publication will follow.

Source: Treace Medical Concepts via GlobeNewswire, Sept 17
Clinical & surgical

Stryker brings Prophecy patient-specific planning to its Incompass total ankle

Stryker says Prophecy has supported more than 100,000 ankle cases over 14 years. At AOFAS it is extending the platform to Incompass, its newest total ankle system, with 3D visualization and both resect-through and pin-through options. The company also introduced Hoffmann LRF smartHEX, a hexapod limb reconstruction platform with a patient-facing app tied to the surgeon's correction schedule.

Why it matters. Patient-specific guides are becoming table stakes for TAA, and the patient app on a hexapod frame addresses the least-loved part of frame care: strut adjustments done at home.
Source: Stryker via PR Newswire

Policy & compliance

Policy & compliance

Comments are closed on the Modifier 25 cut. The final rule is due around November 1.

CMS's 2027 fee schedule proposal would pay the highest-valued service at 100% and every other same-day E/M or procedure at 50% when an E/M is billed with a 0-, 10- or 90-day global procedure. The non-APM conversion factor would fall 1.68% to $32.84 as a temporary 2.5% bump expires. Comments were due September 14. APMA filed comments and joined the Same Day Care Coalition opposing the cut; the AMA organized a sign-on letter from nearly every state and specialty society.

Why it matters. Few specialties pair an E/M with a minor procedure as often as podiatry. The useful work now is pulling last year's Modifier 25 claims and pricing the exposure before January, not after.
Sources: AMA · CMS fact sheet · APMA
Policy & compliance

DME MACs move toward covering topical oxygen for stalled diabetic foot ulcers

A proposed LCD published July 24 would cover topical oxygen for DFUs that shrink less than 50% after four consecutive weeks of optimized standard care, with HbA1c thresholds, documented adequate perfusion, an in-person visit to start and monthly visits after. Comments closed September 5. APMA submitted comments.

Why it matters. The four-week, 50% rule mirrors how most wound clinics already decide to escalate. Practices that document area measurements consistently are the ones that will be able to use it.
Source: HME Business

Products

Products & devices

The bunion company is becoming a foot and ankle company

Treace's AOFAS booth goes well past Lapiplasty: the Lapiplasty Lightning system with SpeedTMT implants, a Tailorplasty MIS tailor's bunion system, SuperBite fully threaded compression screws, a HyperPlate XM dynamic compression plate, CartiBlaster powered joint prep, VitaFuse bioactive glass graft, and a Treace X-ray app for radiographic measurement.

Why it matters. Expect the same rep who covers your Lapidus cases to start pitching midfoot and hindfoot fusion kits. Worth knowing before your next value analysis meeting.
Source: Treace via GlobeNewswire, Sept 15

Practice & business · Voices

Practice & business

An orthopaedic society puts "private practice survival" on its main program

AOFAS Symposium 6, "Practice Management: The Future of Foot and Ankle Orthopaedics," covers AI utilization, private practice survival, in-clinic procedures and ambulatory surgery centers. The same morning, Kaitlin C. Neary, MD gives a keynote titled "Beyond Survival Mode: Designing a Sustainable Life in Surgery."

Why it matters. When two of a surgical meeting's headline slots are about survival, the pressure on independent practice is no longer a podiatry-only story.
Source: AOFAS 2026 program