members of other societies such as the American Academy of Orthopaedic Surgeons (AAOS)or other podiatric societies.Foot and Ankle Market Survey
The treatment of foot and ankle maladies is the second biggest area within the category of extremities, after sales of products to treat shoulder complaints. Though hips, knees, and spine have dominated the orthopedic sector in terms of revenues and headlines, the growth of the extremities area in orthopedics has recently started to come into its own. While shipments of products to treat problems of the shoulder region accounts for $300 million to $350 million in annual sales, the emerging market for foot and ankle treatment products is a close second at around $250 million. Compared to hips, knees or spines, these are small markets, but selected companies have chosen this area as a starting point and, as a result, have experienced significant annual growth.
Some manufacturers of extremity products are routinely posting revenue growth rates for shoulder, foot, and ankle products in the high double digit range. While the shoulder bazaar has long been recognized as a growth market, the foot and ankle market could well be its successor. The market for foot and ankle products may be small but it is growing a strong double digit rates, year over year.
PearlDiver Technologies, Inc. recently surveyed over 800 foot and ankle surgeons regarding their product and manufacturer preferences nationwide. Approximately 19% of the surgeons contacted by PearlDiver in this survey responded to our questionnaire and they identified 16 companies who supply products for foot and ankle treatment. The survey was conducted by both email and by regular mail. All respondents were members of a surgeon society. Members of the American Orthopedic Foot and Ankle Society (AOFAS) represented 47% of the respondents; members of the American College of Foot and Ankle Surgeons (ACFAS) represented 27% of the respondents; and 26% of the respondents identified themselves as members of other societies such as the American Academy of Orthopaedic Surgeons (AAOS)or other podiatric societies.
Geographically, the largest percent of respondents were from the Midwest (32%) and the Northeast (26%), followed by the Southeast and West at 23% and 19%, respectively. PearlDiver researchers asked 10 different questions involving the foot and ankle market in the United States. The questions asked surgeon who they thought were the leaders in this market, which manufacturers they thought had the more innovative product line, which manufacturer had the broadest product offering, and we also asked surgeons and doctors to rank the manufacturers. The most commonly mentioned suppliers were Wright Medical (25%), Synthes (18%), and DePuy (14%), followed by Arthrex at 12%.
According to the survey, when asked; “Who is the leading or number one company for foot and ankle products”, the largest number of responses indicated Wright Medical as number one (36%), followed by Synthes (23%). The following chart shows the ranking of foot and ankle companies according to the PearlDiver survey.
Chart 1: Leading Company in Foot & Ankle Surgical Products
Note: Others include Orthofix, Innomed and Biomet
Source: PearlDiver Consulting Group Foot and Ankle Survery, August 2008
Wright Medical has been reporting strong sales growth in its extremity business and has been aggressively expanding its product line. The recent acquisition of INbone Technologies, as well as the A.M Surgical foot and ankle product line, no doubt contributed to Wright Medical’s strong showing in this survey. Having said that, DePuy remains the largest supplier in the the foot and ankle market.
The PearlDiver survey also tracked usage based on region and found that Wright Medical was also the survey leader in every region except the Northeast. Synthes leads in the Northeast region with 41% of the responses from the doctors and surgeons. (Synthes is not actually an extremities company as such, but is the company with the largest trauma product line—which includes a variety of foot and ankle fracture products.)
The survey also asked the surgeons which firms they believed were the second and third largest foot and ankle product distributors. The majority of the responders believed Johnson and Johnson’s DePuy Orthopedics to be the second biggest foot and ankle market distributor followed closely by Arthrex and Synthes. Other companies that came close to the top three were Tornier, Integra LifeSciences, Stryker, Acumed, and Smith and Nephew.
When surgeons were asked “Which company, in your estimation, has the broadest product offering for foot and ankle products”, 31% responded Wright Medical followed by Synthes with 26%.
When asked; “Which company has the most innovative product line in foot and ankle products”, 27% responded that Wright Medical was number one, followed by Synthes with 20%. DePuy and Arthrex ranked a distant third and fourth, respectively, in both criteria according to the PearlDiver survey. Chart 2 below shows the companies in their respective order based on the survey responses on both the innovative product line and broadest product offering.
Chart 2: Broadest Product Offering and Innovative Product by Companies
Note: Others include tornier, Innomed, Zimmer, and Orthohelix
Source: PearlDiver Consulting Group Foot and Ankle Survery, August 2008
Wright Medical and Synthes are among the top companies from which doctors and surgeons feel most comfortable accepting foot and ankle products. PearlDiver also asked surgeons to identify which companies have, in their personal opinion, the most dependable and knowledgeable sales people. Almost 31% of the surgeons picked Synthes for that designation while 24% selected Wright Medical.
When asked which firm provides the best medical education and training, the response was not for a company but for the foot and ankle societies. Surgeons reported that the foot and ankle societies (AOFAS and ACFAS) provided the best medical training educations. Following the societies, Synthes, and Wright Medical were rated the second and third best medical educational training provider with 20% and 16%, respectively.
Doctors and surgeons had a similar view when asked who they believe is the most committed to serving their specialty. Almost 30% declared it to be the two societies (AOFAS and ACFAS) followed closely by Synthes and Wright Medical as second and third most committed companies. DePuy came in fourth with a response rate of 10%.
PearlDiver also asked members of the foot and ankle societies some general questions. When asked; “What was the most performed foot and ankle surgery?”, 38% responded Bunions and Hallux Valgus, followed by ankle fractures and fixations at 20%. The debate over ankle replacement and ankle fusion surgery was the third response to the “most performed surgery” question.
Chart 3: Driving Factor for the Foot and Ankle Market 
Source: PearlDiver Consulting Group Foot and Ankle Survery, August 2008
Chart 3 above illustrates what the foot and ankle doctors believe has driven this market and will continue to drive it in the future. Product innovation and quality are the driving factors according to 35% of the responses. Increased patient demand comes in a distant second with 21% of the responses, followed closely by minimally invasive procedures and ankle replacements with 16% and 15%, respectively.
Clinical research/innovation and quality are clearly the twin key factors that drive the market. Wright Medical and Synthes received the highest response for their innovative product lines. Synthes is the largest player in the trauma market worldwide and Wright Medical is one of the smaller orthopedic companies doing well in the extremities region—especially foot and ankle. DePuy and Tornier also ranked among the top five